Open Enrollment 2021

Chula Vista Elementary School District

2021 Monday, October 12, 2020 – Friday, October 30, 2020

Open Enrollment

Chula Vista Educators

2 Open Enrollment 2021

Board of EducationLeslie Ray Bunker • Armando Farías • Laurie K. Humphrey • Eduardo Reyes, Ed.D. • Francisco Tamayo

SuperintendentFrancisco Escobedo, Ed.D.

Table of ContentsCost of Benefits for 2021 .......................................................................3

Who Can Be Covered (Dependent Eligibility) ..........................................4

Mid-Year Changes .................................................................................5

Health ....................................................................................................6-8

2nd Opinion Service (Best Doctors) .......................................................9

Vision .....................................................................................................10

Dental ....................................................................................................10

Life Insurance ........................................................................................11

Legal .....................................................................................................12

EASE .....................................................................................................12

How to Enroll Online ..............................................................................13-14

3Open Enrollment 2021

Cost of Benefits for 2021 January 1 through December 31, 2021

EmployeeOnly

Employee &

1 Dep

Employee &

2+ DepEmployee

Only

Employee &

1 Dep

Employee &

2+ Dep

VEBA KAISER 0.00 223.40 713.40 0.00 205.20 695.20

VEBA United Healthcare - Network 1 0.00 241.40 744.40 0.00 223.20 726.20

VEBA United Healthcare - Network 2 0.00 859.40 1,653.40 0.00 841.20 1,635.20

VEBA Alliance $20 Copay 0.00 267.40 770.40 0.00 249.20 752.20

VEBA Harmony $10 0.00 168.40 642.40 0.00 150.20 624.20

VEBA Journey (Harmony) 0.00 75.40 514.40 0.00 57.20 496.20

VEBA SIMNSA 0.00 0.00 0.00 0.00 0.00 0.00

VEBA Select Plus PPO 0.00 988.40 1,762.40 0.00 970.20 1,744.20

ADDITIONAL DEDUCTIONS FOR: EmployeeOnly

Employee &

1 Dep

Employee &

2+ DepEmployee

Only

Employee &

1 Dep

Employee &

2+ Dep

Dependents' Dental Included 47.00 72.00 Included 16.50 37.10

Dependents' Vision Included 5.37 10.08 Included 5.37 10.08

Hyatt Metlaw - Legal Plan

District Contribution: $14,000.04

CHULA VISTA ELEMENTARY SCHOOL DISTRICT

CHULA VISTA EDUCATORS Summary of Benefits Payroll Deductions

January 1 through December 31, 2021

MONTHLY PAYROLL DEDUCTIONS FOR MEDICAL INCLUDES EMPLOYEE-ONLY DENTAL & VISIONWithDelta Dental PPO

WithUnited Concordia Dental HMO

19.50 19.50


Who Can Be CoveredDependant EligibilityPlease refer to the following information below to determine the eligibility of your dependents. In addition, you will need to provide documentation to ensure they are covered. For Open Enrollment, this information must be received no later than November 1, 2020.

SpouseIf you are legally married, you may add your depedent spouse to your medical, dental and/or vision plans.Required Documentation: Marriage License

Children

Adopted Children/Guardianship Adopted children may remain covered on their parent’s plans to age 26. Employees with guardianshipofachildwithoutadoptionmayspeakwiththeRiskManagementstaffforspecifics. Required Documentation: Birth Certificate or Court Adoption/Guardianship Documentation.

Biological Children Children may remain covered on their parent’s plans to age 26 regardless of their student, marital,residential,orfinancialdependencystatus. Required Documentation: Birth Certificate

Grandchildren Grandchildren are not eligible as dependents unless permanent legal guardianship with the employee has been established and a court order is provided. Required Documentation: Court Guardianship Documentation

Registered Domestic PartnerRegistered Domestic Partners (RDP) may be added to District plans, as long as the employee can verify they have registered their domestic partnership with the appropriate state agency.Required Documentation: Declaration of Domestic Partnership from the State of California or other state.


Mid-Year ChangesWhen can employees make changes?

New MarriageYournewspousemaybeenrolledinyourplanonthefirstofthemonthfollowingthedateofmarriage.However, unless Risk Management receives a completed change form within 30 days of the marriage, the new spouse may not enroll for coverage until the next Open Enrollment period. A copy of your marriage license must be presented to Risk Management.

Registered Domestic PartnerRegistered domestic partners must be added within 30 days of a Declaration of Domestic Partnership beingfiledandapprovedwiththeStateofCalifornia.TheemployeemustverifythestatusoftheirdomesticpartnershipbyprovidingtheDistrictwiththeoriginalofthevalidDeclarationofDomesticPartnershipfiledwith,andapprovedby,theStateofCalifornia.

