State Center Community College District Employee Benefits Guide for New Hires

Plan Year: October 1, 2017- September 30, 2018 This guide provides information for new hires about employee health benefits with State Center Community College District

(SCCCD).

Last revised 10/23/2017

Table of Contents New Hire Benefit Enrollment Checklist… ......................................................................................................................... 2 Welcome… .................................................................................................................................................................................. 3 Eligibility, Benefits Overview, and Costs… ....................................................................................................................... 4 Plan rates .. ................................................................................................................................................................................. 5 Dependent Eligibility Verification Memo…. .................................................................................................................... 6 Registered Domestic Partner Coverage Memo ............................................................................................................ 7 Medical Plans ............................................................................................................................................................................ 8 Medical Plan Comparison Chart … ............................................................................................................................. 9-10 Modern Care PPO Medical Plan Information… .......................................................................................................... 11 Bronze PPO Medical Plan Information .......................................................................................................................... 11 Kaiser HMO Medical Plans (High and Low) Information ........................................................................................ 12 Dental Insurance Plan .......................................................................................................................................................... 12 Vision Insurance Plan .......................................................................................................................................................... 13 Employee Assistance Program (EAP) ............................................................................................................................. 13 Group Term Basic Life Insurance & AD&D… .............................................................................................................. 14 Voluntary Long Term Disability Insurance ................................................................................................................... 15 Section 125 Flexible Spending Accounts… .................................................................................................................. 16 Voluntary Benefit Products ............................................................................................................................................... 17 Retirement and other benefits ......................................................................................................................................... 18 Annual Requirement Notices ........................................................................................................................................... 19 Resources ................................................................................................................................................................................. 20

New Hire Benefit Enrollment Checklist Review the benefits guide.

If you are enrolling in a PPO Plan:

Fill out the EdCare Group Enrollment Form electing your medical plan (Modern Care or Bronze), as well as the Dental and the Vision plans.

• Complete the dependent section if you are enrolling dependents. • Sign and date the form.

If you are enrolling in a Kaiser HMO Plan:

Fill out the Kaiser Permanente Group Enrollment Form electing your medical plan (High or Low plan).

• Complete the dependent section if you are enrolling dependents. • Sign and date the form.

Fill out the EdCare Group Enrollment Form electing the Dental and Vision plans. • Complete the dependent section if you are enrolling dependents. • Sign and date the form.

*Please note, the EdCare Group Enrollment form is required for all dental and vision enrollments. If you are enrolling in a PPO Plan, please only submit one EdCare Group enrollment form with all your health benefit elections (medical, dental and vision). All enrollment forms can be found under the New Employee Benefit Enrollment Section at www.scccd.edu/employeebenefits

Complete the Voluntary Long Term Disability Income Insurance Enrollment Form – Complete the employee sections of the form either electing or waiving the voluntary long-term disability insurance plan.

Complete the Life and AD&D Insurance Enrollment Form - Complete the employee sections of the form including the beneficiary information section.

Complete the American Fidelity pre-tax election form if you wish to pre-tax your employee payroll

deduction for the medical plan.

Contact American Fidelity at (559) 230- 2107 ext 0 if you wish to set-up a flexible spending account (medical care reimbursement or dependent day care reimbursement).

Contact the appropriate voluntary benefit vendor if you wish to sign up for any voluntary benefits. Gather your dependent supporting documents (such as certified marriage certificate, certified birth

certificate, etc).

Submit all Enrollment Forms, along with your supporting dependent eligibility documents, to the Office of Human Resources – Benefits Staff. We do request to see original copies, so if you are delivering in-person please bring your originals with you and we will make a copy for our records.

