2023 HEALTH BENEFITS SHOWCASE
WELCOME!
Welcome to the Anaheim Union High School District health benefits website! Use the navigation bar at the top of the page to learn more about each category of benefits. This site will be available to you year-round, so visit whenever you or your family members need additional information.
NEW-HIRE ENROLLMENT
AUHSD utilizes the American Fidelity AFenroll platform. You may self-enroll or schedule an appointment with a representative to assist you. You have 30 days from your hire date to complete your new-hire benefits enrollment. After this enrollment period, your next opportunity to change coverage will be during an annual open enrollment period or earlier if you experience a qualifying life event – like getting married or having a baby – and you notify the health benefits department within 30 days of the event. Review this website as well as the 2023 Health Benefits Guide, linked above, to find information on your benefit offerings.
COVERING YOURSELF AND YOUR FAMILY
You're eligible for benefits beginning on the first day of the month following your date of hire (unless you are hired on the first of the month) if you're an active, regular employee who normally works at least 20 hours per week and unless you are told otherwise by your HR department, there is no monthly premium cost for you and your eligible dependents to be enrolled in the AUHSD health plans.
You may enroll your eligible dependents in the same plans you choose for yourself, including medical, dental, and vision insurance coverage. Eligible dependents include:
- Your legally married spouse* or state-registered domestic partner
- Your children** up through their 26th birth month
- Your children** who are age 26 or older and become mentally or physically disabled prior to age 26 and primarily depend on you for support (see the Summary Plan Document for more information)
Enrolling dependents requires proof of eligibility. To maintain coverage all requirements must be met within required deadlines. Provide the following documents to the health benefits department within 30 days of your date of hire:
- Certified marriage certificate
- Certified birth certificates (for children only)
- Certificate of state registered domestic partnership
- Legal guardianship orders
- Social Security cards, ITIN’s, (or equivalent document) for all dependents
MAKING CHANGES DURING THE PLAN YEAR
The AUHSD plan year runs from January 1 to December 31. You may make changes to your benefit choices once a year during the open enrollment period. Elections you make will be effective for a full year, unless you terminate employment or have a qualified status change:
- A change in legal marital status (e.g., marriage, divorce or legal separation)
- A change in number of dependents (e.g., birth, adoption or death)
- A change in your/your spouse’s/your state registered domestic partner’s employment status (e.g., reduction in hours affecting eligibility or change in employment)
- A substantial change in your/your spouse’s/your state registered domestic partner’s benefits coverage
- A Qualified Medical Child Support order or other judicial decree
- Loss of other coverage
You have 30 days from the life event date to make changes to your coverage. Contact the health benefits department for more details.
* Which does not include a spouse from whom you are legally separated.
** Children include your children, your step-children, children covered under a child support order, your state-registered domestic partner’s children, and children under your legal guardianship ordered by a court.
QUESTIONS?
For health benefits questions contact: benefits@auhsd.us
For enrollment assistance call: American Fidelity at 800-365-9180
2023 HEALTH BENEFITS SHOWCASE
MEDICAL & PRESCRIPTIONS
Anaheim Union High School District is committed to offering medical benefits that provide generous coverage for both employees and their enrolled dependents. You may select between a Preferred Provider Organization (PPO) or an Exclusive Provider Organization (EPO). You decide which plan best fits your budget and medical needs.
DECIDING BETWEEN A PPO AND AN EPO MEDICAL PLAN
It's Your Choice
When reviewing your plan options, consider the medical needs of you and your family, access and availability of your preferred medical provider, and your income. If you’re looking at an EPO, take a close look at the network to determine if the choice of doctors and medical facilities are enough to meet your needs. A PPO can give you more flexibility and control of your medical services, including the potential to be covered for medical bills outside the network, but your personal medical costs could be higher.
RATES, ID CARDS, & COORDINATION OF BENEFITS
Cost to You
Unless you are told otherwise by your HR department, there is no monthly premium cost for you and your eligible dependents to be enrolled in the AUHSD health plans.
ID Cards
Medical ID cards are issued for new enrollments and employees switching plans or adding dependents during an open or special enrollment period. Dental and vision cards are no longer issued. Providers verify coverage directly with the carriers (Delta and VSP).