Divorce/DissolutionTheemployeemustnotifytheDistrictwithin 30 days of the termination/dissolution of marriage or a registered domesticpartnership.Oncethecourt/statehasofficiallyendedthemarriageordomesticpartnershipthedependentwillberemovedthefirstofthemonthfollowing.

Newborn ChildrenA newborn is automatically covered under your medical plan as of his or her birth date forthefirst30days. However,ifthememberelectstocontinuecoveragepastthefirst30days,themembermustenrollthenewbornbycompletingachangeform,supplyingtheoriginalbirthcertificate,andsubmittingbothtotheRisk Management Department within 30 days of the date of birth.

Death of DependantTheemployeemustnotifytheDistrictwithin 30 days of the death of a covered dependent and a copy of thedeathcertificate.

Loss of Other CoverageAn employee and the employee’s eligible dependents may enroll within 30 days of losing other coverage bysubmittingacompletedenrollment/changeformtotheRiskManagementDepartment. The lossofother coverage must be due to ineligibility to continue the other coverage, group continuation of coverage has expired, or the other employer has ceased making contributions toward the other coverage and the loss of coverage is not due to the nonpayment of premiums or for cause. Proof of loss of coverage must beattachedtotheenrollment/changeformalongwiththemarriageand/orbirthcertificate.

New Hire Open Enrollment Qualifying Event


Chiropractic & AcupunctureOptum Health Employees currently enrolled in a health plan (excluding SIMNSA) havecoverage included for chiropractic and acupuncture services. Additional information regarding coverage and copays for these services are listed on the next page as they are plan specific. To locate a provider withinthe network, please call 800-428-6337 for Kaiser members and 888-586-6365 for United Healthcare members. You may also visit www.myoptumhealthphysicalhealthofca.com for additional information.

PrescriptionsExpress Scripts Advantage Network United HealthCare members receive their prescriptions drug benefitsthrough Express Scripts. Your copayand coinsurance amounts are based onwhereyoufillyourprescriptions.Forthe lowest copays, be sure to utilize an Express Scripts Advantage Network(EAN) pharmacy. Non-EAN pharmacies will charge an additional $5-copay per prescription. If you continue to use a retail pharmacy after three fills ofyour medication, then you will pay the maintenance copay for a 30-day supply.

VEBA United Health Care HMO Plans Participating Medical Groups (PMG) - San Diego County

California Schools VEBA | Making Health Care Better for Everyone | VEBAonline.com | 888-276-0250

VEBA WebsiteBe sure to visit the new VEBAonline.com.

The site features improved functionality and personalization for our members.

Learn more about your benefits, get benefit contacts or look for a provider.

VEBA AppTake your health care on the go with the new VEBA mobile app. Download the app for accessible health care information and personalized notifications about your benefits. Available on the iTunes® and Google Play TM stores.

Chiropractic

Provided by OptumHealth Physical Health of California providers, which has more than 2,700 network providers in California.

Three ways to find a provider:1. Go to myoptumhealthphysicalhealthofca.com

and select “Provider Locator.” Choose “California Schools VEBA” from the dropdown menu for Plan/Product.

2. Call Optum Member Services at 1-800-428-6337(5 a.m. to 5 p.m., Pacific Time, Monday - Friday) for the most current and up to date information.

3. Call the provider directly to schedule an appointment and verify they are part of the Optum network for VEBA.

*If your district has added acupuncture, the above info applies.

UHC Medical Plans

In an HMO, you see your PCP first for most medical issues. You do not need a referral for mental health, chiropractic or OB/GYN services.

To find a provider or facility:1. Go to csveba.welcometouhc.com2. Scroll down to choose from the plan options3. Choose the appropriate network and click. “Search the network”4. Click “okay”5. Click “continue”6. Search by Name, Specialty or Medical Group

FINDING A DOCTOR OR FACILITY

PPO Plans

In a PPO, the plan offers both in-network and out-of-network coverage. You can see any doctor but will pay less when you use doctors in the UHC Select Plus network. For the lowest out-of-pocket costs, be sure to select a Tier 1 designated provider or facility.

Performance HMO

Medical groups are ranked in multiple networks based on quality scores from the California Office of the Patient Advocate (opa.ca.gov) and what they charge for services. Copays vary by network. Medical groups in Network 1 have the highest performance ratings and lowest copays.

SignatureValue Alliance HMO

This HMO benefit plan is a health plan that offers access to selected physicians based on their ability to guide their patients to the care and resources that help promote better health outcomes and lower costs. This plan offers a VEBA-funded HRA that helps members meet your deductible. Members can use your HRA funds immediately to help cover the initial deductible expenses.

