Fully Paid Health Benefits Will Continue for Members at LAUSD; Some Medical Plan Changes in 2010

Fully Paid Health Benefits Will Continue for Members at LAUSD; Some Medical Plan Changes in 2010

The Health Benefits Committee, which includes SEIU Local 99 and other unions at LAUSD, negotiates our benefits and works with the District and health insurance vendors to design the health plans. The SEIU Local 99 Bargaining Team does not negotiate our health benefits.

Despite the skyrocketing cost of health insurance, the Committee was able to maintain a majority of our benefit levels. The Committee saved us from having to pay monthly fees for health care benefits. To maintain our benefit levels, some changes to health plans were necessary.

The 2010 Open Enrollment booklet will feature the details of each plan. The booklet is scheduled to arrive in your home around November 1. Please review the plan options carefully and make a selection. If you neglect to respond, you could be placed in a plan you don’t want.

Open Enrollment Begins Sunday, November 1, 2009 and Closes Sunday, November 22, 2009. If you have any questions please contact SEIU Local 99's Member Resource Center at 213-637-0296.

What Did Not Change:
Benefits are still fully paid by the District.
Dental benefits and vendors stay the same.
Vision benefits and vendors stay the same.
Life insurance and vendors stay the same.

Summary of Health Benefits Changes for 2010:

Medical Coverage Opt-Out:
The payment for active District employees who want to opt-out of medical coverage will be increased from $1000 to $3000. Employees who opt-out of medical coverage will still be eligible to enroll in dental and vision coverage. If you choose this option, you will be paid in installments in your monthly paycheck.
Anthem Blue Cross HMO:The network of providers in the Anthem Blue Cross HMO has been reduced and the plan is now called “Anthem Select Network HMO.” Some medical groups previously under this plan will no longer participate, including UCLA and Cedars Sinai. There will be no change to the co-payment and deductible amounts under the Anthem Select Network HMO when compared to the current Anthem HMO, except for prescriptions. All current Anthem Blue Cross HMO recipients will be assigned to the HMO Select Plan.

Anthem Blue Cross HMO Plus, Anthem Blue Cross PPO, and the Anthem Blue Cross Fee for Service plans:These plans have been eliminated and replaced with a new Anthem Exclusive Provider Organization (EPO) Plan. This plan is similar to a PPO plan except that no out of network benefits are provided. You must use an Anthem Blue Cross network provider within the US to receive benefits. UCLA & Cedars Sinai medical groups are included in this plan. Out of state recipients will be assigned to the EPO. All HMO Plus, PPO and Fee for Service plan recipents under age 65 will be assigned to Anthem HMO Select.

Kaiser HMO and HealthNet HMO Plans: There will be higher co-pays, deductibles, and co-insurance requirements for both the Kaiser and HealthNet HMO plans. The UCLA and Cedars Sinai medical groups are included in the HealthNet HMO network. Everyone currently enrolled in the Kaiser or HealthNet HMO plans will automatically be assigned to their respective plans.

New/Newly Eligible Employees: Kaiser HMO Plan and the new Anthem Exclusive Provider Organization (EPO) Plan will not be available to newly eligible employees until they have been employed at the District for at least three years. Kaiser HMO will be available to newly eligible employees only if the employee was previously enrolled in Kaiser immediately prior to being hired by the District.

MetLife Affiliated Dental Health Care Service Plan (SafeGuard DHMO), MetLife Preferred Dentist Program (PPO), and Western Dental DHMO: These plans have not changed.

EyeMed Vision and VSP:These plans have not changed.

Revised Co-Pays
HealthNet HMO Plan:Doctor Visit: $20 per visit
ER Visit: $100 per visit if not admitted
Prescriptions:
In Store (30 day supply)
Generic: $5       Preferred Brands: $25     Non-Preferred Brands: $45
Via Mail: (100 day supply)
Generic $10   Preferred Brands $50   Non-Preferred Brands $90

Anthem Select Network HMO Plan:Doctor Visit: No Change, $10
ER Visit: No Change, $50 if not admitted
Prescriptions:
In Store: (34 day supply)
Generic: $5 Preferred Brands $25 Non-Preferred Brands $45
Via Mail: (100 day supply)
Generic $10   Preferred Brands $50   Non-Preferred Brands $90

Anthem Exclusive Provider Organization Plan:Doctor’s Visit: 20% of charge
ER Visit: $100 deductible if not admitted
Prescriptions:
In Store: (34 day supply)
Generic $10 Preferred Brands $30 Non-Preferred Brands $50
Via Mail: (100 day supply)
Generic $20    Preferred Brands $60      Non-Preferred Brands $100
Kaiser HMO Plan:Doctor Visit: $20 per visit
ER Visit: $100 per visit if not admitted
Prescriptions:
In Store: (30 day supply)
Generic $5 Preferred Brands $25
Via Mail: (100 day supply)
Generic $10   Preferred Brands $50

For a flyer with the above information, click here.

For a flyer with information about changes to RETIREE HEALTH BENEFITS, click here.