SelfInsured Schools of California Schools Helping Schools SISC

Self-Insured Schools of California: Schools Helping Schools SISC Health Benefits Program Information for Peralta Community College District Presented October 11, 2012 by Lola Nickell, SISC Account Manager

Self-Insured Schools of California SISC - Who We Are • Not-For-Profit Joint Powers Authority (JPA) established in 1979, administered by the Kern County Office of Education. – SISC administrative personnel are employees of the public school system. • SISC III is one of the largest school focused health care purchasing pools in California. – Current statewide membership is over 200, 000 lives from over 380 school districts in 39 counties • A JPA governed by a Board of Directors – Like school districts, SISC is subject to the Brown Act. – Our Board of Directors are employees of school districts and are elected by member districts. Our Philosophy – “Schools Helping Schools” 2

The SISC Advantage • Under SISC, districts may select from a wide range of medical, dental, vision, and life plan product offerings to customize a comprehensive benefit package for employees. • Strong financial standing with stabilization reserves. Claims liability fully funded. • Long term health benefits solution: 220+ districts in SISC III for at least 10 years. • Continued growth: 150+ school districts have joined in the last 10 years. 3

SISC: Carriers & Products We offer a wide range of health benefits through major carriers; PPO’s, HMO’s, Rx, Dental, Vision and Life. – Anthem Blue Cross (Self-funded PPO and fully insured HMO) – Blue Shield (Self-funded PPO and fully insured HMO) • Pharmacy Benefits through Express Scripts (Non-HSA plans) – – Kaiser Permanente Delta Dental (Premier and PPO Plans) Vision – VSP and MES Life - Mutual of Omaha 4

SISC Medical Plan Options • HMO Plan Options – Kaiser Permanente, Anthem Blue Cross, Blue Shield – Must live/work within defined service area • Self Funded PPO – 19 Medical + 2 HSA Compatible Options – SISC Plan Design with Anthem Blue Cross or Blue Shield of California Ø Out of Network services paid at Non-Par Fee Schedule (except emergencies) Ø No annual Out of Pocket maximum on OON expenses – Blue on Blue Rules – Outside California: Blue. Card network (BCBSA) • General Information – No waiting periods, no pre-existing limitations – Deductibles run January to December – 4 th Quarter Deductible Carryover on non-HSA PPO plans 5

Outpatient Rx: Anthem & Blue Shield PPO & HMO Plans • Outpatient prescription drug coverage through Express Scripts (Except HSA Plans) • SISC Express Scripts Rx Plan Enhancements: – Costco $0 Co-Pay Program for Generic Drugs – Costco Membership is not required; Excludes some categories: narcotic pain and some cough medications – Generic Co-Pays for Diabetic Supplies – The generic co-payment will be charged on brand only Diabetic supplies (lancets, test strips and syringes) – Maximum 30 Days Supply at Retail Pharmacies. Most pharmacies are in-network EXCEPT Walgreens – 90 Days supply available with Mail-Order through Express Scripts 6

Dental & Vision Plans • Delta Dental Plan – Can offer dual choice to include a Premier (Incentive) Plan and a PPO Plan – All medical plan options must include same dental plan(s) – Those employees enrolling in medical must enroll in dental – Implants are covered benefit • Vision Service Plan – All medical plan options must include same vision plan – All employees enrolling in medical must enroll in vision 7

Value Added Services For Members: • Health Smarts- A robust Health Improvement Program – Includes: Periodic on site biometric screenings and on site flu shot clinic at no charge to member or district – Most Recent Program: Awards up to $150 for participation in online health improvement program; all SISC members age 18+ eligible • SISC Employee Assistance Program (EAP) – Resources for Managers and Supervisors – Voluntary, No cost to use EAP, Available 24 hours /7 days per week – Confidential service by Licensed Professionals • SISC Section 125 Plan – No participation fees for Employee or District 8