Kaiser

A high quality HMO program that utilizes the Kaiser Permanente network of hospitals and physicians.

SIMNSA

A cross-border plan that requires routine care be received in Mexico. Eligibility restrictions apply.

HMO Plans

In an HMO, you must see your Primary Care Physician (PCP) first for most medical issues. Your PCP will refer you to any specialists you may need to see. When selecting your plan, remember:

• You and your dependents must enrollin the same network but can selectdifferent PCPs within that network

• Your network election is effective forthe entire year – you may changePCPs within the network but youcannot change networks until thenext enrollment period

i

Each of the available medical options covers a different network of doctors and may not offer coverage outside of that network. SELECTING YOUR PLAN

UHC Performance HMO • Network 1• Network 2• Network 3

Kaiser HMO

UHC PPO

UHC SignatureValue Alliance HMO

SIMNSA HMO

AVAILABLE PLANS

20192019 Your district offers a number of different medical options. Please review the following information to help select the best plan for you and your family.

C H U L A V I S TA E L E M E N TA R Y S C H O O L D I S T R I C T: CERTIFIC ATED

B E N E F I T O P T I O N S

New Express Scripts BenefitsNew SaveonSP program effective 10/01/19. Thisprogramcovers certain specialty medications. Once you enroll, you mayhavenocopays.ThesemedicationswillcontinuetobefilledthroughAccredo.

Copay waiver effective 01/01/21. Copays will be waived for generic hypertension and preferred generic oral hypoglycemicmedicationswhenfilledataSmart90retailormail-order pharmacy.


Medical Plans

Surgeries for orthopedic, spinal, coronary artery bypass graft and bariatric (if covered) require pre‐certification with Carrum Health or a $1,000 penalty will apply for Select Plus PPO.1 UHC members pay standard copays plus $5/prescription at a non‐EAN pharmacy (non‐EAN pharmacies include CVS, Target, Walgreens and certain independent pharmacies).2 UHC members pay the Retail Refill Allowance (RRA) penalty (equal to 2 times short‐term medication copay for 30‐day supply) if you fill maintenance prescriptions at a network pharmacy other than Smart90.3 Copays waived for preferred generic hypertension and hypoglycemic purchased at mail or Smart 90. This does not include normal retail use or brand drugs.4 Services must be medically necessary and may be subject to prior authorization from OptumHealth.+ NexusACO administered by UMR.*Subject to a $40 minimum and $175 maximum.** Subject to a $80 minimum and $350 maximum.

Disclaimer: Prepared by Gallagher Benefit Services, Inc. on behalf of VEBA.

This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all the terms, coverages, exclusions, limitations, and conditions of the actual contract language. The policies themselves must be read for those details. The intent of this document is to provide you with general information about your employee benefit plans. It does not necessarily address all the specific issues which may be applicable to you. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be directed to your Human Resources/Benefits Department.

FeatureNEW!

UHC Alliance HMO $20What You Pay

NEW!UHC Journey Harmony

What You Pay

NEW!UHC Harmony $10What You Pay

UHC Performance HMO A Network 1

What You Pay


What You Pay

UHC CA Select Plus PPO+ 80/50 SDIn Network Out of Network

What You Pay What You Pay

Kaiser 10$10/$10, 100 DayWhat You Pay

SIMNSAWhat You Pay

Deductible (individual/family) None $2,000/$4,000 None None None $2,000/$4,000 $2,000/$4,000 None None

Medical Out-of-Pocket Maximum (individual/family) $1,500/$3,000 $3,500/$7,000 $1,500 / $3,000 $1,500/$3,000 $3,000/$6,000 $5,000/$10,000 $5,000/$10,000 $1,500/$3,000 $6,350/$12,700

RX Out-of-Pocket Maximum (individual/family) $1,600/$3,200 $1,600/$3,200 $3,000 / $6,000 $3,000/$6,000 $3,000/$6,000 $1,600/$3,200 N/A N/A N/A

Health Reimbursement Account None $800/$1,600/$2,200 None None None None None None None

PCP Office Visit $20 copay $25 copay $10 copay $10 copay $20 copayTTiieerr 11 PPhhyyssiicciiaann:: $30 copay

OOtthheerr IInn‐‐NNeettwwoorrkk PPhhyyssiicciiaann:: 20% coinsurance after deductible

50% coinsurance (after deductible) $10 copay $5 copay

Specialist Office Visit $20 copay $40 copay $10 copay $10 copay $20 copayTTiieerr 11 PPhhyyssiicciiaann:: $50 copay



