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Self-Insured Schools of California:

Schools Helping Schools

SISC Health Benefits Program Information for

Peralta Community College District

Presented October 11, 2012 by Lola Nickell, SISC Account Manager

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Self-Insured Schools of California SISC - Who We Are

• Not-For-Profit Joint Powers Authority (JPA) established in 1979, administered by the Kern County Office of Education. – SISC administrative personnel are employees of the public

school system.• SISC III is one of the largest school focused health care

purchasing pools in California.– Current statewide membership is over 200,000 lives from

over 380 school districts in 39 counties• A JPA governed by a Board of Directors

– Like school districts, SISC is subject to the Brown Act.– Our Board of Directors are employees of school districts and

are elected by member districts.

Our Philosophy – “Schools Helping Schools”

The SISC Advantage

• Under SISC, districts may select from a wide range of medical, dental, vision, and life plan product offerings to customize a comprehensive benefit package for employees.

• Strong financial standing with stabilization reserves. Claims liability fully funded.

• Long term health benefits solution: 220+ districts in SISC III for at least 10 years.

• Continued growth: 150+ school districts have joined in the last 10 years.

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SISC: Carriers & Products

We offer a wide range of health benefits through major carriers; PPO’s, HMO’s, Rx, Dental, Vision and Life.

– Anthem Blue Cross (Self-funded PPO and fully insured HMO)– Blue Shield (Self-funded PPO and fully insured HMO)

• Pharmacy Benefits through Express Scripts (Non-HSA plans)

– Kaiser Permanente– Delta Dental (Premier and PPO Plans)– Vision – VSP and MES– Life - Mutual of Omaha

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SISC Medical Plan Options

• HMO Plan Options– Kaiser Permanente, Anthem Blue Cross, Blue Shield– Must live/work within defined service area

• Self Funded PPO– 19 Medical + 2 HSA Compatible Options– SISC Plan Design with Anthem Blue Cross or Blue Shield of California

Out of Network services paid at Non-Par Fee Schedule (except emergencies)

No annual Out of Pocket maximum on OON expenses – Blue on Blue Rules– Outside California: BlueCard network (BCBSA)

• General Information– No waiting periods, no pre-existing limitations– Deductibles run January to December– 4th Quarter Deductible Carryover on non-HSA PPO plans

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Outpatient Rx: Anthem & Blue Shield

PPO & HMO Plans

• Outpatient prescription drug coverage through Express Scripts (Except HSA Plans)

• SISC Express Scripts Rx Plan Enhancements:– Costco $0 Co-Pay Program for Generic Drugs– Costco Membership is not required; Excludes some categories:

narcotic pain and some cough medications

– Generic Co-Pays for Diabetic Supplies– The generic co-payment will be charged on brand only Diabetic

supplies (lancets, test strips and syringes)

– Maximum 30 Days Supply at Retail Pharmacies. Most pharmacies are in-network EXCEPT Walgreens

– 90 Days supply available with Mail-Order through Express Scripts

Dental & Vision Plans

• Delta Dental Plan– Can offer dual choice to include a Premier (Incentive) Plan and a

PPO Plan– All medical plan options must include same dental plan(s)– Those employees enrolling in medical must enroll in dental– Implants are covered benefit

• Vision Service Plan– All medical plan options must include same vision plan– All employees enrolling in medical must enroll in vision

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Value Added Services

For Members:• Health Smarts- A robust Health Improvement Program

– Includes: Periodic on site biometric screenings and on site flu shot clinic at no charge to member or district

– Most Recent Program: Awards up to $150 for participation in online health improvement program; all SISC members age 18+ eligible

• SISC Employee Assistance Program (EAP)– Resources for Managers and Supervisors– Voluntary, No cost to use EAP, Available 24 hours /7 days per

week– Confidential service by Licensed Professionals

• SISC Section 125 Plan – No participation fees for Employee or District

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Value Added Services

For Districts: • No-Cost Administration Services include:

