IMPORTANT INFORMATION AND CONTACT NUMBERS FOR BENEFIT PLAN OPTIONS A, B AND C

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1 FRESNO UNIFIED SCHOOL DISTRICT EMPLOYEE HEALTH CARE PLAN PLAN BOOKLET IMPORTANT INFORMATION AND CONTACT NUMBERS SECTION Page numbers referenced in this document reflect page numbers in the Plan Booklet

2 IMPORTANT INFORMATION AND CONTACT NUMBERS FOR BENEFIT PLAN OPTIONS A, B AND C Binding the Plan: As a courtesy to you, the Benefits Administrator (Delta Health Systems) and the Fresno Unified School District s Benefit Department may respond informally to oral questions. However, oral information and answers are not binding upon the Fresno Unified School District Employee Health Care Plan and cannot be relied on in any dispute concerning your benefits. Binding information may be obtained only through written request to Delta Health Systems (Benefits Administrator). The Benefits Administrator, the full JHMB Board of Directors, the District s Benefit Department, and any Claim Administrator retain full discretionary authority to: (a) determine all facts relevant to any claim; (b) to construe the terms of the Plan and all other documents relevant to the Plan; and (c) to determine which benefits are payable from the Plan. Plan Options referenced below mean: Plan A (Standard Plan), or Plan B (Alternate Plan), or Plan C (Kaiser Permanente Plan) which are compared on Insert I in the back of this booklet. If you have Questions about: Initial Enrollment Employee Contributions Termination of Benefits Continuation of Coverage (COBRA and Ed Code 7000) Life Insurance Flexible Spending Account information ALL Medical Plan Options A, B and C: Eligibility Anthem Blue Cross Medical Plan ID Cards Anthem Blue Cross Medical Plan Receive Pre-Authorization Find Network providers Prescription Benefits Plan Options A and B: Retail Mail Order Specialty Pharmacy EnvisionRx Plus Plan Contact Name and Telephone Number District s Benefit Department Delta Health Systems (Benefits Administrator) Delta Health Systems (Benefits Administrator) Anthem Blue Cross (for California Residents) Pre-Authorization or Case Management Delta TeamCare (for non-california Residents) Pre-Authorization or Case Management EnvisionRx Options Help Desk Orchard Pharmaceuticals Costco Specialty Pharmacy EnvisionRx Plus Web Site Go to Quick Links. Click on Department Directory, locate Benefits Department and click on the website link iii

3 If you have Questions about: Kaiser Permanente Medical Plan Option C (including Prescription Drug, Behavioral Health and Vision Benefits) ID Cards Preventive Care Benefits under the Patient Protection and Affordable Care Act ALL Medical Plan Options A, B and C Employee Assistance Program (EAP) Plan ALL Medical Plan Options A, B and C Behavioral Health Benefits Plan Chiropractic Benefits ALL Medical Plan Options A, B and C: Dental Benefits ALL Medical Plan Options Pre-Treatment Review Vision Benefits Plan Options A and B Kaiser Permanente Contact Name and Telephone Number U.S. Preventive Services Task Force Recommendations Claremont EAP Avante Health ChiroMetrics Delta Dental PPO Plan Pacific Union Dental Napa Plan Vision Service Plan Safeguard Vision Plan Web Site Must register to obtain benefit information, make appointments, view lab results, order Prescription refills, etc. Regulations: tions/prevention/regs.html Overview: s/preventive/index.html HealthConnect website: HealthConnect is the communication publication and website of the Fresno Unified School District s Joint Health Management Board (JHMB). You can access this Plan Booklet online, including past issues of Employee communications, HealthConnect newsletters, and other information regarding the Plan s benefits. You may send feedback about HealthConnect to jhmbhealthconnect@yahoo.com, or contact your JHMB Board Members listed at Go to Staying Connected. Click on JHMB info, and then JHMB Members. iv

4 12. If You Have Questions Questions concerning the Plan or your COBRA coverage rights can be answered by the District s Benefit Department at (559) For more information about your rights under COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the U.S. Department of Labor s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s website.) 77

5 BENEFITS ADMINISTRATOR Delta Health Systems 3244 Brookside Road 2 nd Floor Stockton, California Phone: (800) District s Benefit Department 2309 Tulare Street Fresno, California Phone: (559)