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	Author:   Drake Lewis   Posted: 12/8/2008; 8:43:57 AM Topic: Home Msg #: 1 (top msg in thread) Prev/Next: /2 Reads: 64866 2012 Open Enrollment 2012 OE Workshop Flyer Actives 2012 OE Workshop Flyer Retirees 2012 FHDA Benefits Guide 2012 CalPERS Plan Changes FAQs 2012 CalPERS and Health Partners Presentations 1) CalPERS Health Webinar Introduction: http://www.youtube.com/watch?v=13Gz0Sl0uBc&;list=UUWHcVDsYvL_xcRjarkRlqoQ&index=17&feature=plcp 2) Anthem Blue Cross & CVS Caremark Presentation: http://www.youtube.com/watch?v=M1ykedJQRis&;feature=relmfu 3) Blue Shield of CA Presentation: http://www.youtube.com/watch?v=IbLESgLLSm8&;feature=context&context=C41b8d1bVDvjVQa1PpcFObBtsQ3v-7GE7P6BrA_MQtUNi1uYEv8l4= 4) Kaiser Permanente Presentation: http://www.youtube.com/watch?v=5mIlPyl1N1o&;feature=plcp&context=C41b8d1bVDvjVQa1PpcFObBtsQ3v-7GE7P6BrA_MQtUNi1uYEv8l4%3D. 5) CalPERS Health Webinar Conclusion: http://www.youtube.com/watch?v=ZNEq1hXPSME&;feature=relmfu Benefits Enrollment Period is scheduled from April 15 through 5pm, May 15, 2012. Mandatory Online Enrollment via iElect.com is necessary for those that are Full - Time Employees and currently enrolled Part - Time Faculty Enrolling for CalPERS coverage for the first time Adding/deleting dependents Participating in the Section 125 Cafeteria Plan Open Enrollment changes and their respective effective dates: Enrolling in a CalPERS medical plan for the first time, July 1, 2012 Changes to existing health insurance, July 1, 2012 Adding dependents, July 1, 2012 Deleting dependents, June 30, 2012 Participating in the Section 125 Cafeteria Plan - Full Time Employees only, July 1, 2012 2012 CalPERS Health Benefit Rates       CalPERS Health Benefit Rates - Bay Area 2012 Benefit Comparison Grid       HMO Benefits Grid       PPO Benefits Grid - Active       PPO Benefits Grid - Retiree How to enroll for Benefits online via iElect.com (Only for FT Active and currently enrolled PTF)              1) Log on to www.iElect.com              2) Enter Employer: FHDA              3) Enter LOGIN: SSN#MMDDYYYY              4) Enter PIN: (as provided by Secova) For Retirees and Survivors - All documentation must be submitted to SECOVA, not FHDA or CalPERS Retirees Supporting Services - Administered by SECOVA Authorization for Automated Debit and/or Credit Policy For deposit and/or Withdrawal of the Following Transactions:              1) Monthly Payment of Retiree Health Plan Contribution (Direct Bill or Balance Bill)              2) Quarterly Survivor Health Plan Payment              3) Monthly Reimbursement of Retiree Health Plan Contribution Overpayments              4) Quarterly Reimbursement of Medicare Part B Premium Electronic Fund Transfer (EFT) Authorization Form

Health Plan Information

Effective July 1, 2012, the District provides medical insurance through CalPERS and offers the following six plans:

HMO Plans

• Blue Shield NetValue
• Blue Shield Access +
• Kaiser Permanente

www.kp.org/calpers

www.blueshieldca.com/bsc/calpers/member

PPO Plans (Administered by Anthem Blue Cross )

• PERS Care - Available in all 50 States
        Anthem Blue Cross Prudent Buyer Preferred Providers Network
• PERS Choice - Available in all 50 States
        Anthem Blue Cross Prudent Buyer Preferred Providers Network
• PERS Select - Restricted to CA residents only
        Anthem Blue Cross Select PPO Preferred Providers Network

http://www.anthem.com/ca/calpers/

CalPERS Health Booklets

• 2012 CalPERS Health Benefit Summary
• 2012 CalPERS Health Program Guide
• 
  2012 Evidence of Coverage Booklets