Coordination of Benefits/Dual Coverage
Coordination of Benefits (COB) usually applies when you or a covered dependent are covered by multiple healthcare plans at the same time. For example, you and your spouse have coverage through each other’s employers; you each cover yourself and/or dependents.
COB designates the order in which the multiple health plans are to pay benefits. Under a COB provision, one plan is determined to be primary and its benefits are applied to the claim first. The unpaid balance is usually paid by the secondary plan to the limit of its responsibility. Benefits are thus "coordinated" among all of the health plans.
Coordination of benefits only applies if both healthcare plans allow for coordination of coverage. At AUHSD, the PPO plan may coordinate coverage while the EPO plan does not coordinate coverage. Read more about COB under the Forms & Resources tab.
PPO PLAN
Understanding PPO Plans – Network: Anthem Blue Cross PPO Prudent Buyer EPO/PPO
PPO plans provide more flexibility when picking a doctor or hospital. They also feature a network of providers, and there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider for a covered service, although it may be at a higher cost to you.
Some key points to consider when selecting a PPO plan:
- You can visit a doctor or specialist you’d like without having to see a PCP first.
- You can visit a doctor or go to a hospital outside the network and you may be covered; however, your benefits will be greater if you stay in the PPO network.
- PPO plans have a deductible that must be met before insurance pays on certain services.
- The AUHSD PPO Plan may coordinate benefits with other plans.
EPO PLAN
Understanding PPO Plans – Network: Anthem Blue Cross PPO Prudent Buyer EPO/PPO
An EPO gives you access to certain doctors and hospitals within its network. A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. But unlike other insurance plan types, non-emergent services are only covered if you see a provider within that EPO’s selected network.
Some key points to consider when selecting an EPO plan:
- You can see the doctor or specialist you’d like without having to see a primary care physician (PCP) first.
- Referrals are not required to be covered when you see a specialist or have a special test done.
- If you opt to see a doctor outside of the EPO selected network, there is no non-emergent coverage, meaning you will have to pay the entire cost of medical services.
- The AUHSD EPO Plan does not coordinate benefits with other medical plans.
TRUSTMARK HEALTH BENEFITS
Third-Party Administrator
Trustmark is the administrator for your health benefits plan, managing all administrative aspects including claims processing, fee negotiation, and eligibility. Trustmark works with your Anthem network to get you the medical care you need. Trustmark is dedicated to meeting the needs of our employees and their families and places customer service and satisfaction as its highest priority.
Contact Trustmark with your medical plan or claims questions or to replace your ID cards.
www.mytrustmarkbenefits.com | 866.280.4120
TELEHEALTH IS AVAILABLE 24/7, 365 DAYS A YEAR!
When you need to see a doctor outside of business hours, LiveHealth Online lets you have a video visit with a board certified doctor using your smartphone, tablet or computer with a webcam. No appointments, no driving and no waiting at an urgent care center. Doctors are available 24/7 to assess your condition and, if it’s needed, they can send a prescription to your local pharmacy.
Have your medical ID card with you when you call!
LIVONGO FOR DIABETES & HYPERTENSION PROGAMS
Make Living Easier
The Livongo for Diabetes and Hypertension programs help make living with diabetes and high blood pressure easier. The programs are offered at no cost to all employees enrolled in the EPO or PPO medical plan and their covered family members living with diabetes and/or hypertension.
Here’s what you get when you join Livongo:
- Tips to Help You Stay on Track: Receive useful information that will help you manage your blood sugar and blood pressure to help you feel your best.
- Unlimited Strips: Get as many strips and lancets as you need, in addition to a free blood glucose monitor and blood pressure monitor, at no extra charge.
- Coaching When You Need It Most: The Livongo coaches are available to support you in your journey to better health.
- Safety and Security: View and access your records anytime. Share it with your doctors if and when you want to.
Have your medical ID card with you for registration.
PRESCRIPTION DRUG PLAN
If you're enrolled in one of AUHSD's medical plans, you automatically have prescription drug coverage through Express Scripts. Simply present your medical ID card at the in-network pharmacy to fill your prescription. Call the pharmacy helpline on the back of your medical ID card for assistance.
