Plan Features & Highlights

Progyny Fertility and Family Building for Anthem PPO and CDHP

Fertility and family building coverage will be available to all employees and spouses enrolled in the Anthem Classic PPO plan and Anthem CDHP plan. Coverage will include fertility treatments such as IVF and IUI, fertility medication, sperm or egg freezing, adoption, surrogacy, and doula benefits. Most benefits are included as components of Smart Cycles. Participants are eligible for two Smart Cycles per lifetime. In addition, participants are eligible for up to $20,000 reimbursement for adoption or surrogacy per lifetime. Participants are also eligible for up to $1,000 reimbursement per child for doula services. Smart Cycle benefits are subject to the same deductible and copay cost sharing as the medical plan in which the participant is enrolled. Click on the Progyny Overview Video , review the Progyny Member Guide, visit the Progyny website or call 866-461-4990 to learn more about this benefit.

View additional flyers to learn more about the benefits offered through Progyny:
Progyny Benefits Overview, Surrogacy Benefit Overview, Adoption Benefit Overview, Doula Benefit Overview, IVF, LGBTQ Family Building Options, Egg Freezing Planning for your Future Family, Progyny Provider Network, Progyny Patient Care Advocates, and Smart Cycles.

Hinge Health Virtual Physical Therapy for Anthem PPO and CDHP

Hinge Health will provide a well-rounded virtual physical therapy program for acute or chronic conditions. Benefits include live video visits with a physical therapist, visits with a certified health coach to address underlying causes, and/or a tablet with sensors to provide feedback on movements during therapy. Benefits vary based on applicability, as determined by intake assessment. Hinge Health benefits are provided at no cost and are exempt from deductibles in the Anthem Classic PPO plan, including the CDHP. Click on the Hinge Health Overview Video or see the Hinge Health Flyer to learn more about this benefit.

Carrum Health for Anthem PPO and CDHP

If you ever need surgery in the future, please remember to check out the Carrum Health Benefit. This optional surgery benefit for Anthem PPO and CDHP participants provides a second opinion and, if surgery is needed, travel for you and a companion to the top surgeon at a world-class surgical facility. Learn more at carrum.me/acwajpia , watch this video, or view the Carrum Flyer.

Hear Carrum Health Testimonials and Knee Replacement Testimonials.

Oncology Guidance for Anthem PPO and CDHP

Carrum Health, JPIA’s concierge and second opinion surgery partner, has expanded to offer oncology services. Oncology Guidance will provide those newly diagnosed with cancer with a registered oncology nurse to guide them through their journey for up to 48 months. In partnership with world-renowned cancer centers Memorial Sloan Kettering and City of Hope, an oncologist will review the diagnosis and treatment plan, consulting directly with the treating physician. This benefit is available for all types of cancer, excluding non-melanoma skin cancer. Oncology Guidance is provided at no cost, unless a CDHP member has not yet met the IRS required minimum deductible for HSA eligibility. In that case, Carrum will work with Anthem to ensure the minimum required deductible has been met collectively before providing 100% coverage.

Breast Cancer Treatment for Anthem PPO and CDHP

Carrum Health's journey further into the oncology space has led to their partnership with the world-renowned City of Hope Cancer Center. Comprehensive treatment bundles include coordinated care, radiation, chemotherapy, and surgery. This benefit is available to participants with a first-time non-metastatic breast cancer diagnosis. Due to the need for repeat visits, participants must live within 60 miles of a City of Hope location in Southern California. Breast cancer treatment bundles through Carrum are provided at no cost. For CDHP participants, the same process used for Oncology Guidance will be applied to maintain HSA eligibility. See the Carrum Health Flyer for more information about this benefit.

Maintenance Medications for Anthem Plans

Maintenance medications are subject to a requirement to be obtained through mail order after two retail fills. In 2020, Walmart, Costco, and Sam’s Club were added as alternatives to mail order to obtain 90-day maintenance medication refills. Retail alternatives for 90-day maintenance refills will expand to include Albertsons, Vons, Pavilions, Safeway and Ralphs.

Anthem PPO Mail Order Pharmacy Benefit

The Anthem PPO's mail order and specialty pharmacy benefit manager's name will change from MedImpact Direct to Birdi. You will notice a different name on mailed packages, but everything else will remain the same. Your ID card is still valid. The phone number and website are the same. Existing refills are still on file.

See the MedImpact flyers and brochures for more information: MedImpact Summary Plan Description, MedImpact Formulary List, MedImpact Safe Harbor List, MedImpact Preferred Drug List and MedImpact Mail Order Retail Alternatives
*Please note, all flyers and information is still listed as MedImpact, however, the name will change to Birdi.

Anthem HMO Mail Order Pharmacy Benefit

The Anthem HMO's mail order and specialty pharmacy benefit manager's name will change from IngenioRx to CarelonRx. You will notice a different name on mailed packages, but everything else will remain the same. Your ID card is still valid. The phone number and website are the same. Existing refills are still on file.

Vision Benefit Enhancements

The VSP vision plan has been enhanced to increase the frame allowance from $180 to $200, and will now include VSP Light Care. VSP members with LightCare can now use their frame allowance, in lieu of prescription glasses, towards their choice of plano ready-made sunglasses or blue light filtering glasses and plano sunglasses.

