Health & Dental Insurance

Some Drugs Will No Longer Be Covered

As part of our routine formulary review process, changes to the National, Essential and Traditional Open Drug Lists take effect April 1, 2020. Most are multi-source brand drugs (those with generic equivalents) that will be removed from the lists or moved to a higher benefit tier. Generic or brand-name alternatives will be covered in their place. The Food and Drug Administration follows a rigorous review process for approving generics to make sure they work just as well or better than their brand-name equivalent.

We’ll notify impacted members by mail starting January 31, 2020. The letters will tell members about other options they have for lower-cost alternative drugs that are covered. Questions? Contact your broker or account rep.

Health & Dental Insurance

Suffolk Public Schools offers its new employees two choices of health insurance plans through Anthem Blue Cross Blue Shield:

  • HealthKeepers 80/20 POS plan with no need for PCP referrals as long as an in-network provider is used and covers about 80% of non-preventative medial needs

  • High Deductible Health Plan (HDHP) is minimum coverage. This plan has a $2,800 single/$5,400 plus 1 and family deductible that must be met each calendar year before pharmacy or medical coverage begins and then covers about 80% of non-preventative medical needs. The HDHP plan also comes with a Health Savings Account (HSA) –this account belongs to the employee and SPS will currently match the employee savings up to $1,400. The HSA is designed to help employees save for payments for medical expenses that may need to be paid due to the deductible.

    Below are the 12 month employee health benefit rates by plan for the 2018 plan year:

  • HealthKeepers 80/20 POS

    Rate Per Pay Check

    Employee Only

                $   29.00

    Employee +1

    162.20

    Family

    267.28

    Family (Dual)*

    133.64


High Deductible Health Plan (HDHP)

Rate Per Pay Check

Employee Only

$    0.00

Employee +1

    87.33

Family

  156.62

Family (Dual)*

    78.31


  • ALL preventative care is covered 100% regardless of the plan you choose

    There are two plans grandfathered for employees hired prior to November 16, 2017:

  • HealthKeepers 90/10 HMO requires PCP referrals and covers an estimated 90% of non-preventative care while using networked providers.
  • KeyCare 15 PPO allows out of network coverage without referrals from PCP. The coverage in network is estimated at 80%, and out of network is estimated at 70%.

If an employee chooses at anytime to change from either of the above plans to the new plans, it is an irrevocable choice. Employees who changed plans for calendar 2018 and were hired prior to November 16, 2017 are not allowed to return to either of the above plans during subsequent years’ open enrollments.

Below are the 12 month employee health benefit rates by plan for the 2018 plan year:

HMO 90/10 Plan

Rate Per Pay check

Employee Only

$ 64.50

Employee +1

232.20

Family

370.28

Family (Dual)*

185.14

 

PPO KeyCare Plan

Rate Per Pay Check

Employee Only

$ 89.00

Employee +1

322.70

Family

497.78

Family (Dual)*

248.89

*Family Dual refers to spouses who both work for Suffolk Public Schools and are eligible for health coverage. Their health coverage discount is 50% of the cost of the family coverage.

 

Enrollment in any plan must be completed within 30 days of your official hire date, otherwise you will forfeit participation until the next plan year, for which open enrollment is held each Fall. Other qualifying status changes must also be applied for within 30 days of the change (see “Other Insurance Facts” below). The plan year begins on January 1st through December 31st annually.

 

Anthem plan information, including benefits, provider lists and prescription information is available through the link below:

https://www.anthem.com/

 

Current Dental Insurance

Suffolk Public Schools also offers two choices of dental plans through Delta Dental. The Basic Plan provides services for diagnostic and preventive care and basic dental care including fillings and oral surgery. The High Plan includes the above benefits and adds prosthetic and complex restorative services, including crowns and bridges, and orthodontic services. All benefits have calendar year deductibles and maximums. Orthodontic services have a $1,000 lifetime maximum per person and only cover dependent children under 19 years old.

The same rules apply for dental insurance enrollment and changes as discussed above under health insurance. However, you do not have to enroll in a health insurance plan to participate in a dental plan.

 2021 Health and Dental Rates 

Other Insurance Facts

  • Effective October 1, 2010, health care reform legislation allows young adults to be covered under the Employee Plus One or Family Plans until the end of the calendar year in which they turn 26, regardless of dependent status.
  • An employee is only allowed to add or change coverage if there is an eligible family status change. Any add/change must be submitted within 30 days of the qualifying event including proper written documentation. All other changes can only be made once a year during open enrollment.

Coverage after Retirement

If eligible, Suffolk Public Schools’ employees may keep their health insurance coverage once they retire.

