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STATE VISION CARE PROGRAM BAM Section 1200 Active Employees and Retirees/Annuitants

STATE VISION CARE PROGRAM BAM Section 1200 Active Employees and Retirees/Annuitants. Presenter: Lisa Hatten CalHR, Program Manager. LEARNING OBJECTIVES. Discuss the vision plans for actives and retirees Describe vision plan eligibility Identify vision plan benefit summaries

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STATE VISION CARE PROGRAM BAM Section 1200 Active Employees and Retirees/Annuitants

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  1. STATE VISION CARE PROGRAMBAM Section 1200 Active Employees and Retirees/Annuitants Presenter: Lisa Hatten CalHR, Program Manager

  2. LEARNING OBJECTIVES Discuss the vision plans for actives and retirees Describe vision plan eligibility Identify vision plan benefit summaries Understand enrollment policies and procedures Discuss the appeal process

  3. GENERAL INFORMATION • California Department of Human Resources (CalHR) administers the contract between the State and the current vision carrier, Vision Service Plan (VSP).

  4. ELIGIBILITY (Basic and Premier) State employees designated: • Rank and file, Managerial, Supervisory, Confidential • All other employees excluded from collective bargaining • Constitutional Officers • Employees of the Judicial Council, Supreme, Appellate & Superior Court Judges

  5. Bargaining Unit 6 - Rank and File • California Correctional Peace Officers Association (CCPOA) has vision coverage through their union benefits trust. • Rank and File in BU6 (R06) are not eligible to enroll in the State's Vision Program as an active employee. • Upon retirement, R06 employees are eligible for the state Retiree Vision Program. • Personnel office should offer these individuals the state Retiree Vision Program at retirement. • Please contact CCPOA for any R06 Vision Inquiries.

  6. BASIC VISION PLANfor Active Employees

  7. Basic Plan Enrollment(Active Employees) • Enrollment for eligible employees and their eligible dependents is automatic (in most cases). • Premiums are paid 100% by the employer • SCO does not transmit dependent data

  8. Basic Plan Enrollment(Active Employees) • STD 700 to State Controller’s Office: • Permanent- Intermittent employees who meet eligibility requirements must complete Vision Plan Authorization (STD. 700) form to enroll. Personnel officer must send original form to State Controller’s Office (SCO). • A permanent-intermittent employee who does not meet the required hours. STD 700 must be processed to cancel.

  9. Effective Dates (Basic and Premier Plan) • Basic vision enrollment is effective based on when the personnel office keys the Personnel Action Request (PAR) document into SCO payroll system. • Effective date–first of following month if employee PAR is keyed by the 10th of month. • Effective date is first of second month if PAR keyed after the 10th. • Eligible dependents are automatically enrolled in basic vision at same time employee’s enrollment becomes effective. *Continued on next page*

  10. Effective Dates (Basic and Premier Plan) • Premier vision coverage is effective the first of the month following the pay period in which the employee’s earning statement shows the employer contribution and the employee’s contribution. This process may take a couple of pay periods to process.

  11. Effective Dates (Basic and Premier Plan) • Basic Plan enrollment must process before the enrollment for Premier can be keyed at VSP. • If the employee enrolls their family members, the entire family must also be enrolled in Premier. • The Premier Plan requires a 12-month minimum enrollment (unless an eligible permitting event occurs).

  12. Basic Vision PlanBenefit Plan Summary • Exam Once every calendar year • Lenses Once every calendar year • Frames Once every calendar year • Lens Options tints/photochromics (Transitions) • Frames up to $75; $95 on featured frames • Contact Lenses up to $110 for eye exam, contacts and contact lens exam (fitting and evaluation)

  13. BASIC VISION PLAN PREMIUMS • The State is responsible for payment of the monthly premium ($8.64) for the Basic Vision Plan. • Family coverage included

  14. PREMIER VISION PLANfor Active Employees

  15. Enrollment(Active Employees) • During Open Enrollment (OE), all eligible active employees receive materials at their home address from CalHR/VSP offering employees the opportunity to enroll in Premier. • 2017 OE – in the fall (Sept/Oct) • All premier enrollments, changes, cancellations are done through VSP during the OE period. NOTE: Employees enroll directly with VSP.

