Transcript OFFICE OF HUMAN RESOURCES AND EQUAL OPPORTUNITY

OFFICE OF HUMAN RESOURCES AND EQUAL OPPORTUNITY
Welcome To The 2008/2009
Benefits Open Enrollment
Workshop
April 2008
OFFICE OF HUMAN RESOURCES AND EQUAL OPPORTUNITY
Presented
By
Christine Vo, Benefits Manager
And
Erica Le, UHC Account Executive
Kim Elliott, UHC Client Service Manager
Pamela Garner, UHC Enrollment Specialist
Vladimir Raguindin, Kaiser Account Manager
Maria Lopez, Kaiser Associate Account Manager
Loretta Chu, Kaiser Enrollment Specialist
Matthew Lundsten, Hartford Enrollment Consultant
BENEFITS OPEN ENROLLMENT: APRIL 7 - 30, 2008
 Benefits election for July 2008 - June 2009.
 Mandatory Medical Election for all Full-Time Employees.
 Employees enrolled in the PPO+ Medical Plan must re-enroll
or coverage will default to the PPO Network Only Medical
Plan effective July 1, 2008.
 PIN Notification Letter from SECOVA, on-line benefits carrier
 Enroll online via www.iElect.com
1. Employer:
2. LOGIN:
3. PIN:
FHDA
Last 4 digits of Employee SSN, immediately
followed by the month, date and year of your
birth year (e.g. Last four SS#MMDDYYYY)
Assigned 5 digits code
HOW TO CHANGE PLAN, ADD/DELETE DEPENDENT(S)
 For employees who don’t have access to a computer or internet, please complete the
Change Request Form to authorize changes to your account and the monthly payroll
deduction (if applicable).
 To add/delete a dependent, you must provide the following documents: Marriage
license, divorce decree signed by the judge, birth/death certificate or legal
adoption papers and copies of social security card for each newly enrolled
dependent or change in status to HR before the updates/changes can be made.
 All required documents must be submitted to HR by April 30, 2008.
dependent(s) will not be covered if we do not receive the necessary documents.
New
 You can not change your selections until the next annual open enrollment
(April 2009) unless you have a qualifying “change in family status”.
 All employees will receive an official benefits confirmation statement from Secova by
May 12th for verification.
DEPENDENTS ELIGIBILITY AUDIT (DEA)
 The District contracts with Secova (formerly known as UltraLink Secova) to
perform an ongoing verification of all enrolled dependents (spouses, and all dependent
children) for all insurance carriers (United Healthcare, Kaiser, Delta Dental, and Vision
Service Plan).
 Maximum Age of Coverage for Dependent Children: ends on the 24th birthday
 The District and the insurance carriers reserve the right to request documentation (tax
records) to verify enrolled family members). Please do not submit any documentation
unless HR/Benefits or your carrier request it.
 DEA mailing scheduled May 8, 2008, employees who have enrolled any dependents via
open enrollment will be required to respond to an audit from Secova. Employees will until
June 6, 2008 to respond.
DOCUMENT REQUIRED FOR
DEPENDENTS VERIFICATION
 You are required to submit a copy of your 2007 Federal Income Return (form
1040 and the Attestation Certification form to Secova. Please do not provide
any supplemental tax records, only the first page and the signature page is
required. It is your responsibility to file your taxes on time as there will be no
exceptions. Failure to provide the necessary documentation when requested
will disqualify the dependent(s) for coverage.
 In lieu of 2007 Federal Income Tax Return (Form 1040), the following
documents are accepted as proofs of legal spouse: 2007 Property Tax Records
or Current Rental Agreement that clearly defines the relationship of the two
individuals.
 You may redact all financial information from the tax form, and you will only
need to disclose the last 4 digits of your SSN.
DOCUMENT REQUIRED FOR
DEPENDENTS VERIFICATION
 If you are divorced and required to carry coverage for dependent child(ren), but cannot claim
your dependent(s) per court order, please submit the Court Order Statement in lieu of the 1040
statement. The maximum age of coverage for these dependents to age 19.