Preventive Care No charge No charge No charge No charge No charge No charge No coverage for non‐network services No charge No charge

Inpatient Hospital Care $250 copay 20% coinsurance (after deductible) No charge No charge No charge 20% coinsurance

(after deductible)50% coinsurance with Prior

Authorization (after deductible) No charge No charge

Mental Health Services (outpatient/inpatient) $20 copay / $250 copay

$25 copay / 20% coinsurance (after

deductible)

$10 copay/No charge

$10 copay/No charge

$20 copay/No charge

$30 copay/ 20% coinsurance (after deductible)

50% coinsurance (after deductible) $10 copay/No charge $5 copay/ No charge

Substance Abuse Services(outpatient/inpatient) No charge / No charge No charge No charge No charge No charge $30 copay/ 20% coinsurance

(after deductible)50% coinsurance (after deductible) $10 copay/No charge $5 copay/ No charge

Infertility Not covered Not covered Not covered Not covered Not covered Not covered Not covered $10 copay Not covered

Outpatient Diagnostic Laboratory and Radiology (standard procedures)

No charge No charge No charge No charge No charge

FFrreeeessttaannddiinngg FFaacciilliittyy oorr PPhhyyssiicciiaann:: No charge

HHoossppiittaall‐‐bbaasseedd LLaabb oorr RRaaddiioollooggyy:: 20% coinsurance

(deductible does not apply)

50% coinsurance (after deductible) No charge No charge

Complex Radiology (PET, MRI) $100 copay $100 copay No charge No charge No charge

FFrreeeessttaannddiinngg PPhhyyssiicciiaann:: 20% coinsurance (after deductible)

HHoossppiittaall‐‐bbaasseedd oorr RRaaddiioollooggyy:: 20% coinsurance plus $100 copayment (after

deductible)


Outpatient Surgery No charge 20% coinsurance (after deductible) No charge No charge No charge

AAmmbbuullaattoorryy SSuurrggeerryy CCeenntteerr oorr PPhhyyssiicciiaann''ss OOffffiiccee::

20% coinsurance (after deductible) OOuuttppaattiieenntt HHoossppiittaall‐‐bbaasseedd SSuurrggiiccaall CCeenntteerr:: 20% coinsurance (after ded.) and $100

copayment

50% coinsurance (after deductible)

Pre‐authorization is required $10 copay No charge

Outpatient Physical/ Rehabilitation Therapy $20 copay $25 copay $10 copay $10 copay/$10 copay $20 copay/$20 copay $30 copay 50% coinsurance

(after deductible) $10 copay $10 copay

Urgent Care (your medical group/other medical group)

$20 copay / $75 copay $25 copay / $50 copay $10 copay/$50 copay $10 copay/$50 copay $20 copay/$50 copay $50 copay 50% coinsurance (after deductible) $10 copay $25 copay/ $50 copay

Emergency Room (copay waived if admitted) $150 copay 20% coinsurance (after

deductible) $100 copay $100 copay $100 copay $100 copay $100 copay $50 copay $25 copay in Mexico/$250 copay (U.S. or out of plan area)

Short-Term Prescription Drugs1

up to 30 day supplyG: GenericP: PreferredNP: Non-Preferred

$10/$30/50%*($5 extra if filled at non‐EAN

pharmacy)

$10/$30/50%*($5 extra if filled at non‐

EAN pharmacy)


EAN pharmacy)

G: $5P: $25

NP: 50% ($40 minimum & $175 maximum)

G: $10P: $30


G: $10P: $30

NP: 50% ($40 minimum and $175 maximum)

No coverage for non‐network pharmacy G: $10P: $10 $5 copay

Maintenance Prescription Drugs2

up to 90 day supply for UHC members3

up to 100 day supply for Kaiser membersG: GenericP: Preferred NP: Non-Preferred

$20/$60/50%** $20/$60/50%** $10/$50/50%**G: $10P: $50


G: $20P: $60


G: $20P: $60


No coverage for non‐network pharmacy G: $10P: $10 Not available

Chiropractor & Acupuncture Service4 $20 copay $30 copay $10 copay $10 copay $20 copay $30 copay 50% coinsurance (after deductible) $10 copay Not covered

Available Medical Groups

Mercy Physicians, Primary Care Associates, Rady Children's

Health Network, Scripps Clinic, Scripps Coastal Medical Center, Scripps Physicians Medical,

UCSD Medical

Sharp Rees‐Stealy, Sharp Community Medical Group,

UCSD Medical

Sharp Rees‐Stealy, Sharp Community

Medical Group, UCSD Medical

Sharp Rees‐Stealy, Sharp Community, Primary Care Associates, Arch Health Partners, Children's

