Health Benefit Changes 2012-13
The changes to health benefits that resulted from last year’s contract negotiations are effective July 1, 2012. Many of you may have already received new cards in the mail. The plan is taking effect July 1st in conjunction with the start of the District’s new fiscal year, allowing the savings to be counted within the entire upcoming 2012-13 fiscal year. The ten dollar ($10) increase in copays for both Kaiser and Health Net were effective July 1st along with the increases in prescription and emergency room copays for both plans. (Please see below.) We will keep you informed about the dates for open enrollment and the benefits fair.
District Rescinds Some Lay-offs
The District started calling back laid-off members this week. We understand that they bought back seventeen (17) counselors and have called back some laid-off elementary positions. The callbacks for secondary positions should begin next week. We will keep you posted as more information and hard numbers become available.
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As a result of our new two year agreement effective July 1, 2012, there will be changes to the medical plans and eligibility. Below is a summary of changes to the District’s benefits and rates effective July 1, 2012.
- Health Net
- Office Visit Copay Change – The office visit copay for the Health Net HMO plan is changing from $5 per visit to $15 per visit. This copay change also applies to vision exams obtained through your medical group.
- Emergency Room Copay Change – The emergency room copay is changing from $25 per visit to $75 per visit. The copay is waived if your visit results in you being admitted to the hospital from the emergency room visit.
- Prescription Copay Change – The retail prescription copays for up to a 30 day supply are changing from $5 to $10 for Generic, $15 to $20 for Brand and $35 remains the same for Non-Formulary. The mail order prescription copays for up to a 90 day supply are changing from $10 to $20 for Generics, $30 to $40 for Brand and $70 remains the same for Non-Formulary.
|
Current Plan |
New Plan Effective 7/1/12 |
|
|
Health Net HMO 5KF $5 OV, |
Health Net HMO Custom 5KF $15 OV, |
|
|
|
|
|
| Annual Deductible (individual/family) |
None |
None |
| Annual Maximum Copayments (individual/two-party/family) |
$1,000 / $2,000 / $2,500 |
$1,000 / $2,000 / $2,500 |
| Physician/Specialist Office Visits |
$5 copay |
$15 copay |
| Room & Board Hospital Inpatient (semi-private) |
No charge |
No charge |
| Outpatient Services |
No charge |
No charge |
| Emergency Room Services (waived if admitted) |
$25 copay |
$75 copay |
| Urgent Care Services
(waived if admitted) |
$20 copay |
$20 copay |
| Ambulance Services |
No charge |
No charge |
| Chiropractic Care |
$10 copay up to 30 visits per calendar year |
$10 copay up to 30 visits per calendar year |
| Vision Exams |
$5 copay |
$15 copay |
| Self-Administered injectables |
No charge |
No charge |
| Prescription Drug Copay (Retail Pharmacy – 30 Day Supply) |
$5 Generic / $15 Brand / $35 Non-Formulary |
$10 Generic / $20 Brand / $35 Non-Formulary |
| Prescription Drug Copay (Mail Order – 90 Day Supply) |
$10 Generic / $30 Brand / $70 Non-Formulary |
$20 Generic / $40 B / $70 Non-Formulary |
| The information presented in the chart is a summary only. The information does not include all of the detailed explanation of benefits, exclusions and limitations. Plan participants should refer to the Evidence of Coverage (EOC) document for coverage details. In the event information in this summary differs from the EOC, the EOC will prevail. | ||
Kaiser
-
- Office Visit Copay Change – The office visit copay for the Kaiser HMO plan is changing from No charge per visit to $10 per visit. This copay change also applies to vision exams obtained from Kaiser as well as for outpatient services.
- Emergency Room Copay Change – The emergency room copay is changing from $35 per visit to $75 per visit. The copay is waived if you are admitted from the emergency room.
- Prescription Copay Change – The retail and mail order prescription copays for up to a 100 day supply are changing from $5 to $10 for Generic and Brand.
|
Current Plan |
New Plan Effective 7/1/12 |
|
|
Kaiser $0 HMO, ER $35, Rx $5, Chiro |
Kaiser $10 HMO, ER $75, Rx $10, Chiro |
|
|
|
|
|
| Annual Deductible (individual/family) |
None |
None |
| Annual Maximum Copayments (individual/family) |
$1,500 / $3,000 |
$1,500 / $3,000 |
| Physician/Specialist Office Visits |
No charge |
$10 copay |
| Room & Board Hospital Inpatient (semi-private) |
No charge |
No charge |
| Outpatient Services |
No charge |
$10 copay |
| Emergency Room Services (copay waived if admitted) |
$35 copay |
$75 copay |
| Urgent Care Services |
No charge |
No charge |
| Ambulance Services |
No charge |
No charge |
| Chiropractic Care |
$10 copay up to 30 visits per calendar year |
$10 copay up to 30 visits per calendar year |
| Vision Exams |
No charge |
$10 copay |
| Self-Administered Injectibles |
No charge |
No charge |
| Prescription Drug Copay (Retail Pharmacy – 100 Day Supply) |
$5 Generic / $5 Brand |
$10 Generic / $10 Brand |
| Prescription Drug Copay (Mail Order – 100 Day Supply) |
$5 Generic / $5 Brand |
$10 Generic / $10 Brand |
| The information presented in the chart is a summary only. The information does not include all of the detailed explanation of benefits, exclusions and limitations. Plan participants should refer to the Evidence of Coverage (EOC) document for coverage details. In the event information in this summary differs from the EOC, the EOC will prevail. | ||
- Single Health Refund(SHR)
The Single Health Refund is being eliminated. If you are currently enrolled in the medical plan as a single, you have been receiving $78.61 as a Kaiser member or $54.08 as a Health Net member. You will no longer be receiving this payment beginning with your September 30th 2012 paycheck.
- There is NO change in Dental or Vision coverage.
Dual Coverage for Two SCTA members
If you and your spouse are both SCTA members and both are enrolled in a medical plan, you will no longer have this ability effective July 1, 2012. You may be covered as an employee or dependent but not both. Dependent children cannot have dual coverage either. They may be covered under one parent only.
- If you have any questions regarding these changes, you may contact the Sacramento City Unified School District Employee Benefit Office at:
Employee Benefits Office at Serna Center
5735 47th Avenue, Sacramento, CA 95824
8:30 a.m. to 4:30 p.m. Monday through Friday
(916) 643-9432
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