2018 Medical Open Enrollment for Employees
2018 Open Enrollment Letter
Summary of Benefits 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
The SBC also contains a phone number to call for questions and the website address where the uniform glossary can be found.
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
Anthem Classic PPO and Advantage PPO Provider Cost & Quality Information
This flyer will help participants compare cost and quality for medical care and prescriptions for the Anthem PPO plans.
Anthem PPO Surgical Options
When selecting providers for surgical procedures,there are two resources to assist participants with finding high quality, lowercost providers.
- Anthem marks surgery centers in search results at www.anthem.com/ca as “Blue Distinction” if they meet elevated standards for positiveoutcomes, competitive pricing, and regularly perform that surgery.
- Another option is using Carrum Health to accesseither Scripps (in San Diego) or Stanford (in the Bay Area) for certainsurgeries, including joint replacement, cardiac, lumbar, and bariatricsurgeries. These two providers were selected due to positive outcomes,experience with these particular surgeries, and excellent reputation. Because Carrum Health has negotiated a bundled pricing arrangement with the providers,the surgeries are provided at no cost to the participant. Anthem picks up theparticipant cost share and pays for travel and accommodations for the patientand an adult companion. A Carrum Health care concierge arranges all medical recordtransfer, before and after the surgery, pre-op and post-op appointments, andarranges travel paid in advance. This benefit must be accessed directly throughCarrum Health. Call 1-888-855-7806 for more information. Carrum Health Information
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).