Medical Plan Information
ACWA JPIA Retiree Enrollment Guidelines
The District is required to offer retiree medical coverage that meets the requirements and guidelines established by ACWA JPIA and the insurance carriers.
Summary of Benefits Coverage
What is the Summary of Benefits and Coverage?
Under the Affordable Care Act (ACA), health insurers and employer groups must provide a summary of benefits and coverage (SBC) to participants and beneficiaries (generally employees and dependents). SBCs must follow standards set forth by the federal agencies. The SBC helps eligible employees and dependents understand their benefits and coverage by using simple language in a consistent format.
The SBC includes brief summaries of:
- Covered services
- Examples of coverage
- Appeals and grievance rights
- Exceptions and limitations
- Cost-sharing provisions, including any deductible, coinsurance, and co-payments
- Continuation coverage
Anthem Blue Cross
Some find these plan summaries more reader friendly than the Summary of Benefits Coverage.
These are provided for your reference:
- Kaiser Traditional HMO
- Kaiser Traditional HMO Retired w/Medicare
- Anthem Advantage PPO
- Anthem Advantage PPO Retired w/Medicare
- Anthem Classic PPO
- Anthem Classic PPO Retired w/Medicare
- Anthem CalCare HMO
- Anthem CalCare HMO Retired w/Medicare
- Anthem Value HMO
- Anthem Value HMO Retired w/Medicare
Proof of Eligible Dependent Status
ACWA JPIA requires the District to guarantee every dependent enrolled in a medical plan is an eligible dependent. The District must show proof of eligibility for each dependent you enroll. Commonly submitted documents are marriage certificates (spouse); birth certificates (child) and court orders (child).
For every dependent you are enrolling, you must submit a copy of the verification document with your medical enrollment form. If you cannot locate the documents, request from the county registrar’s office for where each event occurred (marriage or birth).
Nationwide Access through Anthem Blue Cross PPO’s BlueCard Network
If you or your spouse is enrolled in a Medicare plan and the other is enrolled in Non-Medicare, please refer to the Mixed Medicare rates.