 To request an extension due to late income tax filing: Submit 2008 Application for Automatic
Extension of Time to File U.S. Individual Income Tax Return (form 4868) to Secova no later than
June 6, 2008. The extended deadline is August 15, 2008 (to meet COBRA regulations). You may
request the ultimate deadline of October 15, 2008 by notifying SECOVA no later than June 6,
2008.
 You must also sign an ATTESTATION CERTIFICATION form provided by Secova to declare
that the provided information you are submitting to prove eligibility for your dependent(s) under the
District’s benefit plans is true, accurate, and complete. If providing false, incomplete or misleading
information, or if you fail to update this information in accordance with eligibility guidelines, you may
be subject to the following: reduced coverage levels, repayment of any claims or premiums paid by
the District, and disenrollment of your dependent(s). Please note that it is a felony to falsify IRS tax
forms in any way!
DEPENDENTS ELIGIBILITY
AUDIT (DEA) Cont….
 Failure to provide the required documentation will disqualify the dependent for coverage effective
July 1, 2008, and re-enrollment will not be allowed under the next plan year.
Note: Claims will be placed in pending status until proof of IRS dependency status can be
verified.
Secova Customer Service: Monday - Friday, 8 a.m. - 6 p.m. PST
Secova Western Service Center
PO Box 5080
Costa Mesa, 92628
Email: [email protected]
PHONE: 1-866-208-3204
FAX: 1-866-585-6860
Wellness Initiatives
Biometrics Screening Program
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Sponsored by Human Resources
Program administered by Provant Health Solutions, LLC (in partnership with
UnitedHealthcare)
Free of charge for all RETIREES
Dates: May 12-15, 2008, 8 a.m. - 2 p.m.
Location: Foothill Campus, District Board Room, May 12 and 13, 2008
De Anza Campus, Admin Building, Room #106, May 14 and 15, 2008
Fasting is not required
Nurse Health Coaching/Counseling Available
TEL: (877) 239-3557, Ext 211
 Deadline for registration is Friday, May 2nd
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For appointment:
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For identification, please bring either a District ID card
or UHC/Kaiser ID with you to the event!
Wellness Initiatives
cont…
Health Risk Assessment Program
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Sponsored by Human Resources
Scheduled for the week of October 13th (watch out for more news in the Fall 2008)
On-line HRA
Incentives for both Actives and Spouse to participate
Free Flu Shots
Raffles Event
PLEASE COME AND JOIN US FOR THE FUN AND PROMOTE
HEALTHY LIVING!
DeltaPreferred Option (DPO)
now known as Delta Dental PPO
Advantages:
1)
Save on out-of-pocket expense when
utilizing a PPO Network dental office
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Increase maximum annual coverage from
$2,000 to $2,200 per person, per calendar
year
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Must use any licensed Delta Dentist who is
contracted under the PPO service fees
schedule to maximize your benefits
 PPO Plan is in addition to the
District’scurrent DeltaPremier
Plan (may use any dentist).
Maximum allowance remains at
$2,000 per calendar year
Oral Health Cont…
For information regarding eligibility,
benefits and list of PPO or
DeltaPremier dentists, you can now
access Delta Dental’s web site:
www.DeltaDentalCA.org or call (800)
427-3237
Dedicated fax line for school district
employees: (866) 499-3001 for faxed
eligibility/benefits information
VISION CARE PROGRAM
Administered by Vision Service Plan
(VSP)
Exam and Rx glasses … $10 co-pay
Contacts ……………. . No co-pay applies
Coverage allows:
Annual exam ………every 12 months
Lenses covered in full…… 12 months
Frames (up to $115).. every 24 months
or Contacts …………every 12 months
For information regarding eligibility,
benefits and list of VSP providers, please
access: www.VSP.com or call (800) 8777195
Out-of-Network Reimbursements:
 Up to $45 for Exam, Lenses & Frame
 Up to $105 for Contact Lenses
No ID cards required and no claim forms
MEDICAL PLANS AT A GLANCE
Medical Options:
 District Combined Coverage
Medical Plan (PPO+)
 District Network Only Plan (PPO)
 Kaiser Health Plan – HMO
THIRD PARTY ADMINISTRATOR (TPA) AND
PPO NETWORKS
 The District Self-Funded Medical Plans are administered by United Healthcare
(UHC), GROUP #708611, Customer Care toll free (800) 510-4846.
