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Insurance Information

Health Insurance Open Enrollment 

 

Open Enrollment: May 27, 2021–August 13, 2021

All changes will take effect October 1, 2021

Each Summer, Keyes Union School District conducts an annual Open Enrollment. This is an important time because it is the only time during the year you may change your benefit elections and/or add or delete family members from benefit coverage without documenting a qualifying event.

 

This open enrollment period affects Medical, Dental, and Vision insurance.   This Year VSP is requiring new enrollment forms for all existing members or they will be dropped.  All other plans will automatically renew in your current plan, at the new rate, unless you elect to make a change by the deadline. 

 

Any and all changes will need to be made prior to the close of Open Enrollment on August 13, 2021.  If your elections and changes result in altered payroll deductions, you will find them reflected on your September 30 pay warrant.

 

Your new/changed medical, dental and vision insurance coverage will go into effect on October 1, 2021.

 

For further insurance information including rate changes and coverage please click the corresponding links on this page.  

 

If you would like to discuss plan options and/or need assistance please contact Elizabeth Smiraglia to schedule an appointment at esmiraglia@keyes.k12.ca.us

                    

Please do not wait until the last minute.  

 

All changes and forms must be received at the District Office by August 13, 2021

 

 

NO CHANGES?  If you are enrolled in VSP Vision Plan you will need to complete a new enrollment form.  If not you don't need to do anything.  Your plans will automatically renew at the new rate. 

 

COST: 
All Medical plans had an increase in cost which will be reflected in September payroll. Please see the Employee Benefit Selection Form for new premium and contribution amounts.  There was a 3.5% decrease to Dental and a 2.5% increase to Vision cost.   
 
Waiver of Anchor Bronze Enrollment. (WABE): 
This “OPT OUT” option is available to Full Time employees hired after January 01, 2012 who have other group medical coverage. This option was added with the intent to reduce issues with coordination of benefits due to duel coverage primary insurance It is important to understand you will not be enrolled in a health plan and will pay the premium cost.  WABE is currently $627.00 per month.  Please complete the WABE enrollment form to enroll in WABE and the Blue Shield Enrollment Form.  
 

 SISC Value Added Services:

  • SISC Expert Medical Opinion: Service, SISC has obtained Advance Medical for this program. Members will have unlimited concierge access to a specialist as an additional benefit at no cost to the employee.  Visit:  http://advance-medical.net/sisc/
  •  SISC Employee Assistance Program:  All SISC Members may access free resources if they need help with personal concerns.—emotional, marital, financial, interpersonal, addiction and recovery, legal, stress and more.    Phone 800-999-7222 or access via the internet at anthemeap.com Login Company Code: SISC  See Flyer  MYStrength: is a smart phone application that provides free emotional health and wellness tools to all employees and household memebers. Memeber may download MYStrengeth to their smart phone and call EAP at 1-800-999-7222 for an assigned acess code.
  •  MDLIVE: includes behavioral health therapy and psychiatrist visits.  MDLive provides members with on-demand access to board certified physicians by phone, online video or secure email for a $5.00 co-pay. (In order to remain IRS compliant MDLive visits became subject to the deductible on the HSA plans.  The full cost of a medical visit is $40.00 and is applied to the member’s deductible.) This does not affect any other SISC plan. This feature is currently available to all SISC Blue Shield members. See Flyer
  • Solera4me Diabetes Prevention Program for Blue Shield HMO and PPO members. It is a 16-week cutting edge program that can help members with prediabetes lose weight, adopt healthy habits and significantly reduce their risk of developing diabetes.  It is available at no cost to members that qualify.  For more information visit solera4me.com
  •  Carrum Health NO Cost Hip, Knee, and Spine Surgical options: Blue Shield PPO members get access to top quality surgeons at Scripps with no out-of-pocket cost. All medical bills, including travel expenses are covered.  Call 1-888-855-7806
  •  Discounted Gym Memberships: Choose from over 9,000 participating fitness centers and YMCA’s for a much lower cost than you would pay on your own. You pay $25.00 a month Use the online fitness tracking feature which uses a variety of wearable devices and apps.
  • Vida Digital Health Coaching and Therapy: Vida offers members access to a virtual care platform that treats a full range of lifestyle, chronic and behavioral health conditions. SISC members experienced a nearly 50% decrease in anxiety and depression after 3 months of engagement in the program. Blue Shield and Anthem PPO and HMO Members (active and <65 groups) will have access to a health coach and/or therapist at no charge. Per IRS guidelines, this benefits subject to deductible for HSA members. Members should visit: www.vida.com/sisc  
  • Oncology Center of Excellence Program: SISC partnered with Contigo Health (formerly Health Design Plus) to provide SISC PPO plans with an enhanced cancer benefit. This enhanced benefit provides members facing a cancer diagnosis with the opportunity to have an in‐person or virtual comprehensive consultation at City of Hope at no cost. Participating members receive:
     Evaluation at City of Hope with confirmation of cancer diagnosis
     Access to a personal care nurse to coordinate care
     Clinical trial and genetic risk education
     Transition of care and collaboration with home oncologist for one year post‐evaluation
    Per IRS guidelines, this benefit is subject to deductible for HSA members. Website: SISC.contigohealth.com
  • Hinge Health: SISC PPO members have free access to Hinge’s program which provides eligible members with wearable sensors and a monitoring device to guide them through virtual therapy sessions from home. Hinge also provides unlimited access to a personal health coach, links to educational articles, and information regarding available treatment options. New digital physical therapy options will be available soon through this program. SISC Hinge Health district toolkit: www.hingehealth.com/sisctoolkit .
    Since inception, over 6,400 SISC members have actively engaged in five or more virtual therapy sessions with Hinge Health. SISC members reported a 50% decrease in pain after 3 months of engagement in the program.
  • Kaiser Permanente Telemedicine: Kaiser Permanente members have access to remote healthcare. For primary care, specialty care, and mental health services, KP member can connect with their care team from the comfort and safety of their homes. Kaiser members can access telehealth by signing in to kp.org. 
  • Calm Meditation and Mindfulness App All SISC Kaiser Permanente Members have free access to the highly acclaimed Calm meditation and mindfulness smart phone application. KP members can get access to Calm at kp.org/selfcareapps.  

