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This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official
plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a
complete list of exclusion and limitations, please refer to each carrier’s EOC. The EOC’s are available on the District Website under
“Employee Benefits.” www.leusd.k12.ca.us
2016-17Employee Benefits Booklet
Confidential Management/Admin.
Lake Elsinore Unified School District
This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official
plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a
complete list of exclusion and limitations, please refer to each carrier’s EOC. The EOC’s are available on the District Website under
“Employee Benefits.” www.leusd.k12.ca.us
Benefits Eligibility
Employee Eligibility In general, you are eligible for medical, dental, vision, and life insurance benefits if you
are:
A probationary or permanent employee; and
You work 20 hours or more per week in your regular assignment.
If you are a represented employee, we encourage you to review your collective
bargaining agreement (CBA) each year to verify your specific eligibility requirements.
Dependent Eligibility If you enroll yourself in District benefits, you can also enroll your eligible dependents.
You must provide appropriate proof of the dependent relationship when you enroll your
dependent (see below). You must enroll yourself and your dependents within 30 days
of becoming eligible for District benefits. You may enroll eligible dependents at the
same time you enroll yourself.
Eligible dependents include:
Your legal spouse as defined by state law. (Required documentation: a
marriage certificate & current IRS 1040)
Your California-registered domestic partner subject to AB 205. A California-
registered domestic partner is the same gender as you or may be opposite-gender
only if at least one partner is over age 62. (Required documentation: a certified
copy of the Declaration of Domestic Partnership filed with the Secretary of State.)
Domestic Partner not subject to AB 205: Signed notarized SISC affidavit
A natural child or step-child from birth to age 26; a legally adopted child or a
child who is in the process of being adopted; a child for whom the member has
legal and physical custody/guardianship. A child who is in the process of being
adopted is considered legally adopted when SISC receives legal evidence of (i)
the intent to adopt; and (ii) the member has either: (a) the right to control the
health care of the child; or (b) assumed a legal obligation for full or partial
financial responsibility for the child in anticipation of the child’s adoption. Proof
of eligibility will be required when adding a new dependent for an existing
employee and at the time of hire for a new employee. Failure to submit
supporting documentation within 30 calendar days of the qualifying event may
result in the child or child of a domestic partner being denied coverage.
Disabled Dependent: A disabled dependent may be eligible to continue
coverage beyond age 26 if unmarried and a dependent for Federal Income Tax
purposes (proof required); the member must request a Disabled Dependent
Certification form within 30 days of the loss of coverage. The completed and
signed form must then be reviewed and approved by the carrier’s Medical Review
board.
This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official
plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a
complete list of exclusion and limitations, please refer to each carrier’s EOC. The EOC’s are available on the District Website under
“Employee Benefits.” www.leusd.k12.ca.us
Who must enroll in coverage: All employees who work 90% or more of the
full-time equivalent for the applicable job classification are required to participate
in all health benefits offered by the district. If the district has a three-tier rate
structure, dependent coverage is optional for those products. An eligible
employee who works less than the 90% may enroll when first eligible or decline
coverage.
Your Cost for Benefits If you are eligible for District benefits, there is a CAP that is contributed by the District
according to your CBA. This information is available later in this summary. If you are a
part time employee, the percentage of the CAP will be calculated according to your
assigned hours per day and months per year. The deductions are monthly according to
your number of paychecks per year.
When to Enroll The District’s plans are effective October 1 through September 30. You must enroll
yourself and your dependents within 30 days of becoming eligible for District
benefits. You may enroll eligible dependents at the same time you enroll yourself.
You are allowed to enroll in benefits and make changes to your benefits only:
When you are initially eligible;
During the annual Open Enrollment period; or
If you experience a qualifying status change.
****If you do not come in within the 30 days, you will automatically be enrolled in
the Bronze Tiered PPO Plan (Affordable Care Act) by the Safety/Risk Department.
The Bronze Tier plan payment will come in under the District contribution amount.
Enrolling When you are First Eligible You must enroll yourself and your dependents within 30 days of becoming eligible
for District benefits. You may enroll eligible dependents at the same time you enroll
yourself.