Value Added Services For Districts: • No-Cost Administration Services include: – COBRA – Section 125 Flex Plan – Self-pay Individual Retiree Direct Bill program • Low Cost Administration Services – Retiree Drug Subsidy (RDS) - Optional • SISC has collected $7 million for districts since 2006 • SISC charges $30 per member for annual application • Application fees not charged until subsidy received • Other Administrative Services May Be Offered – Example: Early Retiree Reinsurance Program (ERRP) • SISC filed for ERRP monies on behalf of member districts • Funds paid as of January 2012 totaled $27. 5 million (29 th largest) • ERRP funds applied to offset renewal increases 9

Program Options and Eligibility • Plan Choices – Work with SISC to select a maximum of 6 plans for each employee group (plan options subject to underwriting approval) • Benefit selections may be unique to three groups: Confidential & Management, Classified, Certificated • Eligibility for domestic partners is as stated under AB 205 unless the district requests that eligibility be extended to opposite sex domestic partners (a negotiated benefit) • Eligible Dependents include: legal spouse, DP; Child/Child of DP: natural child, step-child, legally adopted child to age 26; a child for whom the member has legal guardianship to age 18. Disabled overage child who is a dependent for federal income tax purposes and who has been accepted through carrier application process. 10

Participation Requirements WHO MUST ENROLL IN COVERAGE • All employees who work 90% or more of the full-time equivalent for the applicable job classification are required to participate in all health benefits offered by the district WHO MAY DECLINE COVERAGE • An eligible employee who works less than 90% of the full-time equivalent for the applicable job classification or receives less than 90% of the amount that is contributed towards an eight-hour full-time employee may enroll when first eligible or decline coverage. If they enroll, they must enroll in all coverage offered through SISC. • Any deviation from SISC Underwriting Guidelines must be requested in writing by the school district and approved in writing by SISC prior to joining. 11

Retirees • Must enroll at initial enrollment, no re-entry once coverage terminates • May select from medical plans offered to active employees of bargaining unit from which they retired All Retirees must be enrolled in Medicare Parts A&B, otherwise costly monthly surcharges will apply. • Retirees with Medicare A&B may choose instead to enroll SISC Individual Retiree Medical Plan Options – All include Medicare Part D Rx with no donut hole – Kaiser Permanente Senior Advantage Plan $324 Single – Blue Shield Mediare Advantage Plan $354 Single • Retiree must reside in Advantage Plan Service Area – Companion. Care – SISC Medicare Supplement $373 Single • Plan is claim free when services are received from providers who accept Medicare Assignment. No residence limits. 12

Joining SISC: Timing & Action Items SISC Rates are effective October 1 -September 30 • Renewing districts receive 2013 -14 rates by early May • Districts may join SISC with a the first of the month effective date, with 60 days advance notice Depending on effective date, initial rate period maybe short or long. • Example 1: Joining SISC January 1, 2013: Rates quoted will remain in effect to September 30, 2013 • Example 2: Joining SISC July 1, 2013: Rates quoted will remain in effect to September 30, 2014 • SISC Underwriting will provide list of items required for quote, and quote delivery timeline. Quote delivery typically takes place after district receives KP renewal. • Initial commitment is 3 years per JPA agreement • Withdrawal from program – written notice must be received by August 15 for October 1 effective date 13

Joining SISC: Timing & Action Items • Signed SISC JPA Agreement & Bylaws, Plan choice selections will be required 60 days in advance • SISC will coordinate with District and Carriers to provides Open Enrollment meetings for Active and Retiree members • Required: Submission of signed, completed enrollment forms (fillable pdf) – Dependent eligibility documentation required (copies of birth & marriage certificates, DP registration forms, legal custody docs, etc. ) • Support available for members currently in course of care at time of transition 14

Questions? Peralta CCD Committee Members: Thank you for your interest in SISC. Lola Nickell SISC Account Manager lonickell@kern. org 661 -636 -4669 15