 PPO Network Only Medical Plan (PPO) participants MUST choose providers
contracted with the UnitedHealthcare CHOICE Health Plan.
 District Combined Coverage Medical Plan (PPO+) can access providers under the
UnitedHealthcare CHOICE PLUS Health Plan and non-network
providers.
 To determine if your physician is in the network, go to UHC web site:
www.provider.uhc.com
Or call
Customer Care toll free: (800) 510-4846
District Combined Coverage
Medical Plan (PPO+)
Choice to select any providers:
UnitedHealthcare CHOICE PLUS
Health Plan & Non-PPO providers.
ZERO deductible
Utilization of UnitedHealthcare Choice Plus
PPO providers provides:
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100% in payment per contractual rates,
patient is responsible for only co-payments
Option to access any non-PPO providers
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Plan pays 80% of UCR charges, patient is
responsible for the difference in UCR
payment vs. billed
Flexibility: Provides worldwide coverage
regardless whether it is emergency or not
Members who reside outside of US territory
or in non-PPO service areas will default
automatically to the PPO+ Plan and premiums
will be billed accordingly.
Requires employee contribution to insure
dependent coverage.
Chiropractic Care required PRIOR
AUTHORIZATION (after 12 visits).
Maximum annual limit of 30 visits.
Subject to medical necessity.
DISTRICT NETWORK ONLY PLAN (PPO)
MUST choose only providers contracted with the UnitedHealthcare CHOICE Health Plan.
ZERO payment for any out-of-network expenses, except for true Medical Emergency (Level 1 Critical Care
@ PPO level of benefits). You are responsible for the difference in billing!
Utilization of UnitedHealthcare Choice PPO providers provides:
 100% in payment per contractual rates, patient is responsible for only co-payments
Annual Deductible is applicable for hospitalization, physician hospital services, diagnostics X-ray & Lab,
durable medical equipment, outpatient substance abuse, ambulance services, birthing centers, skilled nursing
facility, home/hospice healthcare, ER, etc.
$150/per person/calendar year
$300/for two persons/calendar year
$400/family of three or more/calendar year
50% Higher Out-of-Pocket maximum vs. PPO+ plan
Limited chiropractic care (10 visits annually)
Well Baby Care/Adult Annual Physical - Plan pays 100% up to $300 per calendar year maximum, less copay per visit
$50 Co-pay for Inpatient Mental Health vs. ZERO for PPO+
NO employee contribution to insure dependent coverage
To insure under PPO Network Only Medical Plan, you must have access to contracted PPO
providers and facilities within a 30 mile radius from your home. Otherwise, you must select
PPO+ Plan or Kaiser.
HOW TO FILE MEDICAL CLAIMS
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Effective July 1, 2008, UHC enforces the 90 days claims submission for PPO
contracted providers in an effort to improve the claims payment process.
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For non-contracted claims, UHC requires claim form for medical expense
reimbursement
PPO & Non-PPO claims - Submit claims to: United Healthcare
P. O. Box 30555
Salt Lake City, UT 84130-0555
UHC Customer Care toll free: 1-800-510-4846
COORDINATION OF BENEFITS
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Coordination of Benefits (COB) provision means that when a member is covered under two or
more plans, the benefits of these plans will be coordinated so that the total amount paid out does not
equal more than the actual cost of treatment. Coordination of Benefits is vital in keeping the cost of
coverage as low as possible.
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If the member is entitled to benefits under another health care plan in addition to the District Plan,it is
important to bill both companies at the same time, regardless of whether we are the primary or
secondary carrier. By billing both companies at the same time establishes a record in our system for
timely filing.
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Secondary submission:
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If you are submitting a paper claim, please attach the Explanation of Benefits form the primary
insurance for proper coordination.
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If you are submitting an electronic claim, be sure to complete all the other insurance payment
fields correctly to insure proper coordination with the primary payer.
Payment Allowance
In no event will District Medical Plan’s payment for covered services together with the payment made by
the primary carrier exceed the amount that would have been payable if UnitedHealthcare had been the
primary carrier.
The practitioner agrees to accept the negotiated amount as payment in full, whether that amount is paid
in whole or part by the member, us, or by any combination of payers, including other payers that may
pay as primary.
