Frequently asked questions
WHEN DOES A NEW EMPLOYEE HAVE TO ENROLL IN BENEFITS AND HOW DO I ENROLL?
A new employee has 30 calendar days from their start date to enroll in health coverage. Coverage becomes effective the first of the month following the start date. It is the employee’s responsibility to call the Benefits Department to schedule a new hire benefits orientation. Your benefit options will be explained to you in this meeting. All new hires, including those previously employed at RUSD, must attend a new hire benefits orientation even if your intent is to waive benefits.
I JUST HAD A NEW BABY. HOW DO I ADD HIM/HER TO MY BENEFITS?
You have 30 calendar days from the date of birth of a newborn to add your baby to your plans. Proof of birth is required (i.e. souvenir copy of the birth certificate or hospital birth announcement letter usually provided in the Mother Wellness packet from your hospital). Please call the Benefits Department immediately to add your baby within this time frame. A certificated copy of the birth certificate will be required, but it’s not necessary right away. We will give you time to acquire this certificate after enrolling the baby.
I RECENTLY GOT DIVORCED. HOW DO I DROP MY SPOUSE FROM MY BENEFITS?
You must supply a copy of the final divorce decree that shows date of the divorce. We will drop your spouse when you supply this information to the Benefits Department. Please call the Benefits Department within 30 calendar days of the effective date of the divorce.
HOW DO I DETERMINE IF A PARTICULAR DOCTOR OR FACILITY IS COVERED UNDER MY PPO OR EPO PLAN?
Please see "How to Find a Doctor" for detailed instructions.
WHY DOES MY DOCTOR’S OFFICE ALWAYS WANT TO VERIFY COVERAGE WHEN I GO THERE, WHEN I HAVE AN ID CARD THAT SHOWS MY COVERAGE?
Medical Insurance fraud is a growing problem, and they are simply protecting their business. It is best if that the provider contact Lucent Health to verify your coverage. Also, some offices move too fast and simply see the “Anthem” logo on your ID card, and try to verify coverage via the Anthem web site or by calling Anthem. That will not work! It’s complicated, but has to do with the fact that the District EPO/PPO plans are self-insured, and we simply “rent” the Anthem provider networks – we are not insured by Anthem, so the doctor will not find you in Anthem’s system, but they will find you in our third party administrator’s system, Lucent Health. You may also download your ID on the NEW mobile app
WHAT IS “OPEN ENROLLMENT”?
Open Enrollment is the one time during each year that benefit-eligible employees may change their benefit plan choices and re-enroll in a different plan. This occurs once each year, and changes may not be made at any other time unless there is a “qualifying life event.” New employees do not have to wait for the annual Open Enrollment period, as they enroll shortly after start of employment.
WHEN IS OPEN ENROLLMENT?
Open Enrollment typically occurs in the Fall (Oct/Nov) each year for new benefits choices that would take effect on January 1st. The Benefits Department will send out emails to district email addresses with details and information.
WHAT IS A “QUALIFYING LIFE EVENT” (QLE)?
A change in your life that can make you eligible for a “Special Enrollment Period” that falls outside of Open Enrollment to enroll in health coverage. Examples include: moving to a new state, certain changes in your income (transfer from FT to PT or PT to FT status), changes in family size due to marriage, divorce or having a baby/legal guardianship/adoption (See Enrollment Rights and Required Documentation). If an employee had coverage through a spouse or parent and experiences a “loss of coverage”, proof of loss of coverage is needed (i.e a letter on company letterhead with affected covered member name and coverage termination date).
WHAT IS THE DEADLINE TO CHANGE (ENROLL IN OR DROP) HEALTH COVERAGE DUE TO A QLE?
An employee must notify the Benefits Department within 30 calendar days of the QLE. The effective date for dropping coverage is the last day of the month in which the qualifying event occurred, while the effective date of a change to new or different coverage is the qualifying event date. If the employee misses the 30 day window, they must wait for open enrollment period to enroll in health coverage. *Please note, dropping dependent(s) does not change your monthly payroll deduction, as the district premium rates are "composite rates" (see below)*
HOW DO I CHANGE MEDICAL AND/OR DENTAL PLANS?
You can only change medical and/or dental plans at open enrollment unless you’ve experienced a Qualifying Life Event, in which case you should contact the Benefits Department right away.
WHAT IS THE RATE FOR “EMPLOYEE ONLY” COVERAGE?
RUSD premiums (rates) are “Composite Rates,” which means that Employees will pay one rate regardless of how many dependents they have enrolled. We do not currently offer “tiered” rates for Employee only, Employee + Spouse, Employee + Children or Family, etc.
WHAT IF THE EMPLOYEE IS A 10 MONTH RATHER THAN 12 MONTH EMPLOYEE? HOW ARE BENEFIT PREMIUMS PAID?
All RUSD employees, regardless of whether they are a 10 or 12 month employee, pay benefit premiums on a 10thly payroll cycle. This means there are 10 payroll deductions out of the year with NO deductions in the months of JUNE or JULY and ARE fully covered year round.
I’VE HAD AN INCREASE OR DECREASE IN MY WORK HOURS. WHAT HAPPENS TO MY BENEFIT PAYROLL DEDUCTIONS?
If you have had an increase or decrease in hours that affects your benefit deductions, the Benefits Department will change your deductions. You do not need to do anything. The payroll deduction amounts for various work week hours are listed on page 10 of the Employee Benefits Guide .
WHEN WILL THE EMPLOYEE RECEIVE THEIR MEDICAL ID CARDS?