Physicians

Mercy Physicians, Greater Tri‐Cities, Mid‐County Physicians,

Multi‐Cultural, Scripps Physicians Medical, Children's

Physicians

Check umr.com to find Tier 1 physicians near you All Others Kaiser SIMNSA

Surgeriesfororthopedic,spinal,coronaryarterybypassgraftandbariatric(ifcovered)requirepre‐certificationwithCarrumHealthora$1,000penaltywillapplyforSelectPlusPPO.1UHCmemberspaystandardcopaysplus$5/prescriptionatanon‐EANpharmacy(non‐EANpharmaciesincludeCVS,Target,Walgreensandcertainindependentpharmacies).2UHCmemberspaytheRetailRefillAllowance(RRA)penalty(equalto2timesshort‐termmedicationcopayfor30‐daysupply)ifyoufillmaintenanceprescriptionsatanetworkpharmacyotherthanSmart90.3Copays waived for preferred generic hypertension and hypoglycemicpurchasedatmailorSmart90.Thisdoesnotincludenormalretailuseorbranddrugs.4Servicesmustbemedicallynecessaryandmaybe subject to prior authorization from OptumHealth.+ NexusACO administered by UMR.*Subjecttoa$40minimumand$175maximum.**Subjecttoa$80minimumand$350maximum.

Medical Groups


Medical Plans




FeatureNEW!



What You Pay



What You Pay


What You Pay




SIMNSAWhat You Pay

















deductible)

$10 copay/No charge

$10 copay/No charge

$20 copay/No charge















deductible)





copayment












pharmacy)


EAN pharmacy)


EAN pharmacy)

G: $5P: $25


G: $10P: $30


G: $10P: $30






$20/$60/50%** $20/$60/50%** $10/$50/50%**G: $10P: $50


G: $20P: $60


G: $20P: $60







UCSD Medical


UCSD Medical




Physicians



Physicians





FeatureNEW!



What You Pay



What You Pay


What You Pay




SIMNSAWhat You Pay

















deductible)

$10 copay/No charge

$10 copay/No charge

$20 copay/No charge















deductible)





copayment












pharmacy)


EAN pharmacy)


EAN pharmacy)

G: $5P: $25


G: $10P: $30


G: $10P: $30






$20/$60/50%** $20/$60/50%** $10/$50/50%**G: $10P: $50


G: $20P: $60


G: $20P: $60







UCSD Medical


UCSD Medical




Physicians



Physicians


Disclaimer:PreparedbyGallagherBenefitServices,Inc.onbehalfofVEBA.Thisdocumentisanoutlineofthecoverageproposedbythecarrier(s),basedoninformationprovidedbyyourcompany.Itdoesnotincludealltheterms,coverages,exclusions,limitations,andconditionsoftheactualcontractlanguage.Thepoliciesthemselvesmustbereadforthosedetails.Theintentofthisdocumentistoprovideyouwithgeneralinformationaboutyouremployeebenefitplans.Itdoesnotnecessarilyaddressallthespecificissueswhichmaybeapplicabletoyou.Itshouldnotbeconstruedas,norisitintendedtoprovide,legaladvice.QuestionsregardingspecificissuesshouldbedirectedtoyourHumanResources/BenefitsDepartment.

Medical Groups


Dental and Vision

As a Best Doctors member, you have the expertise of more than 50,000 of the world’s best doctors at your fingertips! Simply by contacting Best Doctors, you can have your medical diagnoses and treatment plans reviewed by carefully selected expert physicians. All services are conveniently provided by phone or online so there is no need for additional travel. And Best Doctors’ services are confidential and completely free to you!

Services Available:

In-Depth Expert Medical Review

Best Doctors will collect your medical records, tests and samples and have them reviewed by a world-renowned expert physician who specializes in your condition. The expert will ensure your diagnosis is accurate and you have the best treatment options.

Critical Care Support™

Medical Records eSummary™

Call on Best Doctors for guidance if you experience a medical event that requires emergency treatment, intensive care or an extended hospital stay. Best Doctors gets an expert immediately involved in your case and works with your local medical team to get you the best care.

Critical Care Support is a trademark of Best Doctors, Inc.

Best Doctors can collect and organize your medical records for you and provide them on an easy-to-access USB drive. You will also receive a personal Health Alert Summary based on the records collected, giving you a total snapshot of your medical wellness.

Medical Records eSummary is a trademark of Best Doctors, Inc.

Ask the Expert™When you have a question about a medical condition, treatment option or symptom, Best Doctors will take the time to listen and an expert physician will provide a personalized response. No needless worrying, wondering or wandering the web for answers.