LABS SERVICE FOR SELF-FUNDED MEDICAL PLANS
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To maximize benefits and minimize out-of-pocket expenses, it is best to utilize
contracted providers such as: LabCorp, Westcliff Med Lab, Hunter Lab,
SleepMed of California, Gyne Path Lab, Los Olivos Med Lab, Stanford Lab
(SHC Reference Lab), and others.
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Non-contracted labs - You will be responsible for the difference between
what the Plan pays (80% of UCR) and the total charge.
PRESCRIPTION DRUG PLAN
 MEDCO is the Pharmacy Benefits Manager (in partnership with UHC), GROUP
#708611, Member Services toll free: 1-877-842-6048.
 Access pharmacy information and refills via:
http://www.medcohealth.com
 MAIL ORDER PRESCRIPTION provided by MEDCO
 To start Mail Order Prescription, contact your physician(s) for NEW prescriptions (90 supply
+ refills) and submit those to MEDCO. It will take at least two weeks for the new
prescriptions to be delivered to your home, so plan accordingly.
 The Plan requires that all MAINTENANCE MEDICATIONS
for chronic medical conditions be ordered via mail order
program. Do not submit any other medication requests
such as one time use or antibiotics.
 Overrides for supplies larger than 90 days needed for extended
travel outside of the U.S. may be arranged by contacting
the Benefits Office.
HOW TO FILE PRESCRIPTION DRUG CLAIMS
A.
Prescription Drug Claims: GROUP #708611 (both medical and prescription
drug share the same group number with UHC).
**MEDCO requires claim form for Rx expense reimbursement
Submit claims to:
Medco Health Solutions, Inc.
P. O. Box 14711
Lexington, KY 40512
Medco Customer Service: 1-877-842-6048 (7/24 hours service)
B.
Prior Authorization (P.A.) required for certain drugs: Physician must contact
Medco at 1-800-753-2851
Half-Tab Program - Effective May 1, 2008
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Designed to support members who want to save money by “splitting” tablets
for select prescription medications.
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Under a Doctor’s supervision, the program allows for doubling the strength of
qualified medications, while reducing the quantity of tablets by half.
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Key benefits: Participating members benefit by paying a reduced co-payment
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Participation is voluntary (members choose to participate with their Doctor)
Program includes 20 medications:
Therapeutic Class
Medications
Lipotropics
Lipitor, Crestor, Pravachol, pravastatin, simvastatin, Zocor
Antidepressants
Lexapro, Pexeva, sertraline, Zoloft
Aceon, Atacand, Avapro, Benicar, Cozaar, Diovan, Mavik,
moexipril, trandolapril, Univasc
Hypotensives
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Notification letters to be sent to those members who take medications included in the program.The member
will be informed about the program and provided a free tablet splitter, as well as given instructions to discuss
the program with their physicians to determine if the program is appropriate for them.
Industry Outlook – Generics
* Significant Generics Entering Marketplace Within Next 24 Months
1. Zyrtec: Allergy drug (OTC) product - Qtr 1, 2008
2. Fosmax: Bone suppression resorption agent (osteoporosis) - Qtr 1, 2008
3. Keppra: Epilepsy treatment or bipolar disorder and neuropathy - Qtr 3, 2008
4. Depakote: Anticonbulsant drug (epilepsy), prevention of migraines, bioplar
disorder, and etc… - Qtr 1, 2008
5. Risperdal: Antipsychotic used to treat schizophrenia, mood disorders or bipolar
disorder - Qtr 3, 2008
6. Imitrex: Vascular serotonin receptor agonist - for treatment of migraines, etc. Qtr 4, 2008
DISEASE MANAGEMENT PROGRAM:
OptumHealth optimizes the health and well-being of individuals and organizations
through personalized health management solutions.
The Program is intended to provide:
Support for individuals who are living with a chronic condition or dealing with
complex health care needs such as coronary artery disease, diabetes,
asthma, etc..
Access to health and wellness information to assist in making more informed
decisions about your health in consultation with your physician. You’ll receive
a welcome kit of educational materials, standard-of-care reminder cards and
condition-specific quarterly newsletters.
Availability – A toll-free nurse hotline is available to you 24 hours/day, 7
days/week. The service offers support for you between physician office visits
to improve your self-management skills.