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Welcome! Welcome to State Center Community College District (SCCCD). As a new full-time employee, this guide will outline all of the health benefits SCCCD offers to assist you in determining which benefit offerings are best for you and your family members. As a benefits eligible employee, it is your responsibility to read this guide in its entirety to ensure the important deadlines and key actions contained within, and their impact on your benefits eligibility, are understood. Our Human Resources benefits staff members are here as a resource as well. You have 31 calendar days, including your date of hire, to complete and submit the benefits enrollment forms to the Benefits Office. **Please note, there is a no-opt out policy in place, which means all eligible employees must enroll in the medical, dental and vision plans. SCCCD does offer 2 medical plans with no monthly employee payroll deductions. **

The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. This guide does not constitute a guarantee of plan coverage or benefits; particular rules and eligibility requirements must be met before benefits can be received. While every effort was taken to accurately report the benefit options, discrepancies or errors are always possible. In case of discrepancy between this guide and the actual plan documents, the actual plan documents will prevail. The benefits of all employees, eligible dependents, and plan beneficiaries are subject to change. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about your Guide, contact the Human Resources - Benefits staff at (559) 244-5933 or (559) 244-5992.

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Eligibility, Benefits Overview and Costs State Center Community College District (“SCCCD”) strives to provide you and your family with a comprehensive and valuable benefits package. We want to make sure you are aware of what benefits are offered, how they work, and the costs associated, to help you and your family maintain a healthy lifestyle. Plan Year SCCCD’s health benefits plan year runs from October 1, 2017 through September 30, 2018. However, the deductible, the out of pocket maximum, and the coinsurance renew every January 1st. Who is Eligible?

Full-time management employees Full-time confidential employees Classified employees working 20 or more hours per week Full-time faculty employees and their eligible dependent(s).

Dependents include:

Legally married Spouse Registered Domestic Partner (as outlined in the Summary Plan Description) Child(ren) – A “child” is a natural biological child, adopted child, step-child, and a child for whom plan coverage is

required due to a medical support order. Dependent children are eligible to continue on the health plans coverage up until the age of 26. Disabled child(ren) age 26 and older who meet the plan criteria. If you have a disabled child who is 26 or older

and you wish to enroll them on the plans, please contact Jennifer Samarin, Benefits Assistant, at (559) 244-5992. An eligible dependent does not include: a spouse following legal separation or a final decree of dissolution of marriage or divorce; any person who is on active duty in a military service, to the extent permitted by law. When do benefits begin? CSEA and POA bargaining unit members –after completing all enrollment requirements, your medical and Employee Assistance Program (EAP) benefits begin the first of the month following your date of hire. Dental, vision and life insurance will begin after the first of the month following completion of six months of service. SCFT bargaining unit members, confidential, and management employees – after completing all enrollment requirements, all of your health benefits (medical, dental, vision, life and employee assistance program) begin the first of the month following your date of hire. What health benefits are offered?

Four (4) Medical Plan Options – Modern Care PPO, Bronze PPO, Kaiser HMO High Plan, Kaiser DHMO Low Plan. Ameritas PPO Dental Plan VSP Vision Plan Halcyon Behavioral Employee Assistance Program (EAP) VOYA Group Life Insurance VOYA Voluntary Long-Term Disability Insurance Voluntary Products and Benefits

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2017-2018 Plan Rates The district contribution toward the medical benefit is $1,029 per month, per employee. The district pays the premiums in full for dental, life, vision and EAP insurance plans. There is no additional cost to add dependents to your medical, dental, vision, life and EAP insurance plans.

Medical Plan Monthly Employee Payroll Deduction

Modern Care PPO $73* Bronze PPO $0 Kaiser High HMO $616.29* Kaiser Low DHMO $0

* Note: You may have the deduction made on a pre-tax basis by enrolling in an American Fidelity Section 125 plan.

Benefit Plan Monthly Employee Payroll Deduction Ameritas PPO Dental Plan $0 (100% paid by District) VSP Vision Plan $0 (100% paid by District) Basic Life Insurance and AD&D Insurance

$0 (100% paid by District)

Employee Assistance Program (EAP) $0 (100% paid by District)

Voluntary Products Monthly Employee Payroll Deduction Voluntary Long-Term Disability Insurance

Rates vary, 100% paid by employee

Section 125/Flexible Spending Accounts

Rates vary, 100% paid by employee

AFLAC Voluntary Products Rates vary, 100% paid by employee American Fidelity Voluntary Products Rates vary, 100% paid by employee

