Coast Community College District takes great pride in oﬀering a benefits program that provides flexibility for the diverse and changing needs of our employees. This brochure highlights the Medical, Dental, Vision, and Basic Life/AD&D insurance benefits available to you this year.
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see Medicare Part D section below for more details.
We continually evaluate our plans in light of changes within the insurance industry and the law. In an eﬀort to keep our plans aﬀordable for you and your family and compliant with the law, we are implementing the following changes:
There are no provider changes this year. We continue to oﬀer two types of medical coverage, the PPO Plan or the HMO plans either through Kaiser or UnitedHealthcare. Delta Dental continues to be our PPO dental oﬀering and VSP continues to be our vision oﬀering.
Eligibility Requirements To participate as an Employee in the Plan coverage that is described herein, an individual must be in one of the following classifications:
The eﬀective date of coverage for Medical, Dental, Vision and Life coverage for employees and their dependents is the first of the month following date of hire. However, coverage will be eﬀective on the first day of employment, if the employment date is the first of the month and it is a scheduled work day for that employee.
NOTE: If you fail to enroll within thirty-one (31) days after completion of the waiting period, you cannot enroll until the next "open enrollment" unless you qualify for a "special enrollment," Please refer to the "Rules for Benefit Changes During the Year" section on the next page.
The definition of an eligible dependent includes your spouse, registered domestic partner (a copy of the Declaration of Domestic Partnership filed with the California Secretary of State), and/or dependent children up to age 26 regardless of student or marital status. Dependent children include stepchildren, legally adopted children and children for whom you or your spouse has been appointed legal guardian by a court of law. To enroll qualified dependents, you must provide proper documentation, e.g. marriage/birth certificates, state/court documents, etc., for each dependent.
Dependents acquired later may be enrolled within thirty-one (31) days of their eligibility date. See the "Rules for Benefit Changes During the Year" section on the next page for additional details as well as instances when the loss of other coverage and other circumstances can allow a Dependent to be enrolled. Otherwise, a Dependent can be enrolled only in accordance with the "Open Enrollment" provision.
An Employee's newborn child will be eligible for benefits for Eligible Expenses that are incurred within the first thirty-one (31) days after the child's birth. Benefits for such child will be available for the 31-day period only. The child will become a Covered Person only if the child is enrolled within the limited 31-day benefit period. The 31-day benefit period also applies to a newborn child who is placed with an Employee for adoption within thirty-one (31) days of the child's birth.
NOTE: During the limited 31-day benefit period, a newborn child is not a Covered Person. Any extended coverage periods or coverage continuation options that are available to Covered Persons will not apply to a newborn child who is provided with these thirty-one (31) days of limited benefits and who is not enrolled within such 31-day period.
Coverage terminates for employees and their dependents the last day of the month in which they are no longer eligible for coverage.
Other than during the annual open enrollment, you may only make changes to your benefit elections if you experience a qualified status change or qualify for a "special enrollment". If you qualify for a mid-year benefit change, you may be required to submit proof of the change or evidence of prior coverage.
We know that your health and the health of your family is a priority for you. That is why Coast Community College District provides you with extensive health care benefits – to keep you feeling good and to provide quality coverage when you or your dependent(s) are ill. The District provides you a choice of medical plans as listed below.
PPO: Employees covered by the PPO Plan select providers on their own or from the Anthem Blue Cross Prudent Buyer PPO (preferred provider) network. Along with the choice and flexibility this type of coverage gives, it requires you to be knowledgeable about your benefits and aware of the procedures necessary to use them. With the PPO plan, you'll pay a lower share of your medical expenses when you use doctors or hospitals that participate in the PPO network. Your share of expenses includes a deductible, coinsurance and co-payments. You won't need a referral to see a specialist. A medical PPO plan will also pay a portion of the cost for services you may receive from non-participating (non-network) providers, but your share of the cost will be higher.
This is a self-funded plan and the District contracts with specialized organizations to administer the medical benefits of this plan. These organizations provide a variety of services—they process claims and make payments, pre-authorize/pre-certify hospitalizations, audit hospital billings, coordinate very complicated health care arrangements, contract and maintain the PPO network listing, and pay for prescriptions—according to the specifications of the Employee Benefit Plan.