Ask the Expert is a trademark of Best Doctors, Inc.

FindBestDoc®Best Doctors draws on more than 50,000 of the world’s top physicians, including 40,000 in the U.S. If you need to visit a specialist, we will search to see if any of our doctors meet your criteria and practice within a distance that works for you.

FindBestDoc is a registered trademark of Best Doctors, Inc.

For more information, or to take advantage of any of the Best Doctors services, call 866.904.0910 or visit members.bestdoctors.com.

I can’t imagine what I would have done if I didn’t have Best Doctors as a free benefit.”

“

Treatment Decision Support™

Oncology Insight with Watson

The Best Doctors Treatment Decision Support (TDS) service is designed to help educate patients on their treatment options to achieve better health outcomes and avoid unnecessary, more costly inpatient surgical procedures, when appropriate.

Treatment Decision Support is a trademark of Best Doctors, Inc.

Oncology Insight with Watson makes the best in cancer-centric second opinions better. We equip our world-renowned expert oncologists with the most advanced in cognitive technology. This tool helps analyze medical records, identify top potential evidence-based treatment options and evaluate specific qualifying criteria to identify any available clinical trials.

Best Doctors


Vision Medical Eye ServicesYour vision plan provides full coverage for covered services and/or materials when you go to a participating provider. Claim forms are available at www.mesvision.com or on the Risk Management webpage.

Dental Plan OptionsDelta PPOUnder the Delta PPO plan, you may visit any licensed dentist of your choice. However, you receive the maximum benefits available under the program when you choose an IN-NETWORK dentist. IfyouchooseanOUT-OF-NETWORKdentist,youwillbe responsible foranyamountabove the“Delta approvedfee,”therefore,youwouldbenefitbyselectingoneoftheDeltaPPOdentistsinCalifornia.DeltadentistsagreetoabidebyDelta’sfeeandqualityguidelines.Diagnosticandpreventativebenefitswillnotaccumulatetowardsthebenefitsmaximumpercalendaryear.

PPO-Network Dentist Out-Of-Network DentistDeductibles per calendar year $25 per person $25 per personBenefitsmaximumpercalendaryear $1,750perperson (1) $1,750 per person (1)

DiagnosticandPreventiveBenefits 100%ofDeltaapprovedfee 100%Deltaapprovedfee(2)

(no deductible applies (no deductible applies for these services) for these services)

BasicBenefits 90%ofPPOapprovedfee80%ofDeltaapprovedfee (2)

MajorBenefits 50%ofPPOapprovedfee50%ofDeltaapprovedfee(2)

(1) Increasefrom$1,500to$1,750effectiveJanuary1throughDecember31,2021only.(2) In 2021, employees will be covered for 3 cleanings (an increase from 2 per year).(3) Whenusinganout-of-networkdentist,youarealsoresponsibleforallchargesinexcessoftheDeltaapprovedfee.

United Concordia DHMOTheUnitedConcordiaoptionisaprepaidplan,i.e.,adentalHMO-typeplan.Toreceivedentalservices,youandallofyourcoveredfamilymembersarerequiredtoselectadentistlocationcontractedwithUnitedConcordia.TherearenoannualdeductiblesunderthedentalHMOplans;however,dependingupontheprocedure, you may be responsible for a co-payment. Your selected contracted dentist will take care of yourdentalcareneeds.Ifyourequiretreatmentfromaspecialist,yourcontracteddentistmusthandlethe referral for you. You may change contracted dentists by notifying United Concordia either by phone, in writing, or by visiting their website at www.unitedconcordia.com.

How often can I go?- One comprehensive examination in any 12 consecutive months.- One pair of standard lenses in any 12 consecutive months. (Standard lenses fit any frame with an eye size less than 61mm.)- One standard frame in any 12 consecutive months.- One pair of contact lenses in any 12 consecutive months. (This benefit is in lieu of lenses and frames.)

Limits for 2021- Frames: up to $130- Contact lenses: up to $130- Progressive lenses: up to $140

- Scratch coating: up to $15- Anti-reflective coating: up to $30- Ultraviolet protection: up to $35


Life InsuranceBasic Term Life Insurance and AD&D CoverageMutualofOmahaInsuranceCompanyistheinsurancecarrierforBasicTermLife,AccidentalDeathandDismemberment(AD&D)coverage,andtheVoluntarySupplementalLifeplan.

TheDistrictprovidesbasiclifeandaccidentaldeathanddismembermentcoveragetoallbenefiteligibleemployees through Mutual of Omaha. Employees are provided a policy of $50,000 of coverage of life insuranceand$50,000ofcoverageofaccidentaldeathanddismemberment.Benefitsarereducedatage70 years old to $32,500 and at age 75 to $25,000. Please note this group term life insurance policy will terminateatretirement.Terminatedemployeesmayconverttoanindividualpolicywithin30daysofthedate of resignation or retirement.