Typically about two weeks. Our insurance carriers and Third Party Administrators (TPA’s) receive a weekly electronic file feed that contains all employee benefits adds/changes/deletes from entries that the RUSD Benefits Department staff enters into our systems or that are entered into the online “AFenroll” system during Open Enrollment. It typically takes the carriers 24 to 48 business hours to update their systems. ID Cards will be mailed up to 10 business days following the carrier system update.
The employee can always call their Kaiser (VEBA) or PPO/EPO (Lucent Health) administrator for their Group# and ID# should they require it prior to receiving the actual ID card.
HOW LONG WILL MY CHILD DEPENDENT BE COVERED?
Child dependents are covered until age 26 and will be terminated from health coverage on the first of the month following their 26th birthday.
WHAT ARE “VOLUNTARY PRODUCTS”?
In addition to the standard medical and dental insurance offerings available at enrollment, employees may elect some non-standard, and optional (or “voluntary”) benefits. These may include extra life insurance, disability insurance, and specialty cancer, critical care and accident insurance products offered through either Pacific Educators or American Fidelity companies. There is an additional cost to the employee for choosing any of these products.
HOW ARE VOLUNTARY PRODUCTS PREMIUMS PAID?
Employees who enroll in voluntary products described above will have the additional premiums deducted from their paychecks. The premiums vary depending on which product or products are purchased. For American Fidelity products, premiums are deducted in the same month as the coverage is for, while premiums for Pacific Educators’ products are taken out a month in advance of the effective coverage date.
WHAT IS A FLEXIBLE SPENDING ACCOUNT?
Under Section 125 of the IRS code, employees are allowed to set aside additional income in Flexible Spending Accounts or “FSA” to reimburse additional out-of-pocket health and/or dependent care expenses that an employee, spouse or eligible child(ren) may incur during the course of the calendar year. The plan premiums are paid from 10thly payroll deductions on a pre-tax basis. This creates an income tax savings for the employee. The amount each employee may contribute to such accounts is limited by IRS regulations, and is subject to “use-it-or-lose-it” provisions, so it is important to carefully estimate your planned expenses in order not to lose your contributions at the end of the calendar year. At RUSD, Unreimbursed Medical Accounts with up to $500 of unused funds remaining at the end of a plan year can be rolled over on and reimbursed to plan participants for qualified medical expenses incurred during the following plan year. Funds over $500 left unused will be lost at the end of the year. Dependent Care Accounts have a "use it or lose it" rule. All funds remaining in this account are forfeited at the end of the year. *Important: This is a benefit that employees MUST renew and re-enroll every open enrollment period.*
WHAT IS “VEBA”?
VEBA is an acronym for Voluntary Employee Beneficiary Association. Such associations are trust funds permitted under US tax law, whose purpose must be to provide employee benefits. Locally, RUSD is associated with the California Schools VEBA, based out of San Diego. While this VEBA trust offers a variety of employee benefit plans, RUSD currently only purchases its Kaiser HMO plan, as we self-insure our other medical plans.
WHAT IS A “DEDUCTIBLE” AND HOW LONG DOES IT COMPARE TO A “CO-PAYMENT”?
A deductible is an amount you must pay each year for covered health care services before your medical plan begins to pay claims in that year (though some services are exempt from the deductible, depending on your plan). A co-payment is an amount (either a fixed dollar amount or a percentage of allowed charges) that you pay even after your deductible is met. For example, you may have met your deductible for the year, but you would still owe your plan’s $20 co-payment amount for each office visit.
WHAT IS MEANT BY “OUT-OF-POCKET MAXIMUM"?
This is the largest amount you would have to pay for covered services in a plan year, in the form of deductibles and co-pays, before your plan begins to pay 100% of allowed charges.
I’M ON A LEAVE OF ABSENCE. HOW DO I PAY FOR MY BENEFITS WHILE I’M NOT WORKING?
Call the Benefits office so we can discuss your options. Some leaves allow continuation of benefits, and other leaves do not.
I’VE RETIRED OR PLAN TO RETIRE SOON. WHAT DO I NEED TO DO TO CONTINUE MY BENEFITS?
Once the Personnel Dept. has notified the Benefits Dept. of your retirement, we will send you a letter asking you to call the Benefits Department and schedule an appointment to switch to retiree benefits. Please see the Retiree Benefits page for more information.
I’M RESIGNING. HOW DO I CONTINUE MY BENEFITS ON COBRA?
Once the Benefits Department has been notified of your termination, a COBRA letter will be mailed to you. If you want to enroll in COBRA, please call the Benefits Department to make an appointment to come in and fill out the appropriate paperwork.
WHO DO I CALL TO FILE A DISABILITY CLAIM?
You will need to call the company that you have your disability policy with to request a claim form. There are different companies that have disability plans. If you are not sure what company you have, you can call the Benefits Department for more information.
HOW DO I FILE A LIFE INSURANCE CLAIM?
Please contact the Benefits office to fill out the forms to request a payout of a life insurance (death) claim. You will also need a “certified” original copy of the death certificate to process the claim.
I WANT TO CHANGE MY BENEFICIARY ON MY LIFE INSURANCE. HOW DO I DO THAT?
You can change your life insurance beneficiary at any time during the year. You may either come into the Benefits Department to fill out a new beneficiary form or download the Beneficiary Change Form and return the completed form to the Benefits Department.
WHY WON'T THE DISTRICT CONTRIBUTE MORE TO MY MEDICAL PLAN, IF MY SPOUSE AND I ARE BOTH EMPLOYEES OF THE DISTRICT, AND ONE OF US IS WAIVING BENEFITS?
The short answer is that this is a negotiated item. There is a stipend available when both parties are RUSD employees and the one waiving benefits is certificated or management. The bottom line is that since both parties receive the same coverage under one partner’s insurance, there is little reason to raise the cost of insurance for everyone by allocating an unnecessary premium allowance for the second party who is already covered.