UNITEDHEALTHCARE - HMO: HMO stands for Health Maintenance Organization. With this kind of medical plan, you will choose a Primary Care Physician (PCP) from the HMO network. Your PCP will be the doctor you see the most – for routine visits and care. They will also coordinate any other health care services you many need. And if you need to see a specialist, your PCP will need to make a referral. The plan includes benefits for routine physical exams, health screenings, childhood immunizations and well-child visits. Features like set co-pays for doctor visits help make your out-of-pocket costs more predictable.
KAISER PERMANENTE - HMO: With the Kaiser Permanente HMO plan, you'll always know what your costs are. There are no deductibles or percentages to figure out; you will be responsible for the plan's set co-pay amounts. And you can receive your care at any of the Kaiser locations, from a team of physician and nurses who want to see you at your best.
You can choose to receive care at any of the medical facilities and aﬃliated physicians, depending on where you live. Whenever you go in to receive covered services, you'll only pay your copayment. You can choose your own personal primary care physician. And if you need to see a specialist, your physician can easily refer you. For some specialties, you don't even need a referral to get an appointment.
Employees enrolled in the PPO plan will have prescription drug through Express Scripts (formerly known as Medco). This means the Medco website, customer service representatives, and written communications will reference the Express Scripts web address www.express-scripts.com. You have access to a vast number of retail pharmacies. Retail pharmacies can be used if you are taking a drug on a short-term basis. If you have questions you may call Express Scripts Member Services 24 hours a day, seven days a week toll free at (800) 711-0917 or you may visit the Express Scripts website at www.express- scripts.com for a list of participating providers in your area. Use Express Scripts by mail if you take regular medications and need an extended fill. Mail order forms can be found on the Express Scripts website.
Kaiser members can fill their prescriptions in person at one of Kaiser's pharmacies or by completing a Kaiser mail-order form and dropping it in the mail. Members should receive their prescriptions within two weeks. Mail-order forms can be found on the Kaiser website or at any Kaiser pharmacy. You may be able to order refills from a Kaiser pharmacy, via mail order or though Kaiser's website at kp.org/rxrefill.UnitedHealthcare (UHC) members can fill their prescriptions in person at one of UHC's participating pharmacies. If you have questions, you may call customer service at (800) 624-8822 or you may visit the UHC website at www.UHCwest.com for a list of participating providers in your area. If taking maintenance medications, UHC oﬀers a Mail Service Pharmacy Program through OptumRx. If you have questions, contact OptumRx at (800) 797-9791.
$200 / $350
$5/procedure No copay
$50/visit(deductible waived if admitted)
The information contained in this summary is not intended to take the place of, or change the carrier's schedule of benefits. In the event the information contained herein varies from the carrier's schedule of benefits, the carrier information shall prevail.
The District provides dental coverage that is designed to help keep you and your family smiling. The Delta Dental PPO program allows members the freedom to visit any licensed dentist, including a dentist from the Delta Dental Premier® indemnity network. However, there are advantages to visiting a Delta Dental PPO network dentist instead of a Premier or non-Delta Dental dentist. Members usually save the most when visiting a Delta Dental PPO dentist, but they also have access to Delta Dental Premier dentists, the largest dental network in the U.S. Delta Dental Premier provides additional cost protections for members when compared to non-Delta Dental dentists because these dentists agree to accept Delta Dental's determination of fees as payment in full.
Cleaning (limited to once every six months)
The District oﬀers comprehensive vision benefits to you and your eligible dependents through Vision Service Plan (VSP). VSP oﬀers an extensive network of providers so whether members live in cities, suburbs or rural areas, our doctors are nearby—an average of only four miles from where members live and work. What's more, VSP doctors provide both eye exams and eyewear, making them a convenient "one-stop" means of obtaining eye care benefits.
You may begin receiving substantial savings on your eye care and eyewear needs at any one of VSP's thousands of provider locations, including optometrists, ophthalmologists and opticians locations throughout the country. Network providers may be accessed on-line at www.vsp.com.
Every 12 months
Contact Lenses (in lieu of glasses)
$120 allowance + 15% off any remaining balance
Covered in full
The information contained in this summary is not intended to take the place of, or change the carrier's schedule of benefits. In the event the information contained herein varies from the carrier's schedule of benefits, the carrier information shall prevail.