Please be sure you submit the following: 

  • Benefit Selection Form or WABE Form indicating all your enrollment choices for the new plan year.
  • Complete the corresponding Insurance Company enrollment form.  (Blue Shield, Kaiser, Delta Dental, VSP)   
  • Required proof of eligibility for Dependents  (Click Adding Dependents Link below.)

To add your spouse or child, please complete the Blue Shield Membership Change form or Kaiser Enrollment form as appropriate.  Attach the required proof of eligibility as required on the chart below.

 

DEPENDENT ELIGIBILITY DOCUMENTATION

The following verification documents are required to enroll a dependent in health benefit plans. SISC requires the Social Security Numbers for all dependents to be covered on the plans and reserves the right to request additional documentation to substantiate eligibility.

Spouse

  • Prior year’s Federal Tax Form that shows the couple was married (financial information may be blocked out).
  • For newly married couples where prior year tax return is not available a marriage certificate will be accepted.

 

Domestic Partner

  • Certificate of Registered Domestic Partnership issued by State of California (AB 205 Compliant)
  • SISC Affidavit of Domestic Partnership (when applicable) (Enrolling a Domestic Partner may cause the employer contribution to become taxable)

 

Children, Stepchildren, and/or Adopted Children up to age 26

  • Legal Birth Certificate or Hospital Birth Certificate (to include full name of child, parent(s) name, and child’s DOB)
  • Legal Adoption Documentation Legal Guardianship up to age 18
  • Legal Court Documentation establishing Guardianship

 

Disabled Dependents over age 26

Blue Shield (All items listed below are required)

  • Legal Birth Certificate or Hospital Birth Certificate (to include full name of child, parent(s) name and child’s DOB)
  • Prior year’s Federal Tax Form that shows child is claimed as an IRS dependent (income information may be blocked out)
  • Proof of 6 months prior creditable coverage
  • Completed Declaration of Disability for Overage Dependent Child

Kaiser (All items listed below are required)

  • Legal Birth Certificate or Hospital Birth Certificate (to include full name of child, parent(s) name and child’s DOB)
  • Prior year’s Federal Tax Form that shows child is claimed as an IRS dependent (income information may be blocked out)
  • Proof of 6 months prior creditable coverage
  • Completed Disabled Dependent Enrollment Application • Most recent Kaiser Certification notice (if available)

If you receive the full District Contribution (benefit cap) towards your insurance, you must enroll in a medical plan unless you OPT OUT of medical insurance by choosing the Waiver of Anchor Bronze Plan Enrollment (WABE). 

You must be covered through another group health plan and do not wish to enroll in the SISC medical plan.  However, you will still be required to pay a premium associated with this option.  Currently $627.00 per month.

 

SISC health benefits program requires 100% participation of all full time employees and employees who receive the full district contribution towards their benefits if they are hired after January 01, 2012.  Selecting this option allows you to maintain your membership in SISC as a full time employee without enrollment in a SISC medical plan.

 

If you select this option, the election is made for the entire plan year.  You and your eligible dependents will not be allowed to enroll in a SISC plan until the next Open Enrollment Period or as the result of a qualifying event:

 

  • Loss of Coverage: You may enroll yourself or your dependents provided you notify the district and provide supporting documentation within 30 calendar days of loss of coverage.   Effective April 1, 2009, loss of coverage under a Medicaid plan, loss of coverage under Children’s Health Insurance Program (CHIP) or eligibility to participate in a premium assistance program under Medicaid or CHIP gives rise to special enrollment rights. You must notify the district within 60 calendar days of loss of coverage or becoming eligible for premium assistance. You must submit a completed and signed enrollment form along with evidence of the loss of coverage.

 

  • New Dependent: If you have a new dependent as the result of marriage, birth, adoption, placement for adoption, or placed in your home as a result of court ordered custody or guardianship, you may enroll yourself and your dependents, provided you request enrollment within 30 calendar days following the date of this event.  Again, you must submit a completed and signed enrollment with supporting documentation of the event.

 

WABE enrollment provides other benefits pertaining to SISC members and include the following member services for the 2021-2022 plan year

        • MDlive – 24/7 physician line
        • EAP – Employee Assistance Program
        • Advance Medical – Expert Medical Opinion
        • Biometric Screenings

To elect WABE please complete the WABE Enrollment Form and the Blue Shield Enrollment Form. 

  

You may OPT OUT of insurance through KUSD if you are

  • A Part Time Employee
  • If you are a Full Time Employee and have other group coverage.

 

Reporting laws require a “Declination of Insurance” form for every employee who is opting out.  Please complete the SISC Declination Form and provide “Proof of Other Coverage.”

You must re-enroll each year for the Flex Plan.  A representative from American Fidelity will be at each site to help you after the start of the school year.  Please watch for further information for dates and times.