Please note: Employees with a hire date from the 1st thru the 15th of the month, benefits
will be effective on the first day of the following month (i.e. DOH-January 10th, benefits
will be effective February 1st). Employees hired after the 15th, benefits will not be
effective for up to 45 calendar days (i.e. DOH-January 16th, benefits will be effective
March 1st).
Making Changes During Open Enrollment Once you have enrolled in benefits, you generally are not allowed to make changes until
the next annual Open Enrollment. Open Enrollment is your one chance each year to
review your coverage and make changes to your benefits. It is also your chance to enroll
if you declined coverage when you first became eligible.
This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official
plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a
complete list of exclusion and limitations, please refer to each carrier’s EOC. The EOC’s are available on the District Website under
“Employee Benefits.” www.leusd.k12.ca.us
Open Enrollment is usually about August 1st to August 26th, and any changes made
during this period take effect October 1st.
Making Changes During the Year
Other than during Open Enrollment, you can make changes to your benefits during the
year only if you experience a qualifying status change. Any changes must be made
within 30 days of the qualifying status change. A qualifying status change might
include:
A change in family status, such as marriage or registration of a domestic
partnership, the birth or adoption of a child, divorce or dissolution of a domestic
partnership, or the death of a dependent. You must provide the benefit department
with proof of the event (such as a marriage certificate, birth certificate, death
certificate, divorce order, or court order.)
The loss of existing coverage for you and/or your eligible dependents (for
example, the termination of coverage that was provided through your spouse’s
employer). Please provide proof of loss with date and names.
A qualified court or administrative order that requires you to provide coverage
for an eligible dependent.
Any benefit changes must be consistent with the qualifying status change. Provided you
make changes within 30 days of the event, the change will take effect on the date of the
event for a birth, adoption, or placement for adoption; changes you make as a result of
other qualifying status changes will take effect the first day of the month after you submit
the appropriate documentation to Safety & Risk Services department.
SISC: IRS 125 Plan
*Flexible Spending Accounts
As part of the Section 125 Plan these benefits are available on a pre-tax basis for your
school district (Unreimbursed Medical and Dependent Daycare expense reimbursement
accounts). A Section 125 Plan allows you to select from a list of eligible benefits that
will meet your needs. The benefits that you choose are then paid for by you on a before-
tax basis. Salary reduction means that you are able to use "pre-tax" dollars to pay for
certain benefits that you may have previously paid for with "after-tax" dollars.
Voluntary Plans Available: American Fidelity (866) 523-1857 Aflac : Agent Mary Isaacs (951)264-2100
*Disability Insurance
A Disability Income Insurance Plan can provide a portion of your income during your
covered Accident or Sickness. SB-22577-0209 (LEUSD employees do NOT pay into
SDI: State Disability Insurance)
*Accident Insurance*Cancer Insurance*Life Insurance
This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official
plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a
complete list of exclusion and limitations, please refer to each carrier’s EOC. The EOC’s are available on the District Website under
“Employee Benefits.” www.leusd.k12.ca.us
An Overview of Your Benefits
The District offers you and your eligible dependents a comprehensive selection of health
and welfare benefits.
Your medical benefits are designed to help maintain the wellness and health of you and
your family. The District offers two types of medical plan options: HMO and PPO.
With the HMO options, you must receive care from providers in the plan’s network; the
plan won’t pay any benefits for care received outside the network except in an
emergency. With the PPO plan, you have the flexibility to receive care from any
provider; however, the plan will pay a higher level of benefits when you receive care
from a provider who participates in the plan’s network. Keep in mind that certain
benefits in each plan may vary, depending on your bargaining unit.
Health Care Benefits
The District offers six medical plans per classification: 1. Option 1: Anthem PPO with a deductible of $500 per individual up to
$1000 per family- 80%-$30 OV-RX $10/$35/$200 ded.
2. Option 2: Anthem PPO with a deductible of $200 per individual up to$500 per family- 90%-$30 OV-RX $10/$35/$200 ded.
3. Option 3: Anthem PPO with a deductible of $300 per individual up to
$600 per family- 100%-$20 OV-RX $9/$35.4. Option 4: Bronze Tiered Plan-PPO with a deductible of $5000, only
employee + child(ren) is eligible.