MyNURSE Hot Line: 1-866-805-8310
UHC - CUSTOMER CARE
 MyUHC.com provides extensive Web-based tools and resources for claims
management, a list of contracted providers, an opportunity to take online health risk
assessments, id card replacement, access to research health topics and an
opportunity to participate in group discussions with medical experts
 Customer Care toll free number (800) 510-4846, GROUP #708611, can also help
you find the right physician, specialist or hospital for your specific needs
 Care Coordination provides Personal Health Support with Disease Management
for employees who are living with chronic conditions or dealing with complex
health care needs. It assists employees in coordinating care for both pre and post
operation procedures. It provides access to resources that can give you confidence
when making health decisions.
 UHC Claims Resolution Assistance: Scheduled Every 3rd Monday for the next 5
months (5/19, 6/16, 7/21, 8/18, and 9/15/08).
 Contact HR at 650-949-6224 to schedule an appointment
KAISER MEDICAL PLAN
Use Web site, kaiserpermanente.org, to:
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Find physicians and facilities near you
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Request routine appointments and order prescription refills
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Get health and drug information
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Contact a pharmacist with non-urgent questions and get answers
delivered to your personal, secure mailbox
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Join a community through our online message board
KAISER MEDICAL PLAN
CONT….
Benefits include:
 $10 co-payment for office visits (No deductibles to meet)
 $10 co-payment for routine physical visits
 $5 co-payment for well-child preventive care visits (under age 2)
 $5 co-payment for scheduled prenatal care and first postpartum visit
 $50 co-payment for non-ER services and Out-of-Area Urgent Care Visits
 $10 per outpatient surgery per procedure
 No charge for vaccines (immunizations), allergy injection visits
 $10 co-payment for individual health education visits
 No charge for hospitalization services
 No charge for Durable Medical Equipment (DME)
 $5 Generic/ $10 Brand Name co-payment for most prescription drugs - 100 days
supply
 No charge for 45 days/calendar year of Inpatient Mental Health Services
 $10 per individual visit or $5 per group visit (20 combined individual and group
visits/calendar year) for outpatient mental health (OMH)
 No charge for home health care, skill nursing facilty care and hospice care up to 100
visits per calendar year
 Hearing Aids coverage is good for every 36 months: $500 allowance
KAISER MEDICAL PLAN CONT…
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$10 co-payment for up to 30 chiropractic visits through American Specialty
Health Plan Network (ASH)
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25% Discount on additional chiropractic visits, acupuncture and massage
therapy through ASH:
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Member Services: 1-800-678-9133
Web Site: www.ashcompanies.com
Health classes and programs, including some you might not expect, like tai
chi and yoga, are available at no cost or for a small fee. Class offerings
vary by location.
NOTE: For more complete benefit information, members should refer to
the Summary of Benefits and Evidence of Coverage.
KAISER’S LIVE-WORK ELIGIBILITY RULE
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Allows ACTIVE employees who reside within the state of CA and
work in the Kaiser service area, to enroll in the Kaiser Medical Plan
regardless of their residence.
Reminder:
 Article 19 (Early Retirees), full-time retirees, surviving spouses and
COBRA enrolleees are not eligible.
 Employees who reside outside of the State of CA should select only
the District’s Combined Coverage Medical Plan (PPO+) or the PPO
Network Only Medical Plan (PPO).
 Dependents follow the employee choice
EMPLOYEE ASSISTANCE PROGRAM (E.A.P.)
Administered by United Behavior Health (UBH)
Services are completely confidential
Designed to enrich and support you as you experience life changes
Program provides resources, expertise, consultation and referrals in helping you with
day-to-day concerns that are related to everyday life to major life events
Services are provided by a large and diverse network of licensed and certified
professionals, they are comprised of attorneys, paralegals, financial consultants, family
mediators and dependent care professionals.
For complicated issues, you can meet with a full range of certified specialists, including
licensed master’s level counselors, psychologists, psychiatrists and substance abuse
professionals
How Do I Get Started?
• Log on to www.liveandworkwell.com or call 1-866-248-4105, Access code:
61570
• Specialists are available 24 hours per day/7 days per week, 365 days a year.