Retirees may remain on the group health plans to the age of 65 if the following qualifications are met:

  • Retiree qualifies for regular or disability retirement through the Virginia Retirement System.
  • Retiree must have been employed with Suffolk Public Schools for a total of twenty (20) years.
  • Retiree must have carried group health insurance with Suffolk Public Schools for the twenty-four (24) months prior to retirement. The retiree may elect the same or a lower tier of coverage. For example, the retiree may change from KeyCare to the HMO, but not the reverse, or from family to retiree only, but not the reverse.
  • Retiree must execute VRS-78 Premium Deduction & Health Insurance Credit Authorization Form which allows VRS to deduct the insurance premiums from the retiree’s monthly VRS retirement check. Only in those cases where the VRS monthly retirement check is not sufficient to pay the monthly insurance premium will a retiree be permitted to make payments directly to Suffolk Public Schools.

Effective January 2018, the School Board pays 50% of the total cost of the Health- Keepers 80/20 POS employee only plan and applies this amount to all other levels of retiree coverage. Health plans, rates and employer shares are subject to change annually. Although retirees are not eligible to remain on our group dental insurance plans to age 65, retirees may remain on their existing dental plan or a lower tier dental plan for 18 months under the federal COBRA law.

Coverage after Separation from Employment (COBRA)

Under the federal COBRA law, employees losing medical coverage due to voluntary or involuntary termination (other than for gross misconduct) of employment or a reduction in hours may continue to maintain their coverage in the School Board’s group at their own expense (current premium plus a 2% administration fee) for themselves and their dependents for up to 18 months or until they become covered under Medicare or some other group insurance option. A special continuation period applies to qualified beneficiaries who are certified disabled under the Social Security Act before their normal 18 month continuation ends. These individuals are entitled to a total of 29 months of continuation but written proof of disability determination is required. Dependents of covered employees who would otherwise lose their coverage due to death, divorce, or legal separation or other loss of dependent status may continue with the School Board’s group at their own expense (current premium plus 2% administration fee) for up to 36 months or until they become eligible for Medicare or other insurance coverage.

 

Phone Numbers for Insurances

Anthem Health Plans

1-800-451-1527

Delta Dental

1-800-237-6060



Questions Regarding any of the above Insurances

Questions concerning any type of health or dental insurance should be directed to Melissa Gardner in the Finance Department at 925-6756 or by emailing her through the school system’s email system. For additional information regarding these plans or specific benefit questions, you may contact the health and dental companies at the above phone numbers or by clicking on their respective logos above to go directly to their websites.

Current Employee & Medicare Eligible

Important Information on the Medicare Part D Prescription Benefit

In January 2006, Medicare added a new prescription drug benefit, Part D, for those who are Medicare eligible. Current employees of Suffolk Public Schools who also participate in our Anthem health insurance plans do not need to take any action at this time since your Anthem health insurance is your primary insurance. It has been determined that your current prescription benefits are on average at least as good as standard Medicare prescription drug coverage (creditable coverage). Because of this determination, you may enroll in the Medicare Part D prescription drug plan without penalty if you enroll within 63 days after your Anthem health insurance coverage ends. If you are interested in the Part D plan when your current Anthem coverage ends, it is very important to enroll within the first 63 days to avoid a penalty.

For more information:

  • www.medicare.gov
  • Refer to your copy of Medicare & You handbook
  • Call 1-800-MEDICARE (1-800-633-4227)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Digital ID Card Experience

Members can view their digital ID card at anthem.com or on our mobile app, anytime.  The digital ID card works just like the one members would get in the mail.  They can show, email or fax it to their doctor right from their phone or computer.  It’s always up to date.  And, they can share it with family members.

 

Members have the option to get a digital ID card only, stopping any ID card being mailed in the future.  Through various communications, members are encouraged to go digital and set their preferences.  A member can set their digital preference through anthem.com or the mobile app during Registration or through their Communication Preference Center.

 

1.      Registration:  When a member registers at anthem.com or on the mobile app, they can select their digital ID card preference. If they register on Sydney their preference is pre-selected to digital.  If a member does not change this digital selection and completes registration, they are consenting to switch to the digital ID card only and won’t receive a printed card in the future.

2.      Communication Preferences:  On Anthem.com or the mobile app, a member can select, review or change their ID card preference anytime under their communication preferences.  Under “Profile” a member would select their Communication Preferences and view or update their preferences.

3.      Members who have their ID card preference set to digital will get an email notification letting them know when they, or a dependent, have a new digital card because of a life event or renewal. 

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