Self-Insured Schools of California: Schools Helping Schools
Self-Insured Schools of California: Schools Helping Schools SISC Health Benefits Program Information for Peralta Community College District Presented October 11, 2012 by Lola Nickell, SISC Account Manager 1 Self-Insured Schools of California SISC - Who We Are Not-For-Profit Joint Powers Authority (JPA) established in 1979, administered by the Kern County Office of Education. SISC administrative personnel are employees of the public school system.
SISC III is one of the largest school focused health care purchasing pools in California. Current statewide membership is over 200,000 lives from over 380 school districts in 39 counties A JPA governed by a Board of Directors Like school districts, SISC is subject to the Brown Act. Our Board of Directors are employees of school districts and are elected by member districts. Our Philosophy Schools Helping Schools 2 The SISC Advantage Under SISC, districts may select from a wide range of medical, dental, vision, and life plan product offerings to customize a comprehensive benefit package for employees. Strong financial standing with stabilization reserves. Claims liability
fully funded. Long term health benefits solution: 220+ districts in SISC III for at least 10 years. Continued growth: 150+ school districts have joined in the last 10 years. 3 SISC: Carriers & Products We offer a wide range of health benefits through major carriers; PPOs, HMOs, Rx, Dental, Vision and Life. Anthem Blue Cross (Self-funded PPO and fully insured HMO) Blue Shield (Self-funded PPO and fully insured HMO) Pharmacy Benefits through Express Scripts (Non-HSA plans)
Kaiser Permanente Delta Dental (Premier and PPO Plans) Vision VSP and MES Life - Mutual of Omaha 4 SISC Medical Plan Options HMO Plan Options Kaiser Permanente, Anthem Blue Cross, Blue Shield Must live/work within defined service area
Self Funded PPO 19 Medical + 2 HSA Compatible Options SISC Plan Design with Anthem Blue Cross or Blue Shield of California Out of Network services paid at Non-Par Fee Schedule (except emergencies) No annual Out of Pocket maximum on OON expenses Blue on Blue Rules Outside California: BlueCard network (BCBSA) General Information No waiting periods, no pre-existing limitations Deductibles run January to December 4th Quarter Deductible Carryover on non-HSA PPO plans 5 Outpatient Rx: Anthem & Blue Shield PPO & HMO Plans
Outpatient prescription drug coverage through Express Scripts (Except HSA Plans) SISC Express Scripts Rx Plan Enhancements: Costco $0 Co-Pay Program for Generic Drugs Costco Membership is not required; Excludes some categories: narcotic pain and some cough medications Generic Co-Pays for Diabetic Supplies The generic co-payment will be charged on brand only Diabetic supplies (lancets, test strips and syringes) Maximum 30 Days Supply at Retail Pharmacies. Most pharmacies are in-network EXCEPT Walgreens 90 Days supply available with Mail-Order through Express 6 Scripts Dental & Vision Plans
Delta Dental Plan Can offer dual choice to include a Premier (Incentive) Plan and a PPO Plan All medical plan options must include same dental plan(s) Those employees enrolling in medical must enroll in dental Implants are covered benefit Vision Service Plan All medical plan options must include same vision plan All employees enrolling in medical must enroll in vision 7 Value Added Services For Members: Health Smarts- A robust Health Improvement Program Includes: Periodic on site biometric screenings and on site flu shot clinic at no charge to member or district
Most Recent Program: Awards up to $150 for participation in online health improvement program; all SISC members age 18+ eligible SISC Employee Assistance Program (EAP) Resources for Managers and Supervisors Voluntary, No cost to use EAP, Available 24 hours /7 days per week Confidential service by Licensed Professionals SISC Section 125 Plan 8 No participation fees for Employee or District Value Added Services For Districts:
No-Cost Administration Services include: COBRA Section 125 Flex Plan Self-pay Individual Retiree Direct Bill program Low Cost Administration Services Retiree Drug Subsidy (RDS) - Optional SISC has collected $7 million for districts since 2006 SISC charges $30 per member for annual application Application fees not charged until subsidy received Other Administrative Services May Be Offered Example: Early Retiree Reinsurance Program (ERRP) SISC filed for ERRP monies on behalf of member districts Funds paid as of January 2012 totaled $27.5 million (29th largest)
ERRP funds applied to offset renewal increases 9 Program Options and Eligibility Plan Choices Work with SISC to select a maximum of 6 plans for each employee group (plan options subject to underwriting approval) Benefit selections may be unique to three groups: Confidential & Management, Classified, Certificated Eligibility for domestic partners is as stated under AB205 unless the district requests that eligibility be extended to opposite sex domestic partners (a negotiated benefit)
Eligible Dependents include: legal spouse, DP; Child/Child of DP: natural child, step-child, legally adopted child to age 26; a child for whom the member has legal guardianship to age 18. Disabled overage child who is a dependent for federal income tax purposes and who has been accepted through carrier application process. 10 Participation Requirements WHO MUST ENROLL IN COVERAGE All employees who work 90% or more of the full-time equivalent for the applicable job classification are required to participate in all health benefits offered by the district WHO MAY DECLINE COVERAGE
An eligible employee who works less than 90% of the full-time equivalent for the applicable job classification or receives less than 90% of the amount that is contributed towards an eight-hour full-time employee may enroll when first eligible or decline coverage. If they enroll, they must enroll in all coverage offered through SISC. Any deviation from SISC Underwriting Guidelines must be requested in writing by the school district and approved in writing by SISC prior to joining. 11 Retirees Must enroll at initial enrollment, no re-entry once coverage terminates
May select from medical plans offered to active employees of bargaining unit from which they retired All Retirees must be enrolled in Medicare Parts A&B, otherwise costly monthly surcharges will apply. Retirees with Medicare A&B may choose instead to enroll SISC Individual Retiree Medical Plan Options All include Medicare Part D Rx with no donut hole Kaiser Permanente Senior Advantage Plan $324 Single Blue Shield Mediare Advantage Plan $354 Single Retiree must reside in Advantage Plan Service Area CompanionCare SISC Medicare Supplement $373 Single Plan is claim free when services are received from providers who accept Medicare Assignment. No residence limits. 12 Joining SISC: Timing & Action Items SISC Rates are effective October 1-September 30 Renewing districts receive 2013-14 rates by early May Districts may join SISC with a the first of the month effective date, with 60 days advance notice
Depending on effective date, initial rate period maybe short or long. Example 1: Joining SISC January 1, 2013: Rates quoted will remain in effect to September 30, 2013 Example 2: Joining SISC July 1, 2013:Rates quoted will remain in effect to September 30, 2014 SISC Underwriting will provide list of items required for quote, and quote delivery timeline. Quote delivery typically takes place after district receives KP renewal. Initial commitment is 3 years per JPA agreement Withdrawal from program written notice must be received by August 15 for October 1 effective date 13 Joining SISC: Timing & Action Items Signed SISC JPA Agreement & Bylaws, Plan choice selections will be required 60 days in advance SISC will coordinate with District and Carriers to provides Open Enrollment meetings for Active and Retiree members Required: Submission of signed, completed enrollment
forms (fillable pdf) Dependent eligibility documentation required (copies of birth & marriage certificates, DP registration forms, legal custody docs, etc.) Support available for members currently in course of care at time of transition 14 Questions? Peralta CCD Committee Members: Thank you for your interest in SISC. Lola Nickell SISC Account Manager [email protected] 661-636-4669 15
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