Garden Grove Unified School District

1. Garden Grove Unified School District Health and Welfare Benefits 2013-2014

2. Benefit Package • As a benefited employee, you are entitled to a comprehensive benefits package including: • Medical • Dental • Vision • Life Insurance

3. Employee Contributions--Premium • Taken directly from your paycheck tenthly • Employee Only – $50 • Employee + I Dependent – $100 • Employee + 2 or More Dependents – $150 • Note: Sign both lines of your Election and Authorization form for tax exempt participation

4. Eligible Dependents • Legally Married Spouse • Marriage Certificate required • Registered Domestic Partner • Proof of state registration required • Children Under Age 26 • Birth Certificate required

5. Qualifying Event • Certain changes in your status allow you to change the dependents on your plan. • New marriage / Domestic partnership • New birth / Adoption • Loss of other coverage in certain circumstances • Divorce or Legal Separation requires you to remove your spouse/former spouse. • All changes MUST be made within 30 days of the qualifying event

6. Open Enrollment • The month of September is Open Enrollment • Open Enrollment is the time to make changes to your plan • Add dependents (outside of a qualifying event) • Change health or dental coverage • Changes become effective October 1st

7. Medical Plans • GGUSD Self-Insured PPO • GGUSD Self-Insured EPO • United Healthcare HMO

8. Preferred Provider Organization (PPO) • Office Visit Co-Pay – $25 • Emergency Room Co-Pay – $100 • Deductible $300 per person • Max $900 per family • Participating Providers – 80% / 20% • Non-Participating Providers – 70% / 30% • Plus fees that exceed allowable PPO rates • Coinsurance Maximum • $10,000 in billed allowable charges • Pharmacy Co-Pays – $5, $10, $35

9. Exclusive Provider Organization (EPO) • Office Visit Co-Pay – $25 • Emergency Room Co-Pay – $100 • Deductible $300 per person • Max $900 per family • 100% coverage after co-pays & deductible • Must use only Participating Network Providers • Pharmacy Co-Pays – $5, $10, $35

10. Finding In-Network Providers on the PPO and EPO plan • Access the Anthem Blue Cross provider search at www.ebam.com or call EBA&M at 855-322-7606. • Check before every appointment as changes can occur throughout the year. • Make sure you are seeing the provider at the address listed. • When searching by name, keep your search broad by not indicating a specialty. • If you have trouble finding a provider by name, try searching by location.

11. Office Visit Co-Pay – $25 Emergency Room Co-Pay – $100 Hospital Admission Charge – $100 per day $300 max per admission $2,000 out of pocket max per calendar year Per member Must use only United Healthcare providers Must choose a primary care physician Must see only doctors within a chosen group Must get referrals to see most specialists Pharmacy Co-Pays – $5, $15, $30 United Healthcare HMO

12. Comparison Chart EPO PPO HMO Office visit co-pay = $25 ER co-pay = $100 Hospital Admission Charge $300 HMO providers only = 100% Limited to primary care physician and group. Primary physician referral needed for most specialists. Pharmacy co-pay $5, $15, or $30 • Office visit co-pay = $25 • ER co-pay = $100 • Deductible = $300/person $900/family • Network only = 100% • Pharmacy co-pay • $5, $10, or $35 • Office visit co-pay = $25 • ER co-pay = $100 • Deductible = $300/person $900/family • Network • 80% / 20% • Out of network • 70% / 30% of allowable • Pharmacy co-pay • $5, $10, or $35

13. Dental • Garden Grove Self-Insured Dental • United Concordia

14. Garden Grove Self-Insured Dental Plan (Fee for Service) • Choose your own dentist • Use network for additional savings! • Annual deductibles • $25 individual • $75 family maximum • Annual limit – $2,000 • Coverage – 90% / 10% • Orthodontia • Plan pays 50% • $2,800 lifetime max

15. United Concordia (HMO) • Must use United Concordia dentists • 100% coverage for most covered services • Orthodontic care (limited coverage) • Employee pays • $1500 for banding for those under 19 • $2000 for banding for those age 19 and older

16. Vision Service Plan • Eye exam – $25 • One eye exam per year • Lenses or contact lenses every 12 months • Frames every 24 months • $120 Allowance • Second Pair Benefit – $200 • Allowance toward 2nd pair of contacts or glasses.

17. Life Insurance • Death Benefit • Class 1 Employees – $50,000 • Class 2 Employees (management) – $70,000 • Limited coverage for dependents: • Spouse – $1,000 • Unmarried Children • Birth to 6 months – $100 • 6 months to 19 years – $1000 • (Full-time students to 23) • Don’t forget to keep the Insurance Department updated on beneficiaries

18. 125 Flexible Spending Account • Tax Exempt • Medical • $2,500 maximum per year • $200 minimum per year • Dependent Day Care • $5,000 maximum filing jointly • $2,500 maximum filing singly

19. How to be a good consumer... • Use it don’t abuse it- we pay for it! • Urgent care vs. emergency room • Pharmaceutical- generic vs. brand name prescriptions • Call Insurance Department first if unsure • Ask questions of your doctor and pharmacist • Keep your EOBs for your records • Stay in network- includes doctor, hospital, lab, anesthesiologist, etc.

20. Conclusion • Forms to be completed • Insurance Election and Authorization Form • Note: Pre-tax deduction authorization is for insurance premium, not flex account • Life Insurance Beneficiary Designation Form • Please hand in this form before you leave • Medical Enrollment Form • Dental Enrollment Form

21. Questions? • Please feel free to contact us with any questions regarding your coverage • Crystal Qualls • 714-663-6523 • cqualls@ggusd.us • Sylvia McMillen • 714-663-6523 • smcmillen@ggusd.us • District Insurance website • www.ggusd.us/departments/insurance/