5. Option 5: Anthem HMO Priority Select: office copay of $20.
6. Option 6: Anthem HMO: office copay of $20.7. Option 7: Kaiser HMO: office copay of $30 (Rx $10/$30)
The District offers your choice of two dental plans and one vision plan.
1. Delta Dental Incentive Plan (PPO)
2. Delta Dental Preferred Option (PPO) Plan
3. Vision Service Plan (VSP)
Flexible Spending Accounts (FSAs): FSAs give you the option to set
aside pre-tax funds to pay for certain eligible health care and dependent
care expenses. Information is available on the District website
(Employee Benefits) under “SISC Flex Plan”.
Group Life and AD & D: The District provides all benefit eligible
employees with life and AD & D (accidental death & dismemberment) to
help provide financial protection. Voluntary supplemental coverage is
available to employees at an additional cost.
This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official
plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a
complete list of exclusion and limitations, please refer to each carrier’s EOC. The EOC’s are available on the District Website under
“Employee Benefits.” www.leusd.k12.ca.us
Important Information About Your Benefits
This section includes some important notices about your right and responsibilities as a
participant in the District’s plans. If you have any additional questions about this
information, feel free to contact the Safety & Risk Services department at (951) 253-
7000, ext. 5380.
Important Notice About Your Rights and Benefits Under Each Plan This booklet is intended to provide only highlights of your benefits; it is not an Evidence
of Coverage (EOC) plan document. Official plan and insurance documents govern your
rights and benefits under each plan. For more details about your benefits, including a
complete list of exclusions and limitations, please refer to each carrier’s EOC. A copy of
the EOC can be obtained from the Lake Elsinore Unified School District website:
www.leusd.k12.ca.us.
Notice of Health Insurance Portability and
Accountability Act of 1996 (HIPAA) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal
law that affects your rights to obtain health benefits and to safeguard your privacy
regarding Protected Health Information (PHI). Specifically, HIPAA includes, but is not
limited to, the following:
Limitations on pre-existing condition exclusions;
Prohibitions against discriminating against individual participants and
beneficiaries based on health status;
Special enrollment periods under certain conditions for qualified individuals; or
Privacy standards
COBRA Rights Once an employee and/or dependent lose coverage, SISC prepares and mails the
COBRA 14-day notification to the qualified beneficiary’s last known address. It
includes information and rates on all of the products the qualified beneficiary is enrolled
in through SISC immediately preceding the qualifying event (loss of coverage).
How to Enroll Go to:
1. www.leusd.k12.ca.us
2. Click “Employee Resources”-"Staff"3. Click “Employee Benefits”
4. Click “Confidential Management/Admin Health Insurance”
5. Review all topics, summaries and plans and once your choice is made:
6. Complete the proper enrollment forms and bring to Safety & Risk with proper
documentation for spouse, dependents or opting out of medical.
An
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Off
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Off
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Ad
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Pla
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Co
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2016-2
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An
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10
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Maxim
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Pays
Mem
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Mem
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Pays
Mem
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Pays
Mem
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Pays
Mem
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Pays
Indiv
idual/F
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ily D
eductible
s
$300/
$600
$200/
$500
$500/
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00
$0/$
0$0
$5,0
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$10,0
00*
Indiv
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of-
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$1,0
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$4,0
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$1,5
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*
Inclu
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PR
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NA
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ER
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Off
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ay
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$30
$20
$30
$60 v
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then 3
0%
aft
er
ded
Urg
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Care
co-p
ay
$20
$30
$30
$20
$30
$60 v
isits 1
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then 3
0%
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er
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Specia
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/Consultants
co-p
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$20
$30
$30
$20
$30
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then 3
0%
aft
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Pre
nata
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ostn
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$20
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0%
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Scans:
CT
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AT
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Dia
gnostic X
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0%
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Infe
rtili
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$100 c
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20%
$100 c
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$100
$100
30%
$100 c
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0%
10%
20%
$200/a
dm
it$0
30%
Outp
atient
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0%
10%
20%
$100/a
dm
it$30
30%
Surg
ery
, O
utp
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(pe
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rme
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Su
rge
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$100
$30
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Surg
ery
, O
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atient
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10%
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$100
$30
30%
10
0-D
$2
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-C $
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80
-G $
30
Pre
mie
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Tra
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MO
$3
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nch
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NT
AL
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AL
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INP
AT
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Facili
ty B
ased C
are
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rea
uth
re
qu
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0%
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$0
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OU
TP
AT
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Facili
ty B
ased C
are
(p
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uth
re
qu
ire
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10%
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$30
30%
OT
HE
R S
ER
VIC
ES
Acupunctu
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In this incentive plan, Delta Dental pays 70% of the contract allowance for covered basic services and major services during the first year of eligibility. The coinsurance percentage will increase by 10% each year (to a maximum of 100%) for each enrollee if that person visits the dentist at least once during the year. If an enrollee does not use the plan during the calendar year, the percentage remains at the level attained the previous year. If an enrollee becomes ineligible for benefits and later regains eligibility, the percentage will drop back to 70%.