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State Center Community College District Office of Human Resources/Benefits 1525 E. Weldon Avenue Fresno, CA 93704

Memorandum

TO: All New, Health Benefit Eligible Employees DATE: October 19, 2017

FROM: Frances Garza, Benefits Coordinator

RE: Dependent Eligibility Verification for Health Benefit Enrollment

This is to inform all benefit-eligible employees that State Center Community College District (SCCCD) will require dependent eligibility verification in order to enroll a dependent spouse, registered domestic partner, and/or children in the District-sponsored health insurance benefits. All employees will be required to provide a copy of the following when submitting benefit enrollment forms:

Legally Married Spouse

• Original, certified marriage certificate and

• Social Security card Registered Domestic Partner*

• Affidavit or copy of Declaration of Domestic Partnership with the California Secretary of State and

• Social Security card Biological Child(ren)

• Original, certified copy of the birth certificate(s) naming employee as child’s biological parent and

• Social Security card(s) Step-child(ren) • Original, certified copy of the birth certificate(s) naming current

legally, married spouse as the child’s biological parent. Applicable spouse documentation required as well. and

• Social Security card(s) Foster Child, Legal Guardianship, or Grandchildren

• Original, certified birth certificate(s), along with court papers showing legal responsibility and/or guardianship of the child(ren) and

• Social Security card(s) *Registered Domestic Partner eligibility guidelines per the EdCare Summary Plan Document and/or Kaiser Evidence of Coverage must be met. You must submit the appropriate dependent verification documents for each dependent you wish to enroll along with your benefit enrollment forms within your 31-calendar day enrollment period (please note, this includes your date of hire). Please submit all documents and forms to the Office of Human Resources – Benefits Staff at 1525 E. Weldon Ave, Fresno, CA 93704.

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State Center Community College District

Office of Human Resources/Benefits 1525 E. Weldon Avenue Fresno, CA 93704

Memorandum

TO: All Benefit Eligible Employees DATE: October 19, 2017

FROM: Frances Garza, Benefits Coordinator

RE: Registered Domestic Partner Coverage On Health Benefits

Registered Domestic partners may be added to your health plans during your initial enrollment or during the annual benefits open enrollment period. Upon meeting the following requirements, registered domestic partner coverage is available on all the health plans (medical, dental and vision):

• Both persons filed a declaration of Domestic Partnership with the Secretary of State, and are

able to present a Certificate of Registered Domestic Partnership at time of enrollment. • Both persons have a common residence. It is not necessary that the legal right to possess the

residence be in both of their names. • Neither person is married to someone else or is a member of another domestic partnership with

someone else that has not been terminated, dissolved or annulled. • The two persons are not related by blood in any way that would prevent them from being

married to each other in California. • Both persons are at least 18 years of age. • Both persons are capable of consenting to the domestic partnership. • Either of the following is true:

o Both persons are of the same sex, or o The domestic partner is of the opposite sex and one or both persons are over age 62 and

also meet the eligibility criteria for Medicare benefits. To obtain further information on the Domestic Partners Registry, please visit the California Domestic Partners Registry page at http://www.sos.ca.gov/dpregistry/. To obtain further information regarding the health plan requirements, please contact the Office of Human Resources – Benefits Staff at (559) 244-5992 or (559) 244-5933.

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MEDICAL PLANS

The following pages will highlight the important features of the 2017-2018 medical plans. The information contained within this guide is a summary of benefits. We encourage you to review the summary plan document and/or evidence of coverage for all plans which may be found at www.scccd.edu/employeebenefits. Please contact the Human Resources benefits staff members should you have questions. There are four (4) Medical Plan Options to choose from - Modern Care PPO, Bronze PPO, Kaiser HMO High Plan, Kaiser DHMO Low Plan. Important features of the medical plans PPO Medical Plans:

The PPO health plans are self-insured by SCCCD and administered by Delta Health Systems. The PPO plans use the Anthem Blue Cross provider network nationwide. When you enroll, you do not need to choose a primary care physician; however, it is recommended you choose a

primary doctor to guide your care. With a PPO, each time you need care, you choose whether to receive your care from a PPO (in-network) or non-

PPO provider (out-of-network). If you choose to go to a non-PPO provider (out-of-network), you will pay for a larger portion of your billed

service. No referral is needed to see a specialist, although precertification may be required.

