2012-13 Health Benefit Changes

Please review the following attachments concerning the benefits changes that resulted from the new two year collective bargaining agreement.  We hope this will provide you with some clarity around the plans and their benefit levels.  All new plans will begin in September.  We will keep you informed about the dates for open enrollment and the benefits fair. 

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, Rx $5/$15/$35, Chiro  Health Net HMO Custom 5KF $15 OV, Rx $10/$20/$35, Chiro 
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.