Plan Features & Highlights

Progyny Fertility and Family Building for Anthem PPO

Fertility and family building coverage will be available to all employees and spouses enrolled in the Anthem Classic PPO plan. Coverage will include fertility treatments such as IVF and IUI, sperm or egg freezing, adoption, surrogacy, and doula benefits. Most benefits are included as components of Smart Cycles. Participants are eligible for two Smart Cycles per lifetime. In addition, participants are eligible for up to $20,000 financial assistance for adoption or surrogacy per lifetime. Participants are also eligible for up to $1,000 financial assistance per child for doula services. Smart Cycle benefits are subject to the same deductible and copay cost sharing as the medical plan in which the participant is enrolled. Click on the Progyny Overview Video , review the Progyny Member Guide, visit the Progyny website or call 866-461-4990 to learn more about this benefit.

View additional flyers to learn more about the benefits offered through Progyny:

Progyny Flyers

Hinge Health Virtual Physical Therapy for Anthem PPO and CDHP

Hinge Health will provide a well-rounded virtual physical therapy program for acute or chronic conditions. Benefits include live video visits with a physical therapist, visits with a certified health coach to address underlying causes, and/or a tablet with sensors to provide feedback on movements during therapy. Benefits vary based on applicability, as determined by intake assessment. Hinge Health benefits are provided at no cost and are exempt from deductibles in the Anthem Classic PPO plan, including the CDHP. Click on the Hinge Health Overview Video or see the Hinge Health Flyer to learn more about this benefit.

Carrum Health for Anthem PPO and CDHP

If you ever need surgery in the future, please remember to check out the Carrum Health Benefit. This optional surgery benefit for Anthem PPO and CDHP participants provides a second opinion and, if surgery is needed, travel for you and a companion to the top surgeon at a world-class surgical facility. Learn more at carrum.me/acwajpia , watch this video, or view the Carrum Flyers.

Hear Carrum Health Testimonials and Knee Replacement Testimonials.

Oncology Guidance for Anthem PPO and CDHP

Carrum Health, JPIA’s concierge and second opinion surgery partner, has expanded to offer oncology services. Oncology Guidance will provide those newly diagnosed with cancer with a registered oncology nurse to guide them through their journey for up to 48 months. In partnership with world-renowned cancer centers Memorial Sloan Kettering and City of Hope, an oncologist will review the diagnosis and treatment plan, consulting directly with the treating physician. This benefit is available for all types of cancer, excluding non-melanoma skin cancer. Oncology Guidance is provided at no cost, unless a CDHP member has not yet met the IRS required minimum deductible for HSA eligibility. In that case, Carrum will work with Anthem to ensure the minimum required deductible has been met collectively before providing 100% coverage. Click on the Carrum Oncology Webinar for more information

Breast Cancer Treatment for Anthem PPO and CDHP

Carrum Health's journey further into the oncology space has led to their partnership with the world-renowned City of Hope Cancer Center. Comprehensive treatment bundles include coordinated care, radiation, chemotherapy, and surgery. This benefit is available to participants with a first-time non-metastatic breast cancer diagnosis. Due to the need for repeat visits, participants must live within 60 miles of a City of Hope location in Southern California. Breast cancer treatment bundles through Carrum are provided at no cost. For CDHP participants, the same process used for Oncology Guidance will be applied to maintain HSA eligibility. See the Carrum Health Flyer for more information about this benefit.

Anthem’s Carelon Rx

Pharmacy benefits under the Anthem PPO and CDHP plans are leaving MedImpact and returning to Anthem’s internal Pharmacy Benefit Manager (PBM), known as Carelon Rx. The copay structure is the same, and the retail pharmacy network is extensive. The formulary list is similar, but some drugs may be covered at different copay amounts or may be excluded. Prescriptions currently covered under MedImpact will be grandfathered-in and covered for 90 days following the January 1, 2024 effective date. Prior authorizations and step therapy already completed will be provided to Carelon Rx for their records. Outreach letters will be sent to participants if certain medications have tier changes or are no longer covered. More information regarding this change in the prescription drug benefit will be sent by Carelon Rx to your home in late November and December. To check your prescription medication coverage, please click the link below.

Anthem PPO/CDHP Prescription Drug Formulary

Anthem Health Guide

This enhanced customer service for PPO and CDHP participants will replace Anthem’s traditional member services. Anthem Health Guides are trained in medical plans and benefits and will be able to refer you to various point solutions such as Carrum, Hinge or Progyny along with other Anthem programs that might be helpful to you. The member services phone number will remain the same for Anthem Health Guide: at (800) 284-2466.

All Anthem participants will receive a new Member ID Card in December for the 2024 plan year.