• To help non-English speakers, UBH have translators who speak 140 languages
• A dedicated TDD line for persons with hearing or speech-impaired conditions.
CHOICES TO MAKE
Current Medical Benefit Coverage:
 District PPO+ Plan: Dependent Contribution Required
1) EE + 1 dependent: $122.00/mo X 12 mo = $1,464 annually
Actual cost: $128.05/mo x 12 mo = $1,536.06
Savings: $72.60 or 5% District supplement (one-time)
2) EE + 2 or more dependents: $199.00/mo X 12 mo = $2,388 annually
Actual cost: $240.05/mo x 12 mo = $2,880.60
Savings: $492.60 or 17% District supplement (one-time)
 District Network Only (PPO) Plan: No Employee Contributions
 Kaiser HMO Medical Plan: No Employee Contributions
VOLUNTARY BENEFITS: SUPPLEMENTAL
LIFE AND AD&D PROGRAM
SUPPLEMENTAL LIFE AND AD&D
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Administered by HARTFORD Life Insurance Co.
Elect this coverage online at iElect.com
Review both coverage and rates online
Download both Enrollment and Evidence of Insurability (EOI) forms from iElect.com for
completion and return to the District by the Deadline of April 30th.
Employee’s coverage: $50K minimum; $150K maximum
Spouse or Domestic Partner’s coverage: $50K minimum; or matching employee’s coverage up
to $150K maximum (previously guaranteed at $20K level)
Dependent Children’s coverage:
Live birth - 6 months = $1K
6 months - 25th birthday = $10K
VOLUNTARY BENEFITS: FLEXIBLE
BENEFITS SPENDING ACCOUNTS (FSA)
FSA (Plan year: July 1, 2008 through June 30, 2009)
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Administered by United Healthcare
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Must elect this coverage online at iElect.com each year. It is not
automatically renewed.
OPTIONS:
1.
HEALTH CARE REIMBURSEMENT ACCOUNT (HCRA):
2.
DEPENDENT CARE REIMBURSEMENT ACCOUNT (DCRA): Pre-tax
Eligible
expenses cannot be paid or reimbursed by any benefit plan, and do not include
health plan contributions or premiums. (Medical, Rx, Dental and Vision expenses
for both you and your eligible dependents). IRS Code 213.
deductions can be used to reimburse any child and dependent care expenses that
would otherwise be eligible for a tax credit, as defined by the IRS.
Care for dependent under the age of 13; care for dependent of any age, who is
physically or mentally incapable of self-care, and who lives with you for more
than half the year, incurred to allow you (and your spouse, if applicable) to work.
IRS Code 129.
FSA CONTRIBUTION REQUIREMENTS
Minimum and Maximum contribution:
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Minimum contribution for both HCRA and DCRA FSA is $500/year
Maximum contribution for HCRA is $3,000/year
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Maximum contribution for DCRA is $5,000/year in combined contributions for any DCRA
FSA, per family, per calendar year
(Note: DCRA allows $2,500 if married and filing separate tax returns)
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It is best to underestimate your expense! Expenses must be incurred in the plan year!
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The money in one FSA account may not be used to cover expenses
in the other, per IRS regulations.
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Any unused funds remaining in your FSA account(s) after the close of
the plan year must be forfeited, as required by the IRS.
FSA Eligible Expenses
 Health Care :
• Medical Plan Deductibles
• Insurance Co-Payments
• Prescription Drugs
• Over-the-Counter Medicines (when used to alleviate personal injury or
sickness)
• Vision Exams/Eyeglasses/Contacts
• Laser Eye Surgery (LASIK)
• *Acupuncture
• *Weight Loss Program
• Dental and Orthodontia (Braces)
•*Chiropractic
• Treatments for Smoking Cessation
• Treatment for Alcoholism and Drug Addiction
• Immunizations
_________________________________________________________________________________________
*When medically necessary.
FSA Eligible Expenses
 Dependent Care:
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Nursery or pre-school
Summer day camp
*Care in a licensed child or adult care facility
Services from individual provide care in or outside your home while you work.
