2018 Open Enrollment for Retirees
Retiree 2018 Open Enrollment Letter
ACWA JPIA Retiree Medical Changes Allowed
The District is required to offer retiree medical coverage that meets the requirements and guidelines established by ACWA JPIA and the insurance carriers. This document explains when and what types of changes a retiree can make to their medical coverage.
Summary of Benefits Coverage
Under the Affordable Care Act (ACA), health insurers and employer groups must provide a summary of benefits and coverage (SBC) to participants and beneficiaries (generally employees and dependents). SBCs must follow standards set forth by the federal agencies. The SBC helps eligible employees and dependents understand their benefits and coverage by using simple language in a consistent format. The SBC includes brief summaries of:
- Covered services
- Examples of coverage
- Appeals and grievance rights
- Exceptions and limitations
- Cost-sharing provisions, including any deductible, coinsurance, and co-payments
- Continuation coverage
The SBC also contains a phone number to call for questions and the website address where the uniform glossary can be found.
Anthem Blue Cross
Some find these plan summaries more reader friendly than the Summary of Benefits Coverage. These are provided for your reference:
- Kaiser Traditional HMO
- Kaiser Traditional HMO Retired w/Medicare
- Anthem Advantage PPO
- Anthem Advantage PPO Retired w/Medicare
- Anthem Classic PPO
- Anthem Classic PPO Retired w/Medicare
- Anthem CalCare HMO
- Anthem CalCare HMO Retired w/Medicare
- Anthem Value HMO
- Anthem Value HMO Retired w/Medicare
Anthem Classic PPO and Advantage PPO Provider Cost & Quality Information
This flyer will help participants compare cost and quality for medical care and prescriptions for the Anthem PPO plans.
Anthem PPO Surgical Options for Pre-Medicare Retirees
When selecting providers for surgical procedures, there are two resources to assist participants with finding high quality, lowercost providers.
- Anthem marks surgery centers in search results at www.anthem.com/ca as “Blue Distinction” if they meet elevated standards for positiveoutcomes, competitive pricing, and regularly perform that surgery.
- Another option is using Carrum Health to accesseither Scripps (in San Diego) or Stanford (in the Bay Area) for certainsurgeries, including joint replacement, cardiac, lumbar, and bariatricsurgeries. These two providers were selected due to positive outcomes,experience with these particular surgeries, and excellent reputation. Because Carrum Health has negotiated a bundled pricing arrangement with the providers,the surgeries are provided at no cost to the participant. Anthem picks up theparticipant cost share and pays for travel and accommodations for the patientand an adult companion. A Carrum Health care concierge arranges all medical recordtransfer, before and after the surgery, pre-op and post-op appointments, andarranges travel paid in advance. This benefit must be accessed directly throughCarrum Health. Call 1-888-855-7806 for more information. Carrum Health Information
Medicare Enrollment FAQS
This flyer will answer employee and retiree questions about Medicare Enrollment as they turn 65 or retire.
If you or your spouse is enrolled in a Medicare plan and the other is enrolled in Non-Medicare, please refer to the Mixed Medicare rates. 2018 Retiree Rates