Additional prescription co-pay savings are available through home delivery and the Smart 90 options.
QUESTIONS?
For health benefits questions contact: benefits@auhsd.us
For enrollment assistance call: American Fidelity at 800-365-9180
2023 HEALTH BENEFITS SHOWCASE
DENTAL & VISION
As part of your comprehensive health insurance coverage, Anaheim Union High School District offers you the option to select dental and vision coverage for you and your dependents.
DENTAL INSURANCE
Dental coverage is available through Delta Dental. You can select the Delta Dental PPO or DeltaCare USA (HMO) plan. It's easy to find a Delta dentist near you by clicking the FIND A DELTA DENTIST button.
Delta Dental PPO
The PPO dental plan covers several categories of benefits when the services are provided by a licensed dentist, and when they are necessary and customary under the generally accepted standards of dental practice. Visit a dentist in the PPO network to maximize your savings. Seeing a Delta PPO network dentist gives you a higher benefit level. If you see an out-of-network dentist, benefit amounts are subject to the Delta contracted fee schedule and you are responsible for the difference between the plan payment and the dentist's usual charge. The benefit level is lower when you see an out-of-network dentist.
DeltaCare USA (HMO)
Dental HMOs are designed to help you and your family maintain oral health and reduce your out-of-pocket costs. You will select an in-network primary care dentist at enrollment or a dentist near you will be assigned. Care must be provided by your selected or assigned dentist, there is no out-of-network coverage under the DeltaCare USA (HMO) plan. Orthodontia treatment is provided under the DeltaCare USA (HMO) dental plan.
VISION PLAN
VSP is our vision carrier. The plan offers a choice between contracted and non-contracted providers but your benefits are greatest if you choose to stay within the VSP network. There is a $10 copay for your vision exam and the allowances vary for lenses, frames, and contacts. Discuss your allowances with your vision provider.
You and your enrolled dependents are eligible for one exam and one set of lenses every 12 months. Frames are offered every 24 months and contact lenses are offered in lieu of lenses and frames.
QUESTIONS?
For health benefits questions contact: benefits@auhsd.us
For enrollment assistance call: American Fidelity at 800-365-9180
2023 HEALTH BENEFITS SHOWCASE
MENTAL HEALTH & EAP
Life is full of challenges and sometimes balancing it is difficult. Mental Wellbeing is an important component of your total health. As part of your medical coverage through Anthem Blue Cross, you have access to mental health services, substance abuse services, and the Employee Assistance Program (EAP).
MENTAL HEALTH
Mental and physical health are equally important components of overall health. Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. it also helps determine how we handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.
Mental health and substance abuse services are covered under both the EPO and PPO medical plans through Anthem Blue Cross. Find a provider near you.
If you are in crisis call 800-999-7222
Available 24 hours a day, 365 days a year.
EAP - 100% CONFIDENTAL
The Anthem EAP offers the appropriate assistance for a wide range of issues and provides referrals to professional counselors or services that can help you resolve emotional health, family, and work issues. All AUHSD benefit eligible employees and members of your household are provided with the employer-paid EAP. Along with unlimited telephonic access, the EAP also offers 3 face-to-face visits with a counselor per person per issue. Work or Life Needs, Clinical Counseling, Financial Information, Legal Information...and more. Available 24/7 - 365 days a year.
Call 800-999-7222 or visit www.anthemEAP.com (Company Code: AUHSD)
QUESTIONS?
For health benefits questions contact: benefits@auhsd.us
For enrollment assistance call: American Fidelity at 800-365-9180
2023 HEALTH BENEFITS SHOWCASE
LIFE INSURANCE
Life Insurance can be an important part of your financial strategy. Anaheim Union High School District provides you with basic life and AD & D insurance to help your loved ones after you pass away.
Think about what your loved ones may face after you're gone. If you need additional coverage, you have the opportunity to purchase additional supplemental life insurance for you and your eligible dependents. Evidence of insurability may be required.
Familiarize yourself with your life plan and your optional life choices and be sure to complete a beneficiary form to ensure your life benefit is distributed to the person or entity you choose.