NOTE: Dependents of you or your spouse and children under
age 19 are not acceptable
Before and After-school programs for children under age 13
A caregiver’s wages and employer taxes
Transportation provided by dependent care provider to and from dependent care
location
Eldercare - Household services (related to the care of the elderly or disabled adults
or children who live with you) provided by a housekeeper, maid, cook, etc., as long
as the individual is partly responsible for the well being and care of your qualified
dependents
*NOTE: To qualify, the school or center must comply with state and local laws, serve at
least seven individuals, and receive a fee for its services.
FSA - Ineligible Expenses
Health Care:
Cosmetics or Cosmetic procedure (not medically necessary)
Electrolysis
Health club dues
Insurance premium
Nutritional and herbal supplements
Teeth bleeching
Toiletries and sundry items (toothbrush, deodorant, etc.)
Teeth bonding (not medically necessary)
Vitamins and minerals (for general health and well-being)
Dependent Care:
Babysitting that is not work related
School costs for kindergarten or higher grades
Long Term Care services
Overnight camps
Day care provided by a spouse, dependent or your child under age 19
Activity and field trip fees
FSA - Auto Rollover (Reimbursement)
Auto Rollover :
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If you wish to apply your out-of-pocket expenses (co-payments and/or deductibles) for the
PPO Network Only or PPO+ medical plans and Medco through United Healthcare, you
must elect this option when enrolling online.
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This option will allow UHC to tabulate all of your out-of-pocket expenses and reimburse
you when your expenses have reached a minimum of $50 without you submitting claim
forms. However, expenses incurred via other carriers such as Kaiser HMO, Delta Dental,
and Vision Service Plan (VSP) are required to be submitted to United Healthcare for
reimbursement manually.
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Kaiser members must select Health Care Reimbursement Account - Claims Filed
Manually option if you elect FSA Health Care Reimbursement Account.
An important difference to remember:
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You can file claims for amounts totaling your entire annual health care contribution from your
Health Care Flexible Spending Account at any time during the year;
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To receive a reimbursement from your Dependent Care Flexible Spending Account, you must have
accumulated sufficient contributions to cover your claim at the time your request is made.
FSA & IRS Regulations
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For additional information regarding:
1) FSA accounts
2) Lists of FSA approved expenses or exclusions by the IRS
3) Claim and direct deposit forms
Please access HR Web Site: http://hr.fhda.edu/benefits or contact United
Healthcare FSA Customer Care at 1-877-311-7849, Group #709593
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IRS web site: http://irs.gov
1) Publication 502 (Health Care Expenses)
2) Publication 503 (Dependent Care)
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DEADLINE FOR PY 2007/2008 (July 07 - June 08): All claims must be received
by UHC no later than September 30, 2008 for reimbursement.

DEADLINE FOR PY 2008/2009 (JULY 08 - JUNE 09): All claims must be
received by UHC no later than September 30, 2009 for reimbursement.
THE CONSOLIDATED OMNIBUS BUDGET
RECONCILIATION ACT (COBRA LAW)
Your Rights under COBRA
Definition: A CONTINUATION of Health Benefits Coverage.

Qualifying Events:
A. Employee Qualifying events
Voluntary Termination of employment;
2. Reduction of working hours results in loss of coverage;
3. Lay-off; or
4. Discharge from the District for reasons other than gross misconduct
1.
B. Dependent Qualifying Events
Divorce or Legal Separation of the employee and the spouse;
2. Employee’s Death;
3. Employee’s Entitlement to Medicare; or
4. Ceasing to be a “Dependent Child” according to the plan’s definition.
1.
COBRA RIGHTS CONT…
LENGTH OF CONTINUATION OF COVERAGE:
A.
B.
Employee’s qualifying event - 18 months
Dependent’s qualifying event - 36 months
SELF-PAY @ 102% OF PREMIUM
Can elect to purchase Medical/Rx only or the entire package
(includes Dental & Vision)
MUST notify the Plan Administrator within 60 days of a qualifying
event to enroll
Premium Payment is due and payable on the first day of coverage and
the first day of each month thereafter. The initial payment must be made
within 45 days of election.
PY 08/09 Rates:
Monthly premium/single insured
Kaiser/Rx
PPO Network Only/Rx
PPO+/Rx
Dental & Vision
$455.58
$644.36
$697.23
$73.38
The Uniformed Services Employment and
Reemployment Rights Act (USERRA)
Your Rights under USERRA: Health Insurance Protection
A.