Kaiser HMO Medical Plans:

The HMO health plans are fully insured plans administered through Kaiser Permanente. • Kaiser members receive comprehensive health care at Kaiser medical group in their specific region. • Kaiser members of SCCCD are considered part of Kaiser’s Northern region. • Kaiser does not offer out-of-network benefits.

Terms to know and understand: Deductible – a fixed annual dollar amount that you pay out-of-pocket during the calendar year, toward health care services before the medical plan begins to pay. Details on the services that first require satisfying the deductible are outlined in this guide and in the summary plan document/evidence of coverage. Coinsurance – A fixed percentage of covered services or prescription drug costs that you pay, after the deductible amount (if any) was paid. The medical plan pays the rest. Out-of-pocket maximum – The most you will pay before the medical plan begins to pay 100% of covered charges. In-network – Health Care Professionals and facilities that have contracts with the medical plan to deliver services at a negotiated rate (discount). You pay a lower amount for those services. Out-of-network – A health care professional or facility that does not participate in your plan’s network and doesn’t provide services at a negotiated rate. Using an out-of-network health care professional or facility will cost you more.

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MEDICAL PLANS –

MODERN CARE AND BRONZE PPO PLANS

SCCCD offers two PPO medical plans - the Modern Care PPO plan and the Bronze PPO plan. Become familiar with what services and benefits the PPO plans cover and do not cover by reviewing the summary plan document which can be found at www.scccd.edu/employeebenefits. Common services not covered under the PPO Plans are learning & behavioral disorders, acupuncture, cosmetic surgery, exercise equipment/health clubs, and hearing aids, just to name a few. If you or a dependent has a medical condition or treatment that you wish to see if it is a covered benefit prior to selecting a PPO health plan, please contact Jennifer Samarin, Benefits Assistant, at (559) 244-5992. Highlighted Benefits under the PPO Health Plans

• Baby Connect – Baby Connect is a new benefit provided at no cost to all Modern Care and Bronze PPO members to provide professional support from a Maternity specialist throughout pregnancy and through post-partum.

• LiveHealth Online – LiveHealth Online is a telemedicine benefit which allows you to talk with a medical doctor

through a mobile device or a computer/laptop using video and audio calling service (such as FaceTime or Skype). You can receive a diagnosis; have a prescription written for non-chronic conditions; or, get general medical advice. This service is available 24/7 for all Modern Care and Bronze PPO members enrolled. There is no cost or copay to you and your families to access this benefit.

• Mental Health & Substance Abuse – All mental health and substance abuse benefits are administered by Halcyon

Behavioral. Halcyon Behavioral has its own network of providers.

• Chiropractic – Chiropractic benefits are administered by PhysMetrics (formerly known as ChiroMetrics). PhysMetrics has its own network of providers.

• Integrated Prescription Management (IPM) - Integrated Prescription Management (IPM) is the prescription drug vendor for both the Modern Care and Bronze plans. There is a drug formulary in place and three price tiers. There are also some prescriptions that may fall under the step therapy requirement and/or prior authorization requirement. For more information please review the listings at www.scccd.edu/employeebenefits.

• Maintenance Prescription Drugs Mail Order Requirement - The Modern Care and Bronze plans require all maintenance drugs to go through the mail order program after 2 fills at the retail pharmacy. Maintenance drugs are medications taken for an extended period of time, usually for chronic, on-going conditions. Maintenance drug mail orders can be set up through BK Pharmacy or your designated Walgreens.

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MEDICAL PLANS – KAISER HMO PLANS SCCCD offers two Kaiser Permanente medical plans, the Kaiser High HMO plan and the Kaiser Low DHMO plan. Become familiar with what services and benefits the Kaiser HMO plans cover and do not cover by reviewing the Evidence of Coverages which can be found at www.scccd.edu/employeebenefits. Highlighted Benefits under the Kaiser HMO Health Plans

• Kaiser members can access a telemedicine video chat option with a Kaiser doctor by using a smartphone or other mobile device.