Eligibility Primary enrollee, spouse (includes domestic partner) and eligible dependent children to age 26
Deductibles N/A
Deductibles waived for D & P? N/A
Maximums The maximum benefit paid per calendar year is $1,200* per person in-network (this amount includes the additional $200 for using a PPO dentist. See note above under Network)
The maximum benefit paid per calendar year is $1,000 per person out-of-network
Waiting Period(s) Basic Benefits
None
Major Benefits None
* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental contract allowances and not necessarily each dentist’s actual fees.
** Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for out-of-network dentists.
Delta Dental of California 100 First St. San Francisco, CA 94105
Customer Service 866-499-3001
Claims Address P.O. Box 997330 Sacramento, CA 95899-7330
deltadentalins.com This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits representative.
Plan Benefit Highlights for: PPO Incentive ($1,200/$1,000) no Orthodontic
Group No: Active, Retirees, and Cobra
Network: PPO/Premier *The plan provides an additional $200 toward the calendar year maximum when you visit a PPO dentist. Look for this information for the dentist of your choice on the Delta find a provider website to take advantage of this additional amount: (Other network affiliations: Delta Dental PPO)
Benefits and Covered Services*
In-PPO Premier Network** Non-Delta Providers**
Diagnostic & Preventive Services (D & P)
Exams, 2 cleanings per cal year, x-rays
70-100 % 70-100% UCR
Basic Services Fillings, simple tooth extractions, sealants
70-100 % 70-100% UCR
Endodontics (root canals) Covered Under Basic Services
70-100 % 70-100% UCR
Periodontics (gum treatment) Covered
Under Basic Services 70-100 % 70-100% UCR
Oral Surgery Covered Under Basic Services
70-100 % 70-100% UCR
Major Services Crowns, inlays, onlays, and cast restorations
70-100 % 70-100% UCR
Prosthodontics Bridges, dentures, implants
50 % 50% UCR
Dental Accident Benefits 100% (separate $1,000 maximum per person per calendar year)
Eligibility Primary enrollee, spouse (includes domestic partner) and eligible dependent children to age 26
Deductibles In-Network: N/A
Out-of-Network: $25 per person, $75 per family, per plan year
Deductibles waived for D & P? In-Network: N/A
Out-of-Network: No
Maximums The maximum benefit paid per calendar year is $2,000 per person in-network
The maximum benefit paid per calendar year is $1,000 per person out-of-network
Waiting Period(s) Basic Benefits
None
Major Benefits None
Orthodontics None
* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental contract allowances and not necessarily each dentist’s actual fees.
** Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists.
Delta Dental of California 100 First St. San Francisco, CA 94105
Customer Service 866-499-3001
Claims Address P.O. Box 997330 Sacramento, CA 95899-7330
deltadentalins.com
This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits representative.