  16. Vision Plan 2017 • Plan design remains the same • Rates remain the same

  17. Enrollment(Active Employees 1) • New hires/newly eligible employees may enroll within 60 days of eligibility through their personnel office using the Premier Vision Enrollment (CalHR 774) form. Please refer to BAM section 1200 for Permitting Event Codes.

  18. Enrollment(Active Employees 2) Enrollment Process For New Hires/Newly Eligible: 1. CalHR 774 form must be completed by employee then turned into the employee’s personnel office. 2. Personnel office will complete section D of the form then fax or mail CalHR 774 form directly to VSP. IMPORTANT NOTE: Please be sure employee’s Personnel Action Request (PAR) has been keyed and that employee is showing basic vision deduction/employer contribution prior to sending Premier form to VSP.

  19. Enrollment of Dependents If employee elects the Premier plan, any eligible dependent(s) who need vision coverage must also be added at the time of enrollment. Important Note: Employees are unable to enroll themselves in premier and leave dependents in basic.

  20. 12-MonthMinimum Enrollment(Active Employees in Premier) • Employees will be required to maintain their enrollment for a 12-month minimum enrollment period. • Employees do not have to re-enroll as enrollment is continuous. Note: Cancellation of premier may only happen during open enrollment AFTER employee has reached the 12-month minimum enrollment (unless a permitting event occurs)

  21. How to Enroll a P.I. employee into Premier VisionSTEP ONE: Send original STD.700 Vision Enrollment Form to SCO STEP TWO: Fax or Mail CalHR 774 Premier Vision Enrollment Form to VSP

  22. Premier Vision PlanBenefit Plan Summary • Exam Once every calendar year • Lenses Once every calendar year • Frames Once every calendar year • Lens Options tints/photochromics (Transitions) • Frames up to $200; $220 on featured frames • Costco Frames up to $110 • Contact Lenses up to $200 for contacts & contact lens exam (fitting & evaluation)

  23. Premier Plan Premiumsas of 1/1/17 Monthly Premier Vision Plan premiums, including employer/employee shares: Employer Share        Employee Share     Total PC1:$8.64                      $8.84$17.48PC2: $8.64                      $17.68$26.32PC3: $8.64                      $28.46$37.10

  24. COPAYMENTS (Active and Retiree Plans) • Exam $10.00 • Lenses and/or Frame $25.00 Premier Copayments 1. Polycarbonate lenses $15.00 2. Premium progressive lenses $40- $120

  25. Send CalHR 774 Form to VSP Please send completed CalHR 774 directly to VSP. Vision Service Plan Attn: Client Services MS 315 PO Box 997100 Sacramento, CA 95899-9986 or Fax: (916) 463.9031

  26. Retiree Vision Plans • At the time of retirement, newly eligible retirees must enroll through their personnel office. Any changes made after retirement due to a permitting event, or during an open enrollment period, retirees must enroll directly through VSP. • A retiring employee already enrolled in the Basic or Premier plan at the time of retirement may elect to continue their vision plan through COBRA for up to 18 months. Please complete the CalHR 695 form and check the box for “COBRA” then send the form directly to VSP.

  27. Appearance of Premier Vision Plan on Pay Warrant Stub-Active Employees CoBen Employees • The $8.64 state contribution is part of the CoBen allowance. When an employee is enrolled into the Premier Vision Plan, the $8.64 is still present in the allowance and $8.64 is still paid to VSP as the employer share of this plan. The balance or employee share (PC1 $8.84, PC2 $17.68, or PC3 $28.46) is reported as a separate miscellaneous deduction. Both deductions are itemized on the warrant stub to verify the deductions occurred and paid to VSP.

  28. . Appearance of the Premier Vision Deduction on the Pay Warrant Stub • Non-CoBen EmployeesThe $8.64 state contribution is still paid for by the state. When an employee is enrolled in the Premier Vision Plan, the $8.64 is still present as the employer contribution and $8.64 is still paid to VSP as the employer share of this plan. The balance or employee share (1 Party $8.84, 2 Party $17.68, or 3 Party $28.46) is reported as a separate miscellaneous deduction. Both deductions are itemized on the warrant stub to verify the deductions occurred and paid to VSP.