IRS Section 125 Plan
The Section 125 Plan is a voluntary plan that is administered by American Fidelity Assurance Company. District employees are able to pay their medical premiums (for employee and dependent coverage), dental premiums and cancer plan premiums with pre-tax dollars. These premiums include the 1/2 of 1% cost for you medical insurance and the $50 monthly cost for family medical coverage. Employees' premium contributions are automatically deducted from their salaries before taxes are taken out. Taxable income is reduced by the amount contributed, so employees pay less in taxes and have more take-home pay.
In addition, District employees can choose to enroll in the health and/or dependent care flexible spending accounts (FSA) which allows an employee to set aside a portion of their earnings to pay for medical, dependent care, and other eligible expenses under the plan. The funds are payroll deducted and are not subject to payroll taxes, resulting in a substantial payroll tax savings.
All employees have access to the Employee Assistance Program (EAP) which is administered by Care Resources. This program provides assistance to you and your household members at no cost to you. Call the EAP when you need guidance or advice, when you need information or a referral. All contact is confidential. They are available 24 hours a day, seven days a week at (800) 479-7721 or (800) 635-3616.
The District provides basic Life and Accidental Death & Dismemberment (AD&D) insurance benefits, underwritten by ING, a ReliaStar Life Insurance Company to all benefits eligible employees working at least 50% to full-time.
Class 1: Full-time faculty, full-time & part-time classified employees Class 2: Board MembersClass 3: 50% to 60% part-time faculty
Class 4: Retirees under age 70 Class 5: Deans and aboveClass 6: Retired Deans and above
Class 7: Part-time faculty with 3.0+ Lecture Hour Equivalents and less than 7.5 Lecture Hour Equivalents
Basic Life Benefit
Basic AD&D Benefit
Classes 1 & 5: 1x annual salary to a minimum of $75,000 up to a maximum of $250,000. Class 2: $100,000Classes 3 & 7: $25,000
Classes 4 & 6: N/A
Classes 1 & 5: Benefit amounts reduce to 50% of original coverage at age 70. Classes 4 & 6: Coverage terminates at age 70.
Dependent Life benefits are available through ING, a ReliaStar Life Insurance Company, to all eligible dependents and are 100% contributory. The following coverages are available:· Spouse/Domestic Partner: $10,000
· Eligible Children from birth to age 26: $2,000
The amount of insurance for a dependent can be no more than 50% of your Life Insurance Amount.
In addition to the Basic Life Insurance the District provides, eligible employees may elect additional coverage by enrolling in a Supplemental Term Group Life Insurance plan underwritten by ING. All active Full-Time Faculty, Full-Time Classified, Board Members, and Deans and above are eligible to enroll the first of the month following 30 days.
Employee: Coverage from $20,000 to $500,000 in $10,000 increments, not to exceed 5 times your annual salary. Employee Guaranteed Issue: You can elect up to $150,000 (reduces to $75,000 for ages 60+) without satisfying medical evidence of insurability if you enroll when first eligible. Benefit amounts reduce to 50% of original coverage at age 70. Coverage terminates at age 70.
Spouse: Coverage from $20,000 to $500,000 in $10,000 increments, not to exceed 50% of the total amount of Employee Supplemental Life coverage. Spouse Guaranteed Issue: You can elect up to $40,000 without satisfying medical evidence of insurability if you enroll when first eligible. Benefit amount reduces to 50% at age 70. Dependent spouse coverage terminates when the spouse is no longer a dependent as defined by the policy. The employee must be enrolled in the Supplemental Life Insurance.
Dependent child(ren): Coverage is $1,000 or $5,000 for infant 6 months to 19 years, 23 years for full-time students. Dependents age 14 days to 6 months are limited to 20% of the elected amount. Dependent child coverage terminates when the child is no longer a dependent as defined by the policy. The employee must be enrolled in the Supplemental Life Insurance.
District paid Short Term Disability (STD) benefits are handled through the District Benefits Oﬃce. This benefit covers eligible District employees unable to work because of disability due to illness, injury, or maternity.
Classified employees who have attained six months permanency are eligible for STD benefits. Full-time contract and tenured faculty employees are eligible for these benefits after the completion of three consecutive months of employment.
