| Effective June 1, 2009, we will be making changes to our health and dental insurance plans. These changes are taking place during our regular open enrollment period. In the weeks ahead, you will receive a personalized packet with more details and cost information. To help provide you with some insight into the new plans we have provided the following answers to some key questions. |
What are the changes and why are we making them?
We will continue to offer Kaiser as well as Blue Shield HMO and PPO plan options, but we are going to purchase these plans through a program called California Choice. The reason is that the plans are less expensive by purchasing the insurance through the California Choice program. Our dental and life insurance benefits will be provided by Guardian. Our VSP vision plan will remain the same. |
I need more info - where can I go to compare plans? Are there books?
Unfortunately, insurance companies don't even provide physician listings because they would be out of date by the time they went to print. We strongly suggest the insurers' web sites to compare plans. If you don't have Internet access in the office or at home - try the public library, it's usually free. Contact info for all plans is on the bottom of the next page. Summary sheets of the medical plans that we offer are also available at www.judymadrigal.com, click on 2009 Insurance Rates.
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What changes can I actually make?
A variety of moves can be made! You can change medical plans, add or delete dependent coverage; just remember you must keep the package intact (medical, dental & vision must remain together). |
What are the changes to the health plan(s) benefit designs?
Each of the plans will have higher co-pays and/or deductibles than the prior plans. That's the bad news. However, the good news, if you choose the Kaiser Elite Plan or the Blue Shield HMO Plan, is that you will have Flexible Spending Account (FSA) dollars available to you to help you offset the increased cost of your higher co-pay(s). If you choose the Blue Shield PPO plan, this plan comes with a Health Savings Account (HSA). The net effect is you will have lower out-of-pocket costs. |
What are the differences between the Flexible Spending Account (FSA) and a Health Savings Account (HSA)?
The FSA dollars are available to you each year to help you offset your out-of-pocket costs. The amounts you don't use do not roll over from year to year; however, new FSA dollars will be available to you next year. HSA dollars that you don't use are yours to keep. You don't lose them. Your HSA balance can continue to grow with no limits. The money in your HSA can be used for today's medical, dental and vision expenses, but can also be used for future expenses for the rest of your life. |
How are the dollars funded into the FSA and HSA?
The FSA dollars are available in full at the beginning of the plan year. The annual HSA amount is funded monthly.
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Can I add additional dollars to these accounts?
You cannot add additional money to the FSA, but you can make additional contributions to the HSA.
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What are the changes to the dental plan?
The plans are virtually identical. The new Guardian dental plan has a great ‘Roll-Over” benefit that allows you to increase your maximum plan benefit.
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Will I need to change dentists?
Possibly. Guardian has one of the largest PPO dentist networks in the state. It is larger than our current Blue Cross dentist network. You will have a very large array of dentists from which to choose, but Guardian’s network is not identical to that of Blue Cross, so your dentist may or may not be part of the network. You can use a dentist that is not a PPO dentist, but your benefit will be less. If you go to www.guardianlife.com, you can search for dentists in your area. Click on “Provider Online Search” and then select “DentalGuard Preferred” for the PPO plan or “Managed Dental Care” for the DHMO plan. |
Are our vision benefits changing?
No, everything remains the same.
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What is the difference between the Kaiser Saver and the Kaiser Elite?
The Elite plan costs more than the Saver plan, but has less out-out-of-pocket to you cost for doctor visits and hospitalizations. Your informational packet will have more detailed information. |
If I have questions, who should I contact?
We have contracted with a firm called Newsura Insurance Services, Inc. They are our new insurance agent for all of our benefit plans. They have a designated representative to respond to all your questions and assist with the enrollment paperwork. After you are enrolled in the plans, they will also be there to help you with questions you may have throughout the year. Our designated representative is Ida Trimmer. Her contact information can be found at the end of these questions and answers section. Newsura will also be visiting your office in the weeks ahead to meet with you personally to help answer any questions you may have.. |
Who needs to participate in open enrollment?
EVERYONE needs to participate in Open Enrollment, regardless of status.
(New employees, very part-time employees, no insurance, with insurance, Everyone!).
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What happens to the deductible I may have already met so far this year?
You will get credit for it towards the plan deductible. You will need to send a copy of your last Explanation of Benefits (EOB) from Blue Shield to Newsura when you send in your enrollment paperwork. They will see that it gets credited.
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When will the new deductions come out of my check?
You will see the new payroll deductions in May for June coverage. Premiums are paid one month in advance. You will be automatically enrolled in our cafeteria plan, which allows you to pay your premium in pre-tax dollars. This plan will prevent your premium from being a taxable item on your paycheck.
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What & when exactly is "Insurance Open Enrollment"?
Open enrollment is the one time of the year when eligible employees are allowed to make changes to their benefits or to enroll for the first time. This includes switching plans, adding new or uncovered dependents or choosing new plans. Remember that Insurance Open Enrollment is only offered one time each year |
Can I simply stay on my current plan?
Yes, unless you are currently enrolled in the Blue Shield PPO Saver plan as this plan is no longer an option. Although you are keeping your current plan, please make note of the significant changes and are required to fill out new enrollment forms since we are switching to California Choice. |
If I am Blue Shield can I enroll my child/children on Kaiser?
No, all family members need to be on the same plan. |
What are the differences between the HMO and the PPO?
There’s a significant difference between an HMO and a PPO. In an HMO, you coordinate all of your care through your primary physician and you pay co-pays for the services you receive. In a PPO, you can use any physician within the PPO network. The Cal Choice PPO plan has a high deductible, but you will receive monthly tax free cash deposits into a Health Savings Account (HSA) that will help you pay for your expenses below your deductible. |
When and how do I get my completed forms back?
In the packet you will receive from Newsura, will be an addressed postage paid envelope. Please complete the form(s), make a copy for your records and mail them back as soon as you have them completed, but no later than April 15th. |
Can I enroll in only the dental plan?
No. Our health benefits are bundled together in a package -- medical, dental and vision. It is not an option to enroll only in the dental plan.
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Can I put my children on the dental only?
Again, this is not a benefit that JMA offers, as our benefits are provided as a package. |
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My hours just increased. What do I have to do to qualify for benefits?
The following qualifications must be met to be eligible for benefits:
- You must work 30+ hours per week on a regular basis.
- You must have completed your 90-day eligibility period.
- You must be regular status and not classified as a Per Diem employee.
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I am unhappy with my current plan. Can I drop out all together?
Yes, you can cancel your insurance at the beginning of any month; however to do so, you must provide written proof that you are covered under another plan. While some offices do offer pay in lieu of benefits, this is not typically an option. Benefits are offered to all employees who qualify. If you choose not to participate because you have other group coverage, this may be taken into consideration. You would need to discuss this further with your site supervisor. |
Can I still go to the same medical group/doctor if I switch to the HMO or PPO?
There is a good chance that your doctor is on both the HMO & PPO; however, we recommend that you call their office to confirm that.
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What should I do with my completed forms?
Please make a copy of each form and mail them in the addressed post paid envelope as you receive them. |
If you have any questions regarding the health, dental, vision or life insurance plans, we suggest you call Ida Trimmer at Newsura.
Ida Trimmer
916-580-1806
idatrimmer@newsura.com.
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| If you wish to call the actual insurance company (we recommend you call Ida first because she is fully aware of all aspects of the JMA plans) here are their telephone numbers:
Newsura: 916-580-1805
Kaiser : 800-464-4000
Blue Shield: 800-424-6521
Guardian: 888-600-1600
Reliance Standard Life: 800-351-7500
Vision Service Plan: 800-877-7195 |
