2020 Open Enrollment Employee - Medical & Dental
Open Enrollment Memo
Medical Plans - Summary of Benefits Coverage & Plan Summaries
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 benefit 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 LiveHealth Online will provide online doctor visits at no cost. Anthem PPO participants continue to have this benefit at no cost. Anyone who is not an Anthem participant may access this benefit for $49 per visit.
Carrum Health (PPO Only) is a special surgery benefit that provides exclusive access to “Centers of Excellence”. These facilities and doctors provide for an improved patient experience, high quality of care, and zero or minimal out-of-pocket costs. Carrum Health - No Cost Surgery Benefit
With the Anthem Anywhere App, you can easily manage your benefits anytime, anywhere. Mobile App
Use online Find a Doctor tool to look for doctors, hospitals, labs and other health care providers in your Anthem Blue Cross plan. Check if your favorite doctor is part of your plan, or look for one near you. Avoid getting care from doctors outside of your plan if you can — it will cost you more or your plan may not cover it all. Find a Doctor
Proof of Eligible Dependent Status
ACWA JPIA requires the District to guarantee every dependent enrolled in a medical plan is an eligible dependent. The District must show proof of eligibility for each dependent you enroll. Commonly submitted documents are marriage certificates (spouse); birth certificates (child) and court orders (child).
For every dependent you are enrolling, you must submit a copy of the verification document with your medical enrollment form. If you cannot locate the documents, request from the county registrar’s office for where each event occurred (marriage or birth).
Dental Plan - Premier Access
A description of Class I, II and III dental benefits and plan information is available here for your reference. Schedule of Dental Benefits
Effective Date of Coverage for Newborn Children
Coverage for a child born will be effective on any first of the month date between the date of the birth and the child’s 3rd birthday. In order for coverage to be effective, you must submit a written enrollment application to Human Resources. The enrollment application must be signed and returned no later than the child’s 3rd birthday. If the enrollment application is not signed and received within these guidelines, your child will be considered a “Late Enrollee” and will be enrolled effective the first of the month during which the enrollment application is received.