After you have been totally disabled by a physician for a minimum of 14 calendar days, you may be eligible for STD benefits. You are eligible to receive benefits if you have exhausted all of your full Sick Leave after the 14 calendar day waiting period, and you are receiving half-pay sick leave. When the waiting period has been satisfied and you move to a half-pay Sick Leave status, the disability benefit begins to pay 50% of your income which, when added to your 50% half-pay Sick Leave will provide 100% of your income. It should be noted that the 14 calendar day waiting period can be satisfied during holidays, weekends and other non-duty days, if applicable.Salary will be continued by STD benefits for up to either 100 work days for classified employees and 110 work days for faculty employees or until you exhaust all Sick Leave. The combined income amounts never total more than 100% of the base salary in eﬀect prior to the date of total disability. The base salary does not include other income such as summer assignments, intersession, or overtime. However, base salary does include shift diﬀerential and professional development stipend for classified staﬀ in eﬀect at the time of disability.STD benefits are paid for faculty overload assignments; however, overload benefits will be exhausted at the end of the first semester in which the employee is disabled. Please note: District employees are not entitled to disability benefits through the State of California.
You need to notify the District Benefits Oﬃce if you are going to be totally disabled for longer than 14 calendar days. The Benefits Oﬃce will provide claim forms for you and your physician to complete.
District-paid Long Term Disability (LTD) benefits are administered by ING, a ReliaStar Life Insurance Company. Benefits begin after the completion of 100 work days of total disability for eligible classified staﬀ and 110 work days of total disability for eligible faculty staﬀ. They are integrated with any other statutory (regulated by law) benefits you may receive coverage will help replace your regular earnings when you are away from work because of a non-occupational sickness or accident.
Eligibility Waiting Period
Class 1: 3 monthsClass 2: 3 months
Class 3: Minimum 6 months or until attainment of permanency Class 4: 3 months
Class 1: 110 daysClass 2: 110 days
Class 3: 100 days
Class 4: 100 days
ING claim forms should be completed approximately 30 days prior to the completion of your 100/110 work day "Elimination Period". The application process is coordinated through the District Benefits Oﬃce.
The District Wellness Program sponsors classes and activities to identify personal risk factors in order to improve health. Health education, disease risk assessment and other wellness activities are being addressed by cancer screenings, blood pressure screenings, blood cholesterol measurements and diet and nutrition information. Be alert for Wellness Committee announcements of new activities and let the District Benefits Advisory Committee representatives know what you would like to see included in the District Wellness Program. Contact the District Benefits Oﬃce for a current list of Wellness Committee members.
Long-term care is help or supervision provided for someone with severe cognitive impairment or the inability to perform two or more activities of daily living such as: bathing, dressing, and eating. Services may be provided at home or in a facility—and care may be provided by a professional or informal caregiver, such as a friend or family member.The odds of needing long-term care services may be greater than you think. A spinal cord injury, stroke, Parkinson's disease or Alzheimer's disease could leave you or a family member in need of long-term care services. When people suddenly find themselves the primary caregiver for a loved one, the responsibility could result in a huge financial and emotional burden. Long-term care insurance helps to oﬀset the cost of long-term care services.As a benefits eligible contract employee, the District has made it possible for you to buy this valuable, portable coverage at group rates. You may enroll in American Fidelity's Long Term Care along with your spouse, parents and grandparents. In addition, the parents and grandparents of your spouse may also enroll. Retirees of the District and their spouses may also participate in the Long Term Care Plans. It's never too early to purchase coverage. And the younger you are when you first purchase long-term care insurance, generally the lower your premium for the life of your insurance plan, regardless of your age or health status in later years. For more information, contact American Fidelity at (800) 365-9180 or the District Benefits Oﬃce at (714) 438-4727.
Voluntary Hyatt Legal Plan membership provides participating employees and family members with access to legal advice and services including: telephone advice and oﬃce consultations on an unlimited number of matters with an attorney of your choice. You may enroll during the open enrollment period. The cost is $21 per month. If you are enrolled, contact Hyatt at (800) 821-6400 or visit their website at www.legalplans.com and enter password: 100010.
Will & Estate Matters
Real Estate Matters
Debt Collection Defense
Document Review and Preparation
Defense of Civil Lawsuits
It is impossible for life insurance to emotionally compensate for a loss, but it may help ease the financial obligations placed on your loved ones. American Fidelity's portable individual life insurance products can help.
A cancer diagnosis can be expensive. Benefit payments from American Fidelity's Limited Benefit Cancer Insurance Plan can be used however you'd like, including house payments, utilities, and meals/lodging expenses.