  29. State of CaliforniaGroup Plan Numbers Active Employees • Basic Vision Plan – 30052011 • Premier Vision Plan – 30034581 Retirees • Basic Vision Plan – 30052010 • Premier Vision Plan - 30058000

  30. SCO Vision Deduction Codes Basic • 475-001 (Non-Coben) • 475-002 (Coben) Premier • 361-475

  31. Vision Plan Premiums as of 1/1/17 COBRA Basic Vision PC1:  $8.81 PC2:   $8.81 PC3: $8.81 COBRA Premier Vision PC1: $17.83 PC2: $26.85 PC3: $37.84 Retiree/Annuitant–Basic Vision Plan PC1: $7.53 PC2:   $14.62 PC3:$15.73 Retiree/Annuitant–Premier Plan Vision Plan PC1: $20.40 PC2: $40.35 PC3: $43.89

  32. RETIREE/ANNUITANT VISION PLANS

  33. GENERAL INFORMATION(Retiree/Annuitant) The State of California Retiree Vision Program offers vision benefits to eligible State of California retirees/annuitants, eligible survivors, and their dependents. Retirees have two plans to choose from, the basic and premier. The Retiree Vision plans (and COBRA) must be offered to eligible retirees upon retirement by their employing agency.

  34. Retiree Vision Basic PlanBenefit Plan Summary • Exam Once every calendar year • Lenses Once every calendar year • Frames Once every calendar year • Lens Options tints/photochromics (Transitions) • Frames up to $75 • Contact Lenses up to $110 for eye exam, contacts and contact lens exam (fitting and evaluation)

  35. Retiree Vision Premier PlanBenefit Plan Summary • Exam Once every calendar year • Lenses Once every calendar year • Frames Once every calendar year • Lens Options tints/photochromics (Transitions) • Frames up to $200 • Costco Frames up to $110 • Contact Lenses up to $200 for contacts & contact lens exam (fitting & evaluation)

  36. ELIGIBILITY CRITERIA(Retiree/Annuitant) • A civil service employee of the state. • An elected member of the Legislature. • A Legislative employee • A constitutional officer. • An employee, judge or justice of the judicial branch of state government.

  37. OPEN ENROLLMENT/MINIMUM ENROLLMENT  Open Enrollment is usually every September or October for retirees to enroll or to make changes to their plan. Any changes made during Open Enrollment are effective the following January 1st  Open Enrollment is Sept/Oct each fall.  There is a 12-month minimum enrollment period  Retirees do not have to re-enroll as enrollment is continuous

  38. DIRECT PAYMENTS OF PREMIUMS • The first 2-3 months of retiree vision premiums are direct billed through VSP. • If there are insufficient funds to make a deduction through a retirement warrant, VSP will direct-bill the retiree for the cost of the premiums. • California State Teachers’ Retirement System (CalSTRS) retirees are direct billed, as they are a select group without an implemented payment deduction system.

  39. How To Use The VSP PlanEligible member/dependent may choose to receive vision care services from a VSP Network Provider or other licensed optometrist, ophthalmologist or optician.

  40. Easy as 1-2-31.Select a VSP doctor.2. Make an appointment.3. The doctor and VSP will handle the rest.If member/dependent needs help locating a doctor, they may call VSP toll-free at: 1 (800) 877.7195 or they can logon to VSP’s website at: www.vsp.com

  41. Send CalHR 695 to VSP Please send completed CalHR 695 directly to VSP. Vision Service Plan Attn: Client Services MS 315 PO Box 997100 Sacramento, CA 95899-9986 or Fax: (916) 463.9031

  42. APPEALS Please send vision enrollment appeals to: vision@calhr.ca.gov Department of Human Resources (CalHR) Benefits Division Attn: Vision Program 1515 S Street, North Bldg, Ste 500 Sacramento, CA  95811-7258 Or Fax (855) 530-6599

  43. CONTACT INFORMATION CalHR – Vision Program Phone  (916) 322.0300 Email  vision@calhr.ca.gov

  44. QUESTIONS

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