2020 Open Enrollment Employee - Medical & Dental

Open Enrollment Memo

Employee Memo

Medical Plans - Summary of Benefits Coverage & Plan Summaries

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.

Kaiser Permanente

Anthem Blue Cross   

Benefit Summaries

Some find these benefit summaries more reader friendly than the Summary of Benefits Coverage.  These are provided for your reference:

Anthem Informational Flyers

Anthem LiveHealth Online will provide online doctor visits at no cost. Anthem PPO participants continue to have this benefit at no cost. Anyone who is not an Anthem participant may access this benefit for $49 per visit. LiveHealth Online

Carrum Health (PPO Only) is a special surgery benefit that provides exclusive access to “Centers of Excellence”. These facilities and doctors provide for an improved patient experience, high quality of care, and zero or minimal out-of-pocket costs. Carrum Health - No Cost Surgery Benefit

With the Anthem Anywhere App, you can easily manage your benefits anytime, anywhere. Mobile App

Use online Find a Doctotool to look for doctors, hospitals, labs and other health care providers in your Anthem Blue Cross plan. Check if your favorite doctor is part of your plan, or look for one near you. Avoid getting care from doctors outside of your plan if you can — it will cost you more or your plan may not cover it all. Find a Doctor

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).

Dental Plan - Premier Access 

A description of Class I, II and III dental benefits and plan information is available here for your reference. Schedule of Dental Benefits

Effective Date of Coverage for Newborn Children

Coverage for a child born will be effective on any first of the month date between the date of the birth and the child’s 3rd birthday. In order for coverage to be effective, you must submit a written enrollment application to Human Resources. The enrollment application must be signed and returned no later than the child’s 3rd birthday. If the enrollment application is not signed and received within these guidelines, your child will be considered a “Late Enrollee” and will be enrolled effective the first of the month during which the enrollment application is received.

Employee & Board of Director Medical Rates

Employee Rates

Board of Directors' Dental Rates

Board Dental Rates

Enrollment Forms

Medical Form

Dental Form

Required Annual Notices

Required Annual Notices