If you were to experience a critical illness event, such as a heart attack or permanent damage due to a stroke, Limited Benefit Critical Illness Insurance may be able to help provide some financial protection so you can focus on your recovery.
This group health plan believes the Anthem Blue Cross PPO and Kaiser Permanente plans are "grandfathered health plans" under the Patient Protection and Aﬀordable Care Act (the Aﬀordable Care Act). As permitted by the Aﬀordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in eﬀect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Aﬀordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Aﬀordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at (949) 253- 1664. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-32721-866-444-3272Â FREE or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.
If you decline enrollment in a Coast Community College District's medical plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in a Coast Community College medical plan without waiting for the next open enrollment period if you:
- Click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507404-656-4507
Phone (Outside of Anchorage): 1-888-318-88901-888-318-8890Â FREE Phone (Anchorage): 907-269-6529907-269-6529
Healthy Indiana Plan for low-income adults 19-64 Website: http://www.hip.in.govPhone: 1-877-438-44791-877-438-4479Â FREE
All other Medicaid
Website: http://www.indianamedicaid.com Phone 1-800-403-09641-800-403-0964Â FREE
Medicaid Website: http://www.colorado.gov/hcpf
Medicaid Customer Contact Center: 1-800-221-39431-800-221-3943Â FREE
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/Medicaid Phone: 609-631-2392609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-07101-800-701-0710Â FREE
Website: http://www.maine.gov/dhhs/ofi/public-assistance/ index.htmlPhone: 1-800-442-60031-800-442-6003Â FREE
TTY: Maine relay 711
Phone: 1-888-365-37421-888-365-3742Â FREE
Phone: 1-800-694-30841-800-694-3084Â FREE
Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/ Pages/default.aspx
Phone: 1-877-598-58201-877-598-5820Â FREE, HMS Third Party Liability
To see if any other states have added a premium assistance program since January 31, 2016, or for more information on special enrollment rights, contact either:
U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov1-866-444-EBSA1-866-444-EBSAÂ FREE (3272) 1-877-267-23231-877-267-2323Â FREE, Menu Option 4, Ext. 61565
OMB Control Number 1210-0137 (expires 10/31/2016)
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Coast Community College District and about your options under Medicare's prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans oﬀering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare's prescription drug coverage:
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.
However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
If you decide to join a Medicare drug plan and drop your current Coast Community College District prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back.
Since the existing prescription drug coverage under Coast Community College District is creditable (e.g., as good as Medicare coverage), you can retain your existing prescription drug coverage and choose not to enroll in a Part D plan; or you can enroll in a Part D plan as a supplement to, or in lieu of, your existing prescription drug coverage.
If you do decide to join a Medicare drug plan and drop your Coast Community College District prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back.
You should also know that if you drop or lose your current coverage with Coast Community College District and don't join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join
Contact the oﬃce listed below for further information. NOTE: You'll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Coast Community College District changes. You also may request a copy of this notice at any time.
More detailed information about Medicare plans that oﬀer prescription drug coverage is in the "Medicare & You" handbook. You'll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
Find a provider at www.anthem.com/ca
Customer Service: 800.711.0917800.711.0917Â FREE
Rx Refills: 800.473.3455800.473.3455Â FREE
American Fidelity Assurance Company (Voluntary Benefits)
Customer Service: 800.365.9180800.365.9180Â FREE,
Benefits: 800.662.1113800.662.1113Â FREE
Flex Account: 800.325.0654800.325.0654Â FREE
The information in this booklet is only a general outline of the Coast Community College District Group Health and Welfare Plan. Specific details and plan limitations are provided in various documents, which may include the summary plan descriptions, policies, contracts, certificates and other plan documents. The oﬃcial documents contain all the specific provisions of the plans. If there are any discrepancies between this summary booklet and the oﬃcial documents, the oﬃcial documents will govern. As this booklet is only a summary, it does not detail all the benefits for which you may be eligible or all the conditions to which such benefits may be subject. Nothing in this material implies that participation in the plans is a guarantee of continued employment with the company. Nor is it a guarantee that participation under the plans for employees or other covered persons will exist or remain unchanged in future years. Coast Community College District Group reserves the right to suspend, amend or terminate these plans and policies at any time. Such rights include the right to obtain coverage from additional or diﬀerent providers at any time in the future.