• Blue Shield Access+ HMO
• Blue Shield NetValue HMO
• Blue Shield 65+ Advantage Plan (Depends on your zip code)
• Kaiser Permanente HMO
• PERS Care PPO
• PERS Choice PPO
• PERS Select PPO

Health Plan Directory

Should you have questions regarding your health plan, member ID cards, verification of provider participation, service area boundaries (covered zip codes), benefits, deductibles, limitations, exclusions, copayments, of if you have a concern that needs attention, please contact the following health plan providers:

HMO Plans

     Blue Shield of California
     Member Services: (800) 334-5847
     www.blueshieldca.com/bsc/calpers/member

     Kaiser Permanente
     Member Services: (800) 464-4000
     www.kp.org/calpers

PPO Plans

      PERS Select, PERS Choice, and PERS Care (Administered by Anthem Blue Cross)
      Member Services: (877) PERS-PPO or (877) 737-7776
      www.anthem.com/ca/calpers

      Pharmacy Benefits (Administered by CVS Caremark)
      Member Services: (877) 542-0284
      www.caremark.com/calpers

Employees interested in changing their health enrollments, and/or participate in the Section 125 Cafeteria Plan, must do so during the Open Enrollment Period. The scheduled Open Enrollment Period will take place from April 15 - May 15, 2012. Employees may add/delete dependents to their existing health plan during the plan year if they experience a qualifying event. Proper documentation such as: birth/marriage certificate(s), State-registered domestic partnership, and social security card(s) for all dependents are required to enroll any new dependents.

CalPERS Health Benefits Insurance Forms

A. For Employees Only

• CalPERS Health Plan Enrollment for Employees - Form HBD-12
• CalPERS Declaration of Health Coverage for Employees - Form HBD-12a

B. For Retirees and Survivors Only

• CalPERS Health Plan Enrollment for Retirees/Survivors - Form HBD-30
     Agency Name: Foothill-De Anza Community College District
     Agency Code: Agency ID #4628924879
• CalPERS Medicare Certification of Status - Form PERS08M0021DMC

C. For COBRA Enrollees Only

• CalPERS COBRA Election Form for Actives - Form PERS HBD-85
• CalPERS COBRA Election Form for Retirees - Form PERS HBD-85R

D. For Dependents Coverage Only

• CalPERS Affidavit of Marriage and Domestic Partnership - Form PERS HBSD-1965
• CalPERS Affidavit of Parent-Child Relationship - Form HBD-40
• CalPERS Disabled Dependent Questionnaire - Form PERS HBD-98
• CalPERS Disabled Dependent Medical Certification - Form HBD-34

E. For Kaiser Senior Advantage

• Kaiser Senior Advantage Group Election Request Form
• Kaiser Senior Advantage Disenrollment Form

Monthly Imputed Income Rates for Same-Sex Domestic Partners Coverage - July to December 2012

• Active Employees
• Part-Time Faculty
• Retirees

Prescriptions

Prescriptions provided for PERS Select/Choice/Care: CVS Caremark

• PERS Select/Care/Choice PDL Drugs Formulary - April 2012
• CVS Caremark Rx Mail Order Form
• PERS Care Summary
• PERS Choice/Select Summary

Prescriptions provided for Blue Shield Access+ and NetValue

• Blue Shield Rx Formulary - April 2012
• PrimeMail Rx Mail Order Form

PayFlex FSA Forms

• PayFlex FSA Flyer
• PayFlex FSA Mobile App Flyer
• PayFlex FSA Enrollment Form
• PayFlex FSA Dependent Care Account
• PayFlex FSA Claim Form
• PayFlex FSA Auto Reimburse Orthodontia Expenses

CalPERS Medical Providers' Links

1) Blue Shield of CA: Access+, NetValue, and 65 PLUS HMOs

Link:https://www.blueshieldca.com/bsc/calpers/member/plan-benefits/index.jhtml

      Blue Shield
      Current Members
      Prospective Members
      Member Services:
      (800) 334-5847

To find Blue Shield of CA providers:
https://www.blueshieldca.com/fap/app/search.html

2) Prescriptions provided by Blue Shield HMOs: PrimeMail®

Link:https://www.blueshieldca.com/consumer/pharmacy/participatingpharmacies/mailserviceprescriptions/pharmacy_mail_service.sp.