Plan Benefit Highlights for: PPO $2,000 with Orthodontic
Group No: Active and Cobra, (Retirees - exclude Orthodontic)
Benefits and Covered Services*
In-PPO Network** Out-of-PPO Network**
Diagnostic & Preventive Services (D & P)
Exams, 2 cleanings, x-rays
100 % 50 %
Basic Services Fillings, simple tooth extractions, sealants
100 % 50 %
Endodontics (root canals) Covered Under Basic Services
100 % 50 %
Periodontics (gum treatment) Covered Under Basic Services
100 % 50 %
Oral Surgery Covered Under Basic Services
100 % 50 %
Major Services Crowns, inlays, onlays and cast restorations
100 % 50 %
Prosthodontics Bridges, dentures, implants
50 % 50 %
Orthodontic Benefits Adults and dependent children
100% 100%
Orthodontic Maximums Separate $3,000 Lifetime maximum per person
Dental Accident Benefits 100% (separate $1,000 maximum per person per calendar year)
50%
SISC and VSP provide you an affordable eyecare plan.
Signature Plan C $20
Your Coverage from a VSP Doctor
WellVision Exam® focuses on your eye health and
overall wellness .......................... every calendar year Prescription Glasses Lenses ........................................ every calendar year • Single vision, lined bifocal, lined trifocal lenses
and tints.• Polycarbonate lenses for dependent children.
Frame ......................................... every calendar year • $150.00 allowance for frame of your choice• $170.00 featured frame brands• 20% off the amount over your allowance• $80 allowance at Costco
~OR~Contact Lens Allowance .......... every calendar year$105.00 allowance for contacts and the contact lens exam (fitting and evaluation). .
Extra Discounts and Savings
Glasses and Sunglasses
• Average 35 - 40% savings on all non-covered lensoptions
• 30% off additional glasses and sunglasses, includinglens options, from the same VSP doctor on the same day as your WellVision Exam. Or get 20% off from any VSP doctor within 12 months of your last WellVision Exam
Contacts
• 15% off cost of contact lens exam (fitting andevaluation)
Laser Vision Correction
• Average 15% off the regular price or 5% off thepromotional price. Discounts only available from contracted facilities.
• After surgery, use your frame allowance (if eligible)for sunglasses from any VSP doctor
Co-Payments
Exam and Prescription Glasses Co-payment varies, contact VSP for additional information.
If you see a non-VSP provider, you’ll receive a lesser benefit. Before seeing a non-VSP provider, call us at 800.877.7195 for more details.
Out-of-Network Reimbursement Amounts: Exam ....................................................... Up to $35.00 Single vision lenses ................................. Up to $25.00 Lined bifocal lenses ................................. Up to $40.00 Lined trifocal lenses ................................. Up to $50.00 Frame ...................................................... Up to $30.00 Contacts .................................................. Up to $90.00
VSP guarantees service from VSP doctors only. In the event of a conflict between this information and your organization's contract with VSP, the terms of the contract will prevail.
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Exceptional Care,Anywhere.
Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. MDLIVE phone consultations are available 24/7/365, while video consultations are available during the hours of 7 am to 9 pm 7 days a week or by scheduled availability. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit www.mdlive.com/pages/terms.html 010113
Pediatric Care
■ Cold & Flu■ Constipation■ Ear Infections■ Nausea■ Pink Eye■ And More!
24/7/365 on-demand access to affordable, quality healthcare. Anytime, Anywhere.
With MDLIVE, you can visit with a doctor 24/7 from your home, office or on the go. Our network of Board Certified doctors is available by phone or secure video to assist with non-emergency medical conditions.
Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today.
Download the App
When should I use MDLIVE?
Instead of going to the ER or an urgent care center for a non-emergency issue
During or after normal business hours, nights, weekends and even holidays
If your primary care doctor is not available
To request prescription refills (when appropriate)
If traveling and in need of medical care
How much does it cost?Your copay for this service is:
Who are our doctors?
MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.
MDLIVE.com/SISC 1-888-632-2738
$5*All enrolled SISC PPO members and Anthem HMO members.
Common Conditions We Treat■ Allergies■ Asthma■ Bronchitis■ Cold & Flu■ Diarrhea■ Ear Infections■ Fever■ Headache■ Infections
■ Insect Bites■ Joint Aches■ Rashes■ Respiratory Infections■ Sinus Infections■ Skin Infections■ Sore Throat■ Urinary Tract Infections■ And More!
Are my children eligible?
Yes. MDLIVE has pediatricians on call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors.
Exceptional Care, Anywhere.