If you leave your job to perform military service, you have the right to
elect to continue your existing employer-based health plan at your
expense for you and your dependents up to 24 months while in the
military.
B.
If you elect to discontinue benefits coverage during your military
service, you have the right to be reinstated in your employer’s health
plan when reemployed, generally without any waiting periods or
exclusions, such as pre-existing exclusions, except for serviceconnected illnesses or injuries.
SUMMARY OF OPEN ENROLLMENT (OE) PROCESS
Mandatory on-line enrollment required for all active employees
The annual OE period is scheduled from April 7-30, 2008. The choices you make during this election will remain
in effect until June 30, 2009, unless you experience a life qualifying event.
All PPO+ members must make an election on-line. Failure to do so will result in defaulting to District Network
Only Plan (PPO), for you and your dependents.
Official Benefits Confirmation Statements will be mailed to employees’ homes by Secova on May 8, 2008 for
verification.
Dependent Eligibility Audit (DEA) materials will be mailed to all employees who insured dependents for Plan
Year 08/09 on May 8th.
DEA Project Deadline: June 6, 2008
 Remember to submit (1) “2007” 1040 Federal Income Tax Returns
and (2) Attestation Certification form to SECOVA
New ID cards will be issued by the medical carrier by June 27th.
Extended Deadline due to late income tax filing for Dependents Verification Project: August 15, 2008 (to
meet COBRA obligations) or October 15, 2008 (ultimate deadline with IRS) provided that you submit the
Form 4868 by June 6, 2008 to Secova.

Please be advised that if you require an extended deadline through October 15, 2008,
COBRA extension beyond August 29, 2008 is not available.
On-line Enrollment reminder
 FSA Auto Rollover: Click Health Care Reimbursement Account - Auto
Rollover (Medical/Rx Only) option when enrolling online if you wish to
apply your out-of-pocket expenses (co-payments and/or deductibles) for the
PPO Network Only or PPO+ medical plans and Medco through United
Healthcare.
 IMPORTANT: When finishing your elections online, you must CLICK the
PLEASE CONFIRM button to activate your benefits for the new plan year
(July 1, 2008 through June 30, 2009). Otherwise, your election will continue
to be in pending status, and no changes will be registered by the system.
 IMPORTANT: This presentation is a brief summary of the most
frequently used benefit provisions. Please refer to the Evidence of
Coverage or the Summary Plan Description for complete details of
benefit limitations, exclusions, and general program parameters.
MOST USEFUL INFORMATION
For information regarding your Group Health Benefits or claim forms please
access:
http://hr.fhda.edu/benefits
For information regarding the PPO+ and PPO Network Only Plans, verify
contracted providers, FSA approved expenses or exclusions by the IRS, please
contact:
UHC Customer Care at 1-800-510-4846 (M-F 8 a.m - 8 p.m. PT)
Medical Group #70861 FSA Group #709593
For list of PPO contracted providers, please access either:
www.provider.uhc.com or www.MyUHC.com
NOTE: No password is required to access
For mail order prescription drugs refills call 1-800-4REFILL or (1-800) 473-3455
MEDCO direct contact number: 1-877-842-6048
FSA direct contact number (administered by UHC): 1-877-311-7849
Benefits Important Contacts
• Benefits Program Coordinator: Vacant - Email: TBD
 Responsible for audit and process Medicare reimbursement checks for
retirees, eligible dependents and surviving spouses; Surviving spouses,
COBRA billing, FSA, and benefit claims resolution
• Patience McHenry - Email: [email protected]
 Responsible for legal compliance, and general benefits assistance
• Christine Vo - Email: [email protected]
 Plan Administrator for all health/welfare benefit plans
H.R. Important Contacts
• Patti Conens - Email: [email protected]
Debbie Haynes - Email: [email protected]
Responsible for all FT Faculty contractual issues
• Kristine Lestini - Email: [email protected]
Margaret McCutchen - Email: [email protected]
 Responsible for all contractual issues relating to classified (CSEA,
SEIU, Supervisors, Confidentials) and Administrators.
H.R. MOST IMPORTANT ASSET