SHORT TERM GROUP DISABILITY
(Classified Staff Only)
Disability Plan highlights:
- Your plan pays a monthly disability benefit of 66 2/3% of your monthly compensation not to exceed:
- (1) a maximum covered monthly compensation of $7,500.00;
- (2) the amount for which the premium is being paid. If applicable, your disability benefit will be reduced by deductible sources of income.
- Coverage begins on the 61st day of disability or after the end of accumulated sick leave, whichever is greater, due to a covered injury or sickness.
- Benefits are payable up to 2 years for a covered injury or sickness.
Refer to the button below for more details.
Accidental Death Benefit
- If you die as the direct result of an injury and death occurs within 90 days after the Injury, a lump sum of $10,000.00 will be paid. Completed beneficiary forms should be sent to the AUHSD Benefits office #77.
Physician Expense Benefit
- If you are absent from work one full day because you are sick, and you seek treatment from a physician on the same day, you are eligible for a Physician Expense Benefit of $25.00 upon submission of a claim form.
- The reason for your absence must be marked “Personal Illness.” (No benefit will be paid for partial sick day, vacation day/personal necessity in lieu of a sick day, or workers’ compensation illness day).
- Claim form requires authorization to disclose information AND proof of doctor visit (itemized billing, explanation of benefits, etc.) for verification purposes.
[Classified Staff Only]
QUESTIONS?
For health benefits questions contact: benefits@auhsd.us
For enrollment assistance call: American Fidelity at 800-365-9180
2023 HEALTH BENEFITS SHOWCASE
FLEXIBLE SPENDING ACCOUNTS
Flexible Spending Accounts (FSA) provide you with an important tax advantage that can help you pay healthcare and dependent care expenses on a pretax basis. AUHSD has partnered with American Fidelity to help you decide if a Flexible Spending Account is right for you.
HEALTH CARE REIMBURSEMENT
The annual maximum contribution - $2,850
The Health Care Reimbursement FSA allows you to pay for certain IRS-approved health care expenses not covered by your insurance or reimbursed by any other benefit plan. Eligible expenses include those incurred by you, as well as your spouse and dependents. Typical expenses include co-pays, coinsurance, deductibles, and prescription drug expenses.
DEPENDENT CARE REIMBURSEMENT
The annual maximum contribution is $5,000
The Dependent Care Reimbursement FSA allows you to use pre-tax dollars toward qualified dependent care. Care must be for a tax-dependent child under age 13 who lives with you or a tax-dependent spouse or child who lives with you and is incapable of caring for themselves. Also, the care must be needed so that you and your spouse (if applicable) can go to work. Care must be given during normal working hours and cannot be provided by another of your dependents. Typical expenses include babysitters, nursery schools, pre-schools, and daycare centers.
"USE-IT-OR-LOSE-IT" RULE
The Health Care and Dependent Care Reimbursement FSAs run on a calendar basis. The current plan year is from January 1 through December 31; claims can only be for services/expenses incurred in the calendar year. All claims MUST be submitted no later than 70-days from the end of the plan year for reimbursement. Any funds left unclaimed will be forfeited. Please refer to your plan documents for additional information.
QUESTIONS?
For health benefits questions contact: benefits@auhsd.us
For enrollment assistance call: American Fidelity at 800-365-9180
2023 HEALTH BENEFITS SHOWCASE
ACTIVE EMPLOYEES READY TO RETIRE
ELIGIBILITY
Employees with fifteen (15) or more years of permanent active employment with AUHSD, who are actively enrolled in benefits when they retire, and who meet the CalSTRS or CalPERS retirement requirements are eligible to apply. You have the opportunity to enroll in retiree medical and/or dental benefits only. Benefit premiums are 100% paid by AUHSD if you are between 60-65. If you elect to enroll in an AUHSD retiree health plan, you may purchase coverage for your currently enrolled dependent(s).
PRE-65 MEDICAL AND DENTAL OPTIONS
The medical and/or dental plan coverage that you have as an active employee will continue into retirement up to age 65. Your age at retirement will determine whether or not you will pay a monthly premium.
If you are under the age of 60:
- You may keep your current EPO or PPO medical plan and PPO or HMO dental plan, or you may switch plans (you may also change your plan elections during an open enrollment period).