Voluntary Life InsuranceVoluntary life insurance benefits allow employees to purchase additional coverage in excess of theamount provided by the District. Please note this coverage is based on age and the premiums increase at eachfiveyearinterval.Therearemanyoptionsforlifeinsurancecoverageavailable.WhenyoucompleteyouronlineenrollmentyouwillbeofferedtheopportunitytopurchaseadditionallifeinsurancethroughAmerican Fidelity.

If you would like additional information on the Mutual of Omaha voluntary life or accidental death and dismembermentcoverage,pleasecontacttheRiskManagementDepartmentat619-425-9600,Ext.1352.ThiscoverageisonlyavailablebyenrollmentthroughRiskManagementwithpaperformsandcannotbecompleted utilizing the online open enrollment tool. For 2021, we have received a rate reduction for many oftheagebracketsthatwillmakevoluntary life insuranceevenmoreaffordable.Pleasereferencethechart below for the rates per $1,000 of coverage:

Beneficiary ChangesImportant:Youcanchangeyourbeneficiaryonyourlifeinsuranceandaccidentaldeathanddismembermenton any day during the year. It is not necessary to wait for open enrollment. Please contact the Risk Management Department for the necessary forms.


Legal and EASEHyatt MetLaw Legal PlanAvoluntarypre-paidlegalplanthroughHyattLegalPlans.ForthoseemployeeswhoenrollduringOpenEnrollment,coveragewillbeeffectiveJanuary1,2021.HyattLegalPlans,aMetLifecompany,isthenation’sleading provider of group legal plans. A Hyatt legal plan is now available at over 1,500 organizations in the U.S.andprovideslegalservicestoover5millionplanparticipantsthroughHyatt’snationwidenetworkof12,000 attorneys.

The2021costoftheplanforCVESDemployeesisonly$19.50permonthwithdeductionsbeginninginyourDecember2020paywarrant.Theplancoversyou,yourspouse,orregistereddomesticpartnerand your dependent children up to age 26. In addition to the fully covered services such as wills, trusts, real estate closings, debt collectiondefense, identity theft defense and trafficmatters, theplan alsoincludesunlimitedtelephoneadviceandofficeconsultationwithalocalattorney.Ifyouuseaparticipatingattorney, there are no claim forms or out-of-pocket expenses for attorney fees. Please note, you will need tocontactHyattat800-821-6400forapre-authorizationpriortoutilizingthebenefit.

IMPORTANTNOTE:Ifyouelecttoenroll,youmustremainenrolledforaminimumofonefullplanyear(12months).AdditionalinformationwillbeavailableattheBenefitsFairorontheDistrict’swebsiteunder“Employment/Benefits.”YoucanalsovisitHyatt’swebsiteatwww.legalplans.com

EASE — Employee Assistance PlanSometimes personal problems orwork challenges can prevent one from living life to its fullest. TheDistrictoffersEASE,a free,confidentialservicetohelpyouandyoureligible familymembersresolveyourpersonalorjob-relatedproblems.AllEASEservicesarestrictlyconfidentialandlegallymaynotbeshared with the District.

EASEspecialistsare licensed,trainedtherapistswhowillassessthenatureofyourproblem(s)duringone or several meetings with you, and assist you with brief problem solving if appropriate. If ongoing assistance is necessary, your referral options will be discussed with you. Any referral may involve charges which will be your responsibility.

PleasegethelpwhenyouneeditbycallingEASEat1-800-722-EASE(3273).


AFenroll® Enrollment InstructionsYour Online Enrollment

Chula Vista ESD Benefits EnrollmentOctober 12, 2020 - October 30, 2020

How to Login1. To access the online enrollment site, go to

www.afenroll.com/enrollCompatible with Safari, Edge, and Chrome.

2. At the login screen, you will enter the site using the following information:

• Type in your user ID:Your Employee ID

• Type in your PIN:The last four digits of your SSN and last two of your birth year. (For example, for SSN 123-45-6789 and birth year 1974, you would type in 678974).

3. Click the ‘Log On’ button.

Helpful Tips • Log Out: If you leave the site in the middle of the

process, click the ‘Log Out’ button to save yourselections.

• Print Confirmation: Be sure to print your confirmation.Once you confirm your enrollment, you may click onthe confirmation link at the bottom of the ‘Sign/SubmitComplete’ to print your confirmation statement.