– COBRA – Section 125 Flex Plan– Self-pay Individual Retiree Direct Bill program

• Low Cost Administration Services– Retiree Drug Subsidy (RDS) - Optional

• SISC has collected $7 million for districts since 2006• SISC charges $30 per member for annual application • Application fees not charged until subsidy received

• Other Administrative Services May Be Offered– Example: Early Retiree Reinsurance Program (ERRP)

• SISC filed for ERRP monies on behalf of member districts• Funds paid as of January 2012 totaled $27.5 million (29th largest) • ERRP funds applied to offset renewal increases

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Program Options and Eligibility• Plan Choices – Work with SISC to select a maximum of 6 plans for

each employee group (plan options subject to underwriting approval)

• Benefit selections may be unique to three groups: Confidential & Management, Classified, Certificated

• Eligibility for domestic partners is as stated under AB205 unless the district requests that eligibility be extended to opposite sex domestic partners (a negotiated benefit)

• Eligible Dependents include: legal spouse, DP; Child/Child of DP: natural child, step-child, legally adopted child to age 26; a child for whom the member has legal guardianship to age 18. Disabled overage child who is a dependent for federal income tax purposes and who has been accepted through carrier application process.

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Participation Requirements

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WHO MUST ENROLL IN COVERAGE

• All employees who work 90% or more of the full-time equivalent for the applicable job classification are required to participate in all health benefits offered by the district

WHO MAY DECLINE COVERAGE

•  An eligible employee who works less than 90% of the full-time equivalent for the applicable job classification or receives less than 90% of the amount that is contributed towards an eight-hour full-time employee may enroll when first eligible or decline coverage. If they enroll, they must enroll in all coverage offered through SISC.

• Any deviation from SISC Underwriting Guidelines must be requested in writing by the school district and approved in writing by SISC prior to joining.

Retirees

• Must enroll at initial enrollment, no re-entry once coverage terminates• May select from medical plans offered to active employees of

bargaining unit from which they retired

All Retirees must be enrolled in Medicare Parts A&B, otherwise costly monthly surcharges will apply.• Retirees with Medicare A&B may choose instead to enroll SISC

Individual Retiree Medical Plan Options – All include Medicare Part D Rx with no donut hole– Kaiser Permanente Senior Advantage Plan $324 Single– Blue Shield Mediare Advantage Plan $354 Single

• Retiree must reside in Advantage Plan Service Area– CompanionCare – SISC Medicare Supplement $373 Single

• Plan is claim free when services are received from providers who accept Medicare Assignment. No residence limits.

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Joining SISC: Timing & Action Items

SISC Rates are effective October 1-September 30• Renewing districts receive 2013-14 rates by early May• Districts may join SISC with a the first of the month effective

date, with 60 days advance noticeDepending on effective date, initial rate period maybe short or long.

• Example 1: Joining SISC January 1, 2013: Rates quoted will remain in effect to September 30, 2013

• Example 2: Joining SISC July 1, 2013:Rates quoted will remain in effect to September 30, 2014

• SISC Underwriting will provide list of items required for quote, and quote delivery timeline. Quote delivery typically takes place after district receives KP renewal.

• Initial commitment is 3 years per JPA agreement• Withdrawal from program – written notice must be received by

August 15 for October 1 effective date

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Joining SISC: Timing & Action Items

• Signed SISC JPA Agreement & Bylaws, Plan choice selections will be required 60 days in advance

• SISC will coordinate with District and Carriers to provides Open Enrollment meetings for Active and Retiree members

• Required: Submission of signed, completed enrollment forms (fillable pdf)– Dependent eligibility documentation required (copies

of birth & marriage certificates, DP registration forms, legal custody docs, etc.)

• Support available for members currently in course of care at time of transition

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Questions?

Peralta CCD Committee Members:

Thank you for your interest in SISC.

Lola Nickell

SISC Account Manager

lonickell@kern.org

661-636-4669

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