Visit grandrounds.com/sisc Or call 1-844-252-3056
Use Grand Rounds to receive second opinions and schedule office visits with top doctors. Whether you want to learn about a new diagnosis, confirm a course of treatment, or find a great specialist in your insurance network, we can help. It’s a free new benefit for you and your family, 100% covered by SISC.
Grand Rounds connects you with world-class doctors for expert medical guidance. And we handle all the legwork:• Matching you to a top physician for your exact medical needs
• Scheduling appointments for you and your family
• Collecting health records from previous doctors
• Providing support and guidance throughout the process
Get the medical care you deserve.
*In accordance with federal and state law, and professional ethical standards.
Have there been a few bumps in the road?
Have questions about home, work or family?
How we can help
When you or a household member contacts us, we’ll work with you to figure out the next steps. If you need counseling, we can arrange several free visits with a licensed professional. If you have money or legal questions, we can put you in touch with a financial advisor or a lawyer.
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}} Addiction and recovery}} Dealing with identity theft
Employee Assistance Program
Maybe you’re a few months behind on bills and want to getback on track. Or you’re new to town and looking for a daycarecenter. Whatever your concern, a call to the EmployeeAssistance Program (EAP) can help you through it.
What is EAP anyway?
You may have heard about EAP but aren’t sure what it is. EAPis a service available to you and members of your householdat no extra cost. It’s designed to help you with everydayproblems and questions, big or small. No need to fill outpaperwork or make an appointment to speak with an EAP staffmember. Just call 800-999-7222 or visit anthemEAP.com.You’ll be connected in an instant, and we’re here 24 hours aday, every day, to help you.
If online help is more your style, visit anthemEAP.com. You’llfind articles, checklists, quizzes and other helpful tools. Youcan browse resources, attend a webinar or take an onlineclass—right at your own desk. Here are just some of the topicscovered:
Remember, EAP is here for you 24/7, so you can call at the time and place that are right for you. Your privacy is important tous. No one will know you’ve called EAP unless you give them permission in writing.*
EAP can help smooth it out. Call 800-999-7222
or go to anthemEAP.com and enter SISC.
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name andsymbol are registered marks of the Blue Cross Association.
MCASH3151ABC 2/12
CUSTOMER CARE: 24 HOURS A DAY, 7 DAYS A WEEK | 1025 West Navitus Drive | Appleton, Wisconsin 54913
Share a Clear Viewnavitus.com
Have questions about your pharmacy benefi ts with Navitus Health Solutions? Visit
www.navitus.com for answers!
For information specifi c to your plan, visit Navi-Gate® for Members. Activate your
account online using the Member Login link and an activation email will be sent
to you. The site provides a wealth of information and is available 24 hours a day,
seven days a week. Navi-Gate for Members allows you to access personalized
pharmacy benefi t information online.
Some of the features offered include:
MY PRESCRIPTION BENEFITS
View general information about your pharmacy benefi t.
PHARMACY SEARCH
Find a participating pharmacy in your local area — search
for 24-hour pharmacies, and it provides a map to help you
fi nd a pharmacy.
DRUG SEARCH
Learn about prescription and over-the-counter drugs, how
they are used, warnings and more.
HEALTH INFO
Keep on top of important health news and information.
MAIL ORDER
Learn about available mail order options, if applicable to your pharmacy benefi t.
WHAT’S MY COPAY?
Determine your estimated cost for specifi c prescriptions.
NAVI-GATE® FOR MEMBERSPharmacy Benefi t Information at Your Fingertips
Navi-Gate for
Members Offers
Easier Access
to Your
Prescription
Benefi t
Information
N1045-1213
CUSTOMER CARE: 24 HOURS A DAY, 7 DAYS A WEEK | 1025 West Navitus Drive | Appleton, Wisconsin 54913
Share a Clear Viewnavitus.com
MEDICATION HISTORY
Medication history is displayed for enrollees and dependents in the form of a table for a
specifi ed date range.
DRUG INTERACTIONS
Understand how the effect of a particular drug is altered when taken with another
drug or food. Contains thousands of drug interactions between prescriptions, over-the-
counter drugs, as well as herbal, vitamin and nutritional products. Includes severity
rankings so steps can be taken to lessen harmful effects.
Please contact Navitus Customer Care if you have any additional questions or concerns.