Vision Benefit Enhancements
The VSP vision plan has been enhanced to increase the frame allowance from $180 to $200, and will now include VSP Light Care. VSP members with LightCare can now use their frame allowance, in lieu of prescription glasses, towards their choice of plano ready-made sunglasses or blue light filtering glasses and plano sunglasses.

Plan Provider Flyers

Flexible Spending Accounts (FSAs)

Use pre-tax money for your co-pays on medical, dental, vision care, and prescription costs through a Flexible Spending Account. This includes deductibles, costs for alternative healthcare, and orthodontia. This benefit is now even easier to use with the availability of a debit card or direct deposit. The EZ mobile app by WageWorks/Health Equity is now available on your iphone or Android smartphone. The mobile app lets you submit claims, snap photos of receipts, and manage your account from anywhere-it puts the WageWorks/Health Equity web portal in the palm of your hand.

Flexible Spending Account (FSA) designations must be made each year. If would like to contribute to an FSA in 2024, you must make that election during Open Enrollment. The IRS has not yet announced the 2024 maximum annual contribution. Elections cannot be changed mid-year unless a documented qualifying event supports the change.

Health Savings Account (HSA) for Anthem CDHP or Kaiser CDHP

Health Savings Account (HSA) deduction elections for 2024 should be made during Open Enrollment, as the deduction elected for the prior year will not continue without a completed form on file. Changes to your deduction amount can be made throughout the year. The 2024 maximum HSA contribution, for employer and employee contributions combined, will be $4,150/individual enrolled or $8,300/family enrolled. There is an additional $1,000/year catch-up contribution allowed for participants who will be age 55 or older at any point in 2024. Those enrolled in another health plan offering first dollar coverage, including Medicare, may not contribute to an HSA. Learn more about Health Savings Accounts by reading these Frequently Asked Questions.

Employee Assistance Program

The District’s W.E.L.L. Program is a service to ensure employees’ well-being and productivity. Confidential, professional counseling and referral services are provided for stress-causing problems such as emotional problems, anxiety, depression, burnout, substance/alcohol/drug abuse, marriage and family relationships, and eating disorders. Counseling, treatment, and referral services are also available for smoking cessation, financial counseling, and legal matters. Employees or members of their immediate family may obtain professional assistance through the self-referral W.E.L.L program. Initially, there will be no charge to the individual employee or immediate family member for counseling services. After the third evaluation session, there will be a co-payment from the employee which will be on a graduated basis.

To take advantage of these services, contact:

Jo Ann Simmons-Walker, M.S., M.F.T.

10630 Town Center Dr., Ste. 111

Rancho Cucamonga, CA 91730

(951) 204-7124 (24 hours a day, 7 days a week)
jsimmonsmft@gmail.com

www.joannsimmonsmsmft.com

All employees, their spouse or domestic partners, and children who are legal dependents are eligible for W.E.L.L. services. Records of services you receive are treated as medical records by the provider and do not become part of your District personnel file. Release of information will only be made with your written approval.

Supplemental Insurance

The life insurance provider remains as Metropolitan Life Insurance Company (MetLife). The Open Enrollment period will be the only time to increase/add your voluntary life insurance coverage. If you wish to do so, please complete the MetLife Insurance Enrollment form and Medical History Statement.

Supplemental life insurance (above the basic District-provided life insurance) can be purchased in amounts up to $500,000 (in $10,000 increments) for employees. Life insurance for spouses can be purchased in $5,000 increments up to half of the amount of the employee policy. Life insurance for children (under 19 years old) can be purchased in amounts of $2,000, $5,000, or $10,000. The cost of supplemental life insurance is based on the insured’s current age and the amount of coverage elected to purchase.

*The coverage amount for your spouse cannot exceed 50% of employees Additional Life Coverage. The coverage amount for your child(ren) cannot exceed 50% of your Additional Life Coverage.

Age of Insured as of Jan. 1st	Monthly Rate Per Multiple of $1,000
Under 30	$0.098
30-34	$0.105
35-39	$0.137
40-44	$0.204
45-49	$0.329
50-54	$.0498
55-59	$0.831
60-64	$0.956
65-69	$1.876
70-74	$3.213
75 or over	$10.602

District-Paid Benefits

AD&D Insurance

A $25,000 accidental death & dismemberment (AD&D) policy is provided for all full-time, regular District employees.

Short-Term & Long-Term Disability Insurance

Short-term disability (STD) and Long-term disability (LTD) insurance is a benefit for all full-time, regular District employees. STD & LTD insurance replaces up to 60% of your pre-disability base salary if you become disabled. Contact Human Resources for more information.