• Re-Enter/Make Changes: You may re-enter theenrollment site (including to ‘View Only’ your originalselections) to make changes at any time during yourenrollment period. Please note: Before you exit thesystem, you must re-confirm with your PIN or yourenrollment will not be valid.

• Opting Out: If you choose not to select benefits,you must enter each product module and make thatchoice.

• Required: Social Security Numbers and Dates of Birthare required for all employees and their dependents.

• Adding Dependent: If you are adding a dependent asa beneficiary, their Social Security Number is required.

• Physician Codes: Have your Primary Care Physician(PCP) codes available.

• Signature: You will use your PIN to confirmapplications and your enrollment confirmation.

Changing Your PINYou will be asked to change your PIN and complete the security questions, after your initial login to the system. Enter a new PIN and confirm it on the next line. You may choose any combination of letters and numbers. Entering your PIN is the equivalent of your digital signature. Before you can complete your PIN change, you must select a security question, answer it, and provide your email address. This will allow you to reset your PIN if you forget it. Click the ‘Save New PIN’ button.


Important Items to Consider• Review your beneficiaries/dependents.

• Review all available benefit options, includingportable insurance plans that you may keep, even ifyou change jobs.

What You Need• Driver’s license

• Bank account information (if signing up for directdeposit)

• Spouse and children’s dates of birth and SocialSecurity Numbers

• Beneficiary information (and, if a trust, the full nameand date of trust)

To view a step-by-step video on how to enroll using AFenroll®, please visit americanfidelity.com/howtoenroll.

If you have questions or need help at any time during the online enrollment process, contact one of our American Fidelity account managers.

American FidelitySouthern California Branch Office36310 Inland Valley Drive, Suite 100Wildomar, CA 92595800-365-9180 ext. 0

Preparation Is KeyYou have a busy schedule, and we know your time is important. That’s why we offer several ways to educate you on the benefit options for you and your family.

• Watch for group meetings which may be available toupdate you on changes.

• Reach out to your American Fidelity accountmanager for any questions you may have.

If you prefer to make a virtual appointment with an American Fidelity Representative, please click the link below:

https://americanfidelity.com/chulavistaesd

AFenroll® Enrollment Instructions


ContactsVendorsVEBA 888-276-0250 619-278-0021www.vebaonline.com

Kaiser Member Services 800-464-4000 www.kp.org

United Healthcare (UHC) 888-586-6365 www.myuhc.com

Express Scripts 800-918-8011(mail order) 800-633-2662 www.expressscripts.com Optum Health (Chiropractic) Kaiser Members 800-428-6337UHC Members 888-586-6365 www.myoptumhealthphysicalhealthofca.com

SIMNSA 619-407-4082 www.simnsa.com Delta Dental PPO 888-335-8227 www.deltadentalins.com

United Concordia DHMO 866-357-3304 www.unitedconcordia.com

Medical Eye Services (MES) 800-877-6372 www.mesvison.com

Mutual of Omaha 800-775-8805 www.mutualofomaha.com

Best Doctors888-362-8677www.bestdoctors.com

The Standard 888-937-4783 www.standard.com

American Fidelity 800-365-9180 www.afadvantage.com

FBC Deferred Compensation 800-274-0503 ext 5 www.fbcretire.com

EASE 858-277-3273800-722-3273 Hyatt Metlaw Legal 800-821-6400 www.metlife.cominfo.legalplans.com

Risk Management StaffAnthony Carlton Director of Benefits/Risk Management

Wendy HuntHuman Resources – Tech V

Isabel Snyder Human Resources – Tech V

Ray LopezPersonnel/Risk Management/Data Analyst

619-425-9600 ext 1352

CHUL

A VISTA ELEMENTARY

SCHOOL DISTRIC

T

Chula Vista Elementary School District 84 East J Street, Chula Vista, CA 91910

www.cvesd.org

The Chula Vista Elementary School District is committed to providing a working and learning environment free from discrimination, harassment, intimidation and bullying. The District prohibits discrimination, harassment, intimidation and bullying based on race, color, ancestry, national origin, ethnic group identification, age, religion, marital or parental status, physical or mental disability, sex, sexual orientation, gender, gender identity or expression, genetic information; the perception of one or more of such characteristics, or association with a person or group with one or more of these actual or perceived characteristics in any program, practice or activity it conducts. For inquiries or complaints related to employee-to-employee, student-to-employee, or work/ employment related discrimination or harassment, contact: Human Resources Service and Support Department, Jeffrey Thiel, Ed.D., Assistant Superintendent/ Title IX Coordinator, 84 East J Street Chula Vista, CA 91910, [email protected], (619) 425-9600, Ext. 1340.

Documents

Open Enrollment 2021