- Mental health and EAP benefits continue.
- You will need to pay for your medical and dental premiums until you turn 60.*
*If you are retiring in a Management or Administrator position, and were hired or promoted to a Management or Administrator position PRIOR to April 6, 2007, please contact the health benefits department.
If your age is 60 up to 65:
- You may keep your current EPO or PPO medical plan and PPO or HMO dental plan, or may switch plans (you may also change your plan elections during an open enrollment period).
- Mental health and EAP benefits continue.
- Your medical and dental benefit premiums will be paid by AUHSD until the first day of the month in which you turn 65 (unless you are born on the first of a month in which case your benefits end one month earlier).
POST-65 MEDICARE-ELIGIBLE COVERAGE
If you are age 65 or older at retirement and qualify for Medicare, you may purchase the AUHSD Medicare Supplemental Plan (Medigap).* Medicare parts A & B enrollment are required to participate in this plan. Information on the plan will be mailed to your home once you complete the retirement/resignation form with your HR department.
The Medicare Supplemental Plan works seamlessly with Medicare. Claims are processed automatically so you will never deal with claim forms. Best of all, you will not have a deductible and NO MEDICAL CO-PAYS, only co-pays for prescriptions.
- Hearing aids are NOT part of your plan.
- Prescription drug coverage is included.
POST-65 DENTAL COVERAGE
If you are age 65 or older at retirement, you may continue on your dental plan regardless of whether or not you elect AUHSD’s Medicare Supplemental Plan offer. * You will be billed a monthly premium which must remain current in order to keep your coverage active.
*If you are retiring in a Management or Administrator position, and were hired or promoted to a Management or Administrator position PRIOR to April 6, 2007, please contact the health benefits department.
MONTHLY PREMIUM RATES
Effective 01/01/2023-12/31/2023*
*An administrative service fee of $1.65 will be applied to all elected coverages.
FOR QUESTIONS REGARDING...
- Dependent Coverage
- Vision & Life Insurance
- Flexible Spending Accounts
- Open Enrollment
Review the Guide:
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Find additional resources located throughout the Benefits Showcase including the Forms & Resources tab.
QUESTIONS?
For health benefits questions contact: benefits@auhsd.us
For enrollment assistance call: American Fidelity at 800-365-9180
2023 HEALTH BENEFITS SHOWCASE
FORMS & RESOURCES
Click the links below to access forms and resources.
MEDICAL
- Locate an Anthem In-network Medical or Mental Health Provider
- Claims Reimbursement Form (Medical and Mental/Behavioral Health)
- Glossary of Health Coverage and Medical Terms
- Coordination of Benefits/Dual Coverage
- Coordination of Benefits Form - Trustmark
- COBRA Information and Rates
- Find the best price for in-network medical procedures
- Anthem Special Offers/Discounts
PRESCRIPTIONS
DENTAL & VISION
EAP
FLEXIBLE SPENDING ACCOUNTS
ADDITIONAL SUPPORT
Here are some “roadmaps” for using your health benefits when you have a major life change – like getting married or adopting a child – or when you need to do something as simple as change your address.
Updating Your Personal Information
It’s important that AUHSD has your valid, up-to-date information so you don’t miss any important notices or materials. Your new information is transmitted to all health benefits carriers and to your payroll department for submission to CalPERS or CalSTRS.
Adding or Dropping a Family Member due to a Qualifying Life Event
If you marry, establish a domestic partnership, add a child to your family, or one of your eligible family members loses coverage and needs to join your plan, you have 30 days from the day of the event to add your new family member to your benefit plans.
Family members become ineligible for health benefits through divorce, legal separation, the end of a domestic partnership, or death. You must notify the benefits department within 30 days of the event. Children reaching the age of 26 are automatically dropped from the plans at the end of their birth month.
More Resources
You have great benefits as an AUHSD employee or retiree. Use these additional resources to help you navigate your health benefits.
+ Filing a Medical Claim Appeal
+ Foreign Travel - Emergency Care
Click HERE to find more resources on the District web page.
QUESTIONS?
For health benefits questions contact: benefits@auhsd.us
For enrollment assistance call: American Fidelity at 800-365-9180