Ginger App for Kaiser

Kaiser members are now eligible for Ginger, a mental health and wellbeing app. This app offers educational content and 24/7 text-based coaching sessions with certified coaches. Ginger provides emotional support to cope with some of life's most common challenges from stress and low moods to issues with work, relationships, and sleep. Once the benefit is activated, it is available for 90 consecutive days in a rolling 12-month period. Review the Ginger Flyer to learn more about this benefit.

Modern Health

Modern Health is a mental health and wellbeing benefits platform that solves the mental healthcare “access” problem by bringing one-on-one coaching, therapy, and mental health resources to your phone or tablet, typically within 48 hours of request. Click on the Modern Health Webinar (Pre-recorded) to learn more about this benefit.

View additional Modern Health flyers:
Getting Started With Modern Health, Invite your Dependents to Modern Health, Modern Health FAQ, Circles-Live Community Sessions, and Welcome to Modern Health

Plan Provider Flyers

Flexible Spending Accounts (FSAs)

Flexible Spending Accounts (FSA) designations must be made each year. If you would like to contribute to an FSA in 2023, you must make that election during Open Enrollment. The IRS has not yet announced the 2023 maximum annual contribution. The projected annual limit on salary reduction contributions for health care FSAs is $3,050. The annual limit for salary reduction contributions for dependent care FSAs is $5,000. Both limits apply to calendar years. The maximum amount of funds in a Health Care Flexible Spending Account (FSA) that can be rolled over from one calendar year to the next is $610. Dependent Care Flexible Spending Accounts have a 2 ½ month grace period into the next year; receipts are due by 3/31.

Use pre-tax money for your co-pays on medical, dental, vision care, and prescription costs through a Flexible Spending Account. This includes deductibles, costs for alternative healthcare, and orthodontia. This benefit is now even easier to use with the availability of a debit card or direct deposit. The EZ mobile app by WageWorks/Health Equity is now available on your iphone or Android smartphone. The mobile app lets you submit claims, snap photos of receipts, and manage your account from anywhere-it puts the WageWorks/Health Equity web portal in the palm of your hand.

Health Savings Account (HSA) for Anthem CDHP or Kaiser CDHP

Health Savings Account (HSA) deduction elections for 2023 should be made during Open Enrollment, as the deduction elected for the prior year will not continue without a completed form on file. Changes to your deduction amount can be made throughout the year. The 2023 maximum HSA contribution, for employer and employee contributions combined, will be $3,850/individual enrolled or $7,750/family enrolled. There is an additional $1,000/year catch-up contribution allowed for participants who will be age 55 or older at any point in 2023. Those enrolled in another plan, including Medicare, may not contribute to HSA. Learn more about Health Savings Accounts by reading these Frequently Asked Questions.

Employee Assistance Program

The District’s W.E.L.L. Program is a service to ensure employees’ well-being and productivity. Confidential, professional counseling and referral services are provided for stress-causing problems such as emotional problems, anxiety, depression, burnout, substance/alcohol/drug abuse, marriage and family relationships, and eating disorders. Counseling, treatment, and referral services are also available for smoking cessation, financial counseling, and legal matters. Employees or members of their immediate family may obtain professional assistance through the self-referral W.E.L.L program. Initially, there will be no charge to the individual employee or immediate family member for counseling services. After the third evaluation session, there will be a co-payment from the employee which will be on a graduated basis.

To take advantage of these services, contact:

Jo Ann Simmons-Walker, M.S., M.F.T.
10630 Town Center Dr., Ste. 111
Rancho Cucamonga, CA 91730
(951) 204-7124 (24 hours a day, 7 days a week)
jsimmonsmft@gmail.com
www.joannsimmonsmsmft.com

All employees, their spouse or domestic partners, and children who are legal dependents are eligible for W.E.L.L. services. Records of services you receive are treated as medical records by the provider and do not become part of your District personnel file. Release of information will only be made with your written approval.

Supplemental Insurance

The life insurance provider remains as Metropolitan Life Insurance Company (MetLife). The Open Enrollment period will be the only time to increase/add your voluntary life insurance coverage. If you wish to do so, please complete the MetLife Insurance Enrollment form and Medical History Statement.

Supplemental life insurance (above the basic District-provided life insurance) can be purchased in amounts up to $500,000 (in $10,000 increments) for employees. Life insurance for spouses can be purchased in $5,000 increments up to half of the amount of the employee policy. Life insurance for children (under 19 years old) can be purchased in amounts of $2,000, $5,000, or $10,000. The cost of supplemental life insurance is based on the insured’s current age and the amount of coverage elected to purchase.

*The coverage amount for your spouse cannot exceed 50% of employees Additional Life Coverage. The coverage amount for your child(ren) cannot exceed 50% of your Additional Life Coverage.

Age of Insured as of Jan. 1st	Monthly Rate Per Multiple of $1,000
Under 30	$0.098
30-34	$0.105
35-39	$0.137
40-44	$0.204
45-49	$0.329
50-54	$.0498
55-59	$0.831
60-64	$0.956
65-69	$1.876
70-74	$3.213
75 or over	$10.602

District-Paid Benefits

AD&D Insurance

A $25,000 accidental death & dismemberment (AD&D) policy is provided for all full-time, regular District employees.

Short-Term & Long-Term Disability Insurance

Short-term disability (STD) and Long-term disability (LTD) insurance is a benefit for all full-time, regular District employees. STD & LTD insurance replaces up to 60% of your pre-disability base salary if you become disabled. Contact Human Resources for more information.