• Kaiser members can access account information through the Kaiser Permanente mobile app. You can email your doctor’s office, view test results, refill your prescriptions, etc.

• Kaiser members are eligible for Wellness Coaching at no extra charge. Wellness coaching gives members personal guidance to help achieve wellness goals.

DENTAL INSURANCE PLAN

All benefit-eligible employees and their eligible dependents can enroll in the district sponsored dental plan through Ameritas PPO. With the Ameritas PPO plan, each time you need dental care, you choose whether to receive your care from a PPO (in-network) or non-PPO provider (out-of-network). If you choose to go to a non-PPO provider (out-of-network), you will pay for a larger portion of your billed service.

This is an incentive-level plan, with all employees and dependents starting at the 70% incentive level. Tier levels are 70%, 80%, 90% and 100%. Employees and dependents must use the plan once per year in order for the incentive level to move to the next tier.

$0 deductible Maximum calendar year benefits: The plan pays up to $1,500 per year, per member. In-network discounts: to find out if your dentist is in the Ameritas PPO network, search the directory at

https://ameritas-dental.prismisp.com/

Coverage summary (please see actual summary plan document for full benefit information). Diagnostic/Preventative Services Basic Services Major Services Orthodontia Services

Incentive Level - starting at the 70% incentive level

Incentive Level - starting at the 70% incentive level

Covered at 50% Covered at 50% with lifetime benefit of $1250

For more information including summary plan document visit: www.scccd.edu/employeebenefits

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VISION INSURANCE PLAN

The District offers a vision plan through VSP for eligible employees and eligible dependents at no premium cost. The plan will provide benefits, up to the amounts shown below, for the vision services and supplies that are listed.

This is a summary of benefits only for in-network providers. Please refer to contract for details.

Copay $10 for examinations and prescription glasses

Exams Once every 12 months.

Contact Lenses (in lieu of glasses)

Once every 12 months. $130 allowance for contact lenses. Fitting and evaluation not included in allowance. May pay up to $60 for fitting/evaluation.

Lenses for Glasses (per pair)

One pair every 12 months. Single vision, lined bifocal and lined trifocal lenses covered 100%. Various co-pays apply to lens enhancements.

Frames One pair every 24 months. Participating provider allowance of $170.

Primary Eyecare Treatment and diagnosis of eye conditions like pink eye, vision loss and monitoring of cataracts, glaucoma and diabetic retinopathy. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details. $20 co-pay.

Employee Assistance Program (EAP)

The Employee Assistance Program (EAP) is offered through Halcyon Behavioral. EAP is a confidential counseling service available to eligible district employees and anyone within the eligible employee’s household. Eligible employees and members of their households are allowed 6 free sessions per year, per issue. The EAP plan can be used 24 hours a day, 7 days a week. Halcyon EAP also offers referrals, consultations, web-based services and other resources. Legal assist, financial assist, family assist, estate guidance, elder and adult care referrals, and identity theft recovery, are just some of the services Halcyon EAP covers. Halcyon EAP information, webinars, resources, and providers can be found at www.halcyoneap.com/. Username is edcare. Halcyon EAP customer service for benefit or claims questions is 888-425-4800.

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GROUP TERM BASIC LIFE INSURANCE AND

ACCIDENTIAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE

SCCCD provides employer-paid Group Term Basic Life Insurance and AD&D insurance for benefit eligible employees. The employer-paid life insurance and AD&D is offered through VOYA Financial. Summary of Benefits SCCCD provides $50,000 of basic life and AD&D insurance to you, the employee, and $5,000 of coverage for your enrolled dependent(s) at no cost to you! Management and Confidential Employees also receive an additional employer-paid, age-based benefit under the life insurance plan. Contact the Human Resources Benefits staff for details.

VOYA also offers the following added benefits to eligible employees and their eligible dependents at no charge.