3) Kaiser Permanente HMO

Link: http://my.kaiserpermanente.org/ca/calpers/benefits.html

      Kaiser Member Services:
      (800) 464-4000
      TTY: (800) 777-1370

4) Anthem Blue Cross - PERS Care/PERS Choice/PERS Select

Link: http://www.anthem.com/ca/calpers/

      Anthem Blue Cross
      Customer Service Numbers:
      (877) 737-7776
      (818) 234-5141 (outside the continental U.S.)
      1-818-234-3547(TDD)

       24/7 NurseLine
       1-800-700-9185

       HMC (Disease Management)
       1-800-522-5560

5) Prescriptions provided by Anthem Blue Cross PPOs: CVS Caremark

Link: http://www2.caremark.com/calpers/

CVS Caremark Mail Service Order Form:
https://www.caremark.com/portal/asset/mof_unauth.pdf

      CVS Caremark
      PO BOX 94467
      PALATINE, IL 60094-4467

       Customer Service Representative
       (800) 552-8159

The District provides excellent paid Health and Welfare Benefits for all employees and their eligible dependents.

This page is for active employees. Click here for Retiree Information.
*For items not listed below, please contact Personnel for assistance.

ACTIVE EMPLOYEE SERVICES *Links will open in a new window or tab.
Medical	Dental	Vision	Wellness
EAP/Counseling (Outpatient)	Prescription Drugs (Mail Order--EPO/PPO)	Flexible Spending Accounts (Dependent Care and Health Care)	Life Insurance (Hartford/AD&D)
Supplemental Life Insurance* *Optional insurance. Must be selected by employee during Open Enrollment, for a fee.	Long Term Disability (LTD)	Worker's Comp	COBRA/HIPAA USERRA/WHCRA
Quick Links links to the following provider websites: Kaiser, UHC, Delta Dental, VSP, and EAP/UBH		Contact Benefits Unit

QUICK LINKS *Links will open in a new window or tab.
MEDICAL	Kaiser (HMO): www.kaiserpermanente.org find doctors, Kaiser facilities, register for health-realted classes and nutritional courses, get information on disease management, health and wellness UnitedHealthcare (EPO/PPO): www.myuhc.com find network doctors and facilities, manage health accounts, monitor medical records and office visits, diagnose common illnesses, access health calculators, get up-to-date information on disease management, health and wellness
DENTAL	Delta Dental (DPO): www.deltadental.com find dentists, track office visits and records, view invoices, get information on common tooth and gum diseases and procedures
VISION	Vision Services Providers (VSP): www.vsp.com find optometrists, track office visits and records, view invoices, find discounts on eyewear--when available
EAP/UBH	Employee Assistance Program/United Behavioral Health: www.liveandworkwell.com find counselors, life coaches, crisis intervention hotline, financial management help, information for work-life balance, and emotional and mental support for employees and family. Initial five (5) visits are free.

Please Note:

• For EPO, you must access providers from UnitedHealthCare CHOICE Health Plan.
  
  
  It is imperative that you obtain the provider's tax ID number and verify it with UnitedHealthcare Customer Service @ 1-800-510-4846, to ensure fully paid benefits.
  
  
• For PPO, you can access providers from UnitedHealthcare CHOICE PLUS Health Plan, or any non-contracted provider.
  
  
• When using www.myuhc.com, Please search under "FACILITY" for list of Ambulance Services, Ambulatory Surgical Center, Dialysis Center, Extended Care Facility, Home Health Agency, Home IV Therapy, Hospice Center, Labs, Medical Equipment Vendors, Medical Rehab Center, MRI, Nursing Home, Physical Therapy, Radiology Center, and Urgent Care Center.