Health Insurance Plans 2011-2012

We continue to have fully paid benefits!!  Thank you negotiating team!!

Most generic prescriptions can be filled with a 0% co-pay at COSTCO.


HANFORD ELEMENTARY SCHOOL DISTRICT

CERTIFICATED HEALTH INSURANCE PLANS

 

 

Medical/Prescription

 

Medical – Anthem Blue Cross

Claims & Inquiries:                         3335 S. Fairway

Visalia, CA  93277

Customer Service:                           1-800-662-5502

Group Number:                                40648A

www.anthem.com/ca/sisc

 

Network

Prudent Buyer PPO

Plan Type

PBC 80-D (80% Plan)

Calendar Year Deductible

$200 per individual/$500 per family

Co-Pay

$30 for office visits

Maximum Co-Insurance (Once the member’s 20% totals the maximum co-insurance, the plan will pay 100% of the allowable amount for the remainder of the calendar year)

$1,000/per individual, $3,000/per family

 

       

PRESCRIPTION – Medco

Medco Pharmacy (inquiries):          1-800-987-5241

MedCall (24 hr nurse info):             1-800-977-0027

www.medco.com

 

Deductible

$200 Brand Name Deductible

Co-Pays

Retail - $15 Generic / $50 Brand Name

Mail Order - $40 Generic / $135 Brand Name

 

 

EMPLOYEE ASSISTANCE PROGRAM (EAP)

BEHAVIORAL HEALTH PLAN (BHP)

EAP Services:                                  1-800-999-7222

 

Employee and all members of employee’s household – up to 6 sessions per problem situation

with EAP provider.  If the presenting problem requires more lengthy or specialized treatment,

then referred to a Behavioral Health Plan (BHP) provider

 

Dental

 

DENTAl – Stanislaus Dental Foundation

Claims & Inquiries:                         P.O. Box 576007                                                                                            

Modesto, CA  95357-6007      

Customer Service:                           1-800-962-7362

Group Number:                                751

http://www.stanislausmedicalsociety.com/

  

Network

PPO

Annual Maximum

$2,000.00

Incentive Plan

(The portion that Stanislaus pays increases to 80%, 90%, and 100%, respectively, during the second, third, and subsequent calendar years of a patient's eligibility, provided s/he has utilized the Program during the preceding calendar year)

70% / 80% / 90% / 100%

General Preventative Care – Major Dental Varies

Patient covered for 3 prophylaxis (cleanings) in a 12-month period

 

 

VISION

 

vision – Medical Eye Services (MES)

Claims & Inquiries:                         P.O. Box 25209                                                                                              

Santa Ana, CA  92799-5209

Customer Service:                           1-800-877-6372

Group Number:                                M93-M-C-001

www.mesvision.com

  

Network

PPO

Examination (every 12 months)

$5.00 Co-Pay

Frame Allowance (every 12 months)

$90.00 (member pays amount over allowance)

Cosmetic Contact Lenses – In lieu of frame and lenses (every 12 months)

$100.00 (member pays amount over allowance)

 

 

 

 

 

LIFE INSURANCE

 

GROUP LIFE INSURANCE – Blue Shield of California

Claims:                                            P.O. Box 7725                                                                                                

San Francisco, CA  94120       

Customer Service:                           1-888-800-2742

Group Number:                                38042

Policy Amount:                               

$50,000 (upon your death, payable to your beneficiary)

 

ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)

INSURANCE

 

AD&D INSURANCE – Prudential Insurance Company

Claims:                                            P.O. Box 13676                                                                                               Philadelphia, PA  19176 

Customer Service:                           1-800-778-3827

Group Number:                                AG-42393-CA

Policy Amount:                                $2,000 (employee-only, district-paid)

Additional Insurance:                     

Available upon employee enrollment, deducted from payroll check

on a post-tax basis

 

 

DISABILITY INSURANCE AVAILABLE THROUGH

CTA/THE STANDARD INSURANCE (not the District)

 

The Standard insurance COMPANY – CTA Benefits & Services

P.O. Box 2773

Portland, OR  97208       

http://www.standard.com/cta/

Customer Service:                           1-800-522-0406

Fax Number:                                    1-888-414-0390

Group Number:                                CT501239

 

ADDITIONAL LIFE AND AD&D INSURANCE PLANS ARE ALSO AVAILABLE

THROUGH THE STANDARD INSURANCE COMPANY – POST TAX PAYROLL DEDUCTION.

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