For more information, please visit www.scccd.edu/employeebenefits

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VOLUNTARY LONG TERM DISABILITY INSURANCE SCCCD provides all benefit eligible employees the opportunity to purchase voluntary long term disability (LTD) insurance coverage offered through VOYA. All individuals who apply during their initial enrollment period (31-days from date of hire) are guaranteed acceptance. Individuals who apply during any annual benefits open enrollment period are not guaranteed coverage and will need to go through an Evidence of Insurability (EOI) Questionnaire subject to approval. Summary of Benefits If an employee is covered under the Voluntary LTD insurance plan, should he/she be determined to be totally disabled, completely and continuously unable to perform each of the essential functions of his or her occupation, and requires the regular care and attendance of a physician, he/she may apply for a monthly disability benefit of 60%, up to a maximum $5,000, of eligible income in accordance to the Long-Term Disability Summary Plan Document.

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2017-2018 SECTION 125 FLEXIBLE SPENDING ACCOUNTS Section 125 plan year: October 1, 2017 through September 30, 2018 What is a Section 125 flexible spending account? Section 125 Flexible Spending Accounts (FSA) are governed by the IRS and allow eligible employees to deduct their employee payroll deduction toward the medical plan pre-taxed, as well as set aside pre-tax funds to use toward approved out-of-pocket medical, dental and vision expenses as well as dependent day care expenses. What does it mean to have your employee payroll deduction toward the medical plan pre-taxed? Since your medical insurance premium is taken out of your paycheck every month, you may elect to have the deduction come out pre-taxed, which means your income is decreased by the amount of your premium and you could pay less in taxes. EXAMPLE OF SECTION 125 PRE-TAXING AND YOUR PAYCHECK:

What is a Dependent Day Care Flexible Spending Account? Dependent Day Care FSAs allow you to contribute pre-tax dollars to qualified dependent care. The maximum amount you may contribute each year is $5,000 (or $2,500 if married and filing separately). A Dependent Day Care FSA is used to reimburse yourself for eligible dependent care expenses incurred. What is an unreimbursed Medical Account? Unreimbursed Medical Accounts may be used to reimburse yourself for eligible medical, dental, and vision expenses incurred for yourself and your dependents on the health plans. This could include copays, deductibles, prescriptions, glasses, contacts, as well as other expenses allowable under Section 125 guidelines. The maximum amount you may contribute each year is $2,500. The district’s administrator for the Section 125 FSA plans is American Fidelity (AFA). Please note: Any unspent deferrals in the FSA plans at the end of the plan year will be forfeited. This is known as the “use it or lose it rule” and is part of the IRS regulations governing the plans. How do I enroll to have my employee payroll deduction for the medical plan pre-taxed? Complete the American Fidelity Election Form for pre-taxing and return to the Benefits Office within 31-days from date of hire. How do I enroll in a Medical Flexible Spending Account (FSA) or Dependent day care flexible spending account (FSA)? You must contact American Fidelity at (559) 230-2107 ext 0 to schedule your appointment. Enrollment in an FSA must be done within 31 days from date of hire. Otherwise your next opportunity to enroll is during the annual benefits open enrollment period.

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VOLUNTARY BENEFIT PRODUCTS There are several voluntary products that are available for regular, benefit eligible employees through payroll deductions. Voluntary products include life insurance, accident insurance, tax sheltered annuities (403(b) and 457 plans), and other voluntary products. If you are interested in enrolling for a voluntary benefit, please contact the vendor directly.

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Retirement and Other Benefits

Full-time employees of SCCCD contribute into a retirement system. There are two retirement systems that employees may participate in, CalPERS and CalSTRS. If you are not sure which system are you apart of or you have questions, please contact Payroll at (559) 244-5900.

Elective Retirement Savings Plans

For additional retirement savings, we make available 403(b) tax-sheltered annuity (TSA) and 457 deferred compensation plans to all employees. Both plans consist of pretax contributions and tax-deferred earnings. Please call TCG Administrators at (800) 943-9179 or refer to www.CalSTRS403bComply.com for our 403(b) Plan information, including a list of our approved vendors.