We hope you fi nd Navi-Gate for Members informative and useful.
TO ACCESS, GO TO: WWW.NAVITUS.COM > MEMBERS > MEMBER LOGIN
Confidential/Administrator-Benefit DirectoryAnthem PPO Anthem HMO
Group #: 40656 Bronze 2-Tier Anchor: Emp.+Child(ren)
Member ID#: Located on front of Card Customer Service: 1-800-825-5541
Blue Cross of California
Navitus: 1-866-333-2757 www.navitus.com
Costco Mail Order: 1-800-607-6861 www.pharmacy.costco.com www.anthem.com/ca/sisc
PO Box 60007
Los Angeles, CA 90060
MD Live (PPO Members Only) : 1-888-632-2738
www.mdlive.com/sisc
Group #: 57AGTE & 57AGTN Member ID#: Printed on Card
Customer Service: 1-800-227-3771
Navitus: 1-866-333-2757 www.navitus.com
www.anthem.com/ca/sisc
Blue Cross of California – California Care
P.O. Box 629
Woodland Hills, CA 91365
KAISER PERMANENTE Chiropractic Network for Kaiser & Anthem Group #: 231876-0005 Member ID#: Medical Record # on your card
Membership Info Center: 1-800-464-4000
www.kaiserpermanente.org
Kaiser Permanente Medical Care
Program Membership Information Center
P.O. Box 41920
Los Angeles, CA 90041
American Specialty Health Plans (ASHP)
No Referral is needed from Primary Physician
To confirm your provider is a participating chiropractor, call 1-
800-678-9133 Mon. thru Friday 5:00 a.m. to 6:00 p.m.
DELTA DENTAL VISION PLAN
Delta Dental Incentive (PPO) 7079-7076
Delta Preferred Option (PPO) 7079-7276 Member ID#: Employee’s Social Security #
Customer Service (CMS): 1-866-499-3001
Internet: www.deltadentalins.com
E-mail: [email protected]
For a printed list of Delta dentists in your area:
1-800-427-3237 or visit the internet site.
Vision Service Plan Member ID#: Employee’s Social Security #
VSP: Customer Service: 1-800-877-7195 Internet: www.VSP.com
MES: Customer Service: 1-800-877-6372
Internet: www.MESVision.com
Voluntary Products SISC FLEXDisability/Accidental/Life Plans/CancerAmerican FidelityAccount Representative: Ester Garcia 1-866-523-1857 Disability Claims: 1-800-662-1113Reimbursement Accts: 1-800-654-8489www.afadvantage.com AflacAgent: Mary Isaacs [email protected]
Employee Assistance Program (EAP) LIFE INSURANCE
EAP services may be obtained by calling the 24-hour
toll-free number 1-800-999-7222. www.anthemeap.com
Prudential $50,000 per employee
$200,000 for Administrators
Member ID#: Employee’s Social Security #
NOTE: Contact Safety & Risk Services if wish to purchase
supplemental Term Life insurance.
Prudential Supplemental/AD&D: 1-800-631-0311
Julie Scranton, Safety & Risk Services Supervisor-ext. 5281
Cara Quinn, Safety & Risk Services Clerk-ext. 5380
Unreimbursed Medical/Dependent Care-Voluntary
Account Balances/Activity: http://sisc.kern.org/flex 1-800-972-1727 ext. 44161-661-636-4416Email: [email protected]
Costco Mail Order: 1-800-607-6861 www.pharmacy.costco.com
This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official plan and insurance
documents govern your right and benefits under each plan. For more details about your benefits, including a complete list of exclusion and limitations, please refer to each carrier’s EOC. The EOC’s are available on the District Website under “Employee Benefits.” www.leusd.k12.ca.us
Lake Elsinore Unified School District
Board of Education
Heidi Matthies Dodd
Stan Crippen
Superintendent Dr. Doug Kimberly
LEUSD Benefits Team
Julie Scranton
Safety & Risk Services Supervisor
Cara Quinn
Safety & Risk Services Clerk
Contact Information: [email protected]
Safety & Risk Services Department
(951) 253-7000
Extension-5380
Susan E. Scott
Juan I. Saucedo
Steven L. Wood
