Transcript Self-Insured Schools of California: Schools Helping Schools

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
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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”
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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.
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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)
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Kaiser Permanente
Delta Dental (Premier and PPO Plans)
Vision – VSP and MES
Life - Mutual of Omaha
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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
 Out of Network services paid at Non-Par Fee Schedule (except
emergencies)
 No annual Out of Pocket maximum on OON expenses
– Blue on Blue Rules
– Outside California: BlueCard network (BCBSA)
•
General Information
– No waiting periods, no pre-existing limitations
– Deductibles run January to December
– 4th Quarter Deductible Carryover on non-HSA PPO plans
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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
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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
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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
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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 (29th largest)
• ERRP funds applied to offset renewal increases
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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 AB205 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.
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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.
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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
– CompanionCare – SISC Medicare Supplement $373 Single
• Plan is claim free when services are received from providers
who accept Medicare Assignment. No residence limits.
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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
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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
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Questions?
Peralta CCD Committee Members:
Thank you for your interest in SISC.
Lola Nickell
SISC Account Manager
[email protected]
661-636-4669
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