Leaves Classified Employees may be entitled to different leaves based on the CSEA bargaining unit contract. For more information on the leaves offered, including vacation, sick, jury duty, bereavement, FMLA, etc., please refer to your CSEA bargaining unit contract or contact Human Resources at (559) 244-5900. Police Officers Association Employees may be entitled to different leaves based on the POA bargaining unit contract. For more information on the leaves offered, including vacation, sick, jury duty, bereavement, FMLA, etc., please refer to your POA bargaining unit contract or contact Human Resources at (559) 244-5900. Faculty Employees may be entitled to different leaves based on the SCFT bargaining unit contract. For more information on the leaves offered, including sick, jury duty, bereavement, FMLA, etc., please refer to your SCFT bargaining unit contract or contact Human Resources at (559) 244-5900. Management/Confidential employees may be entitled to different leaves based on Board Policies, Administrative Regulations and/or Personnel Commission Rules. For more information on the leaves offered, including vacation, sick, jury duty, bereavement, FMLA, etc., please refer to the Board Policies, Administrative Regulations, and/or Personnel Commission Rules or contact Human Resources at (559) 244-5900.

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Annual Required Notices COBRA General (Initial) – The Consolidated Omnibus Budget Reconciliation Act (COBRA) requires group health plans to offer continuation coverage to covered employees, former employees, spouses, former spouses, and dependent children when group health coverage would otherwise be lost due to certain specific events. Those events include the death of a covered employee, termination or reduction in the hours of a covered employee’s employment for reasons other than gross misconduct, a covered employee’s becoming entitled to Medicare, divorce or legal separation of a covered employee and spouse, and a child’s loss of dependent status (and therefore coverage) under the plan. COBRA sets rules for how and when continuation coverage must be offered and provided, how employees and their families may elect continuation coverage, and what circumstances justify terminating continuation coverage. Employers may require individuals to pay for COBRA continuation coverage. The premium that is charged cannot exceed the full cost of the coverage, plus a 2 percent administration charge. Please visit: www.scccd.edu/employeebenefits for more information. Creditable Coverage - Medicare Part D Notice – The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. For more information please visit: www.scccd.edu/employeebenefits CHIPRA Notice - If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW (877-543-7669) or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. Women’s Health & Cancer Rights Act (WHCRA) notice - Do you know that your health plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema? Review your summary plan document/evidence of coverage or call your insurance plan for more information. Summary plan documents and Evidence of Coverage documents can be found at www.scccd.edu/employeebenefits. Newborns and Mothers Health Protection Act - Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean delivery. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

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Resources SCCCD Human Resources – Benefits Staff For questions on enrolling in benefits - Benefits Assistant Phone: (559) 244-5992 Benefits Coordinator Phone: (559) 244-5933 Main line: (559) 244-5900 Fax: (559) 499-6006 Website: www.scccd.edu/employeebenefits Modern Care and Bronze PPO Plan Resources Claims, Explanation of Benefits Questions - Delta Health Systems (DHS) (800) 422-6099 DHS Member website: https://www.deltahealthsystems.com/home/login_member.php Integrated Prescription Management (IPM) prescription drug vendor - (877) 860-8846 IPM website (view claims, formulary, copays): https://www.rxipm.com/#Home Kaiser Permanent HMO Plan Resources Customer Service, claims, explanation of benefits questions - Kaiser Permanente (800) 464-4000 Member website: www.kp.org Dental Plan Resources Claims, Explanation of Benefits Questions - Administrative Solutions Inc./Ameritas (800) 487-5553 Find a provider: https://ameritas-dental.prismisp.com/ Vision Plan Resources Eligibility, claims, explanation of benefits questions – VSP (800) 877-7195 Member website: www.vsp.com Employee Assistance Program Resources Halcyon EAP (888) 425-4800 Website: www.halcyoneap.com (username log in: edcare) Section 125/Flexible Spending Accounts American Fidelity (559) 230-2107 ext 0 or (866 ) 504-0010 ext 0 Website: www.afadvantage.com