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Insurance Information

Health Insurance Open Enrollment 

 

Open Enrollment: May 25, 2023–August 16, 2023

All changes will take effect October 1, 2023

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.   All  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 16, 2023.  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/or vision insurance coverage will go into effect on October 1, 2023.

 

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 Dana Garibay, [email protected] to schedule an appointment.

                    

Please do not wait until the last minute.  

 

All changes and forms must be received at the District Office by August 16, 2023

 

 

NO CHANGES?   If you are not making changes, 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 2023-2024 Employee Benefit Selection Form for new premium and contribution amounts. The good news is there is a decrease cost of Dental or Vision insurance.    
 
  • NEW! Effective 4/1/2023 Eden Health becomes available to SISC Anthem and Blue Shield PPO members. This added value benefit expands access to Primary Care Physicians through a smart phone application. Members enrolled on an HSA plan are not eligible for Eden Health.
  • Effective 10/1/2023, MDLive visits will have a $10 co-pay. HSA members will continue to pay the full cost of the visit until their deductible is met.
  • Effective 1/1/2024, Hinge and Vida will no longer be available to SISC HSA members.
  • Effective 5/11/2023. The Federal Public Health Emergency is ending. At that time, the SISC PPO plans are reverting to standard plan benefits for COVID testing and vaccinations.

Covid‐19 testing will no longer be covered out of network.

Covid‐19 testing will be subject to standard plan cost sharing.

Over‐the‐counter Covid‐19 tests will no longer be covered.

Covid‐19 Vaccinations will only be covered in‐network.

Consolidated Appropriations Act 2021, RxDC Reporting

The Center

 

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

  • A Certificate of Registered Domestic Partnership issued by the State of California or a certified copy of the Declaration of Domestic Partnership that includes the dated, signed Secretary of State Certification Stamp. (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 under the employee / retiree's Plan. There can be no break in coverage. 
  • Completed Disabled Dependent Enrollment Application • Most recent Kaiser Certification notice (if available)

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. 

 

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).  (Enrollment in Medicade allows opt out of 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.  The WABE rate for the 23-24 school year (Eff. 10/1; September payroll deduction) wil lbe $613.00
 

WABE enrollment provides other benefits pertaining to SISC members and include the following member services for the 2023-2024 plan year:
 24/7 Physician Line (MDLive)
 Employee Assistance Program—EAP (Anthem
Blue Cross)
 Expert Medical Opinions (Teladoc Medical Experts)
 Biometric Screenings (when offered by district)

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

 

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.

  

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.  There will be a virtual meeting with a representative from American Fidelity on August 29th and 30th.  You will also be able to update or establish your disability plans at that time.    American Fidelity will be sending out instructions on setting up appointments in the beginning of August.   
SISC Added Value Programs