Overview
CHANGES TO THE CUSD HEALTH PLAN EFFECTIVE 09-01-07
AND WHERE TO FIND ADDITIONAL INFORMATION ON THE CHANGES
1. New Provider Networks
a. In California the new provider network is the Prudent Buyer Network. The directory for the Prudent Buyer Network can be found here on the CUSD Website:
http://www.cusd.com/benefits/Prudent%20Buyer%20Directory.pdf
b. Outside California (remaining 49 states) the new provider network is the First Health Network. The link to the directory for the First Health Network can be found here on the CUSD Website:
http://www.cusd.com/benefits/providers.htm
2. Medical Office Visit Copay of $20 for each visit or service billed to the Health Plan. Effective 09-01-08 the Medical Office Visit Copay will increase to $25 – Page 5 of CUSD Summary Plan Document
3. Chiropractic Office Visit Copay of $13 for each chiropractic office visit. – Page 7 of CUSD Summary Plan Document
4. Emergency Room Copay on the second visit and each subsequent visit in a calendar year. – Page 5 of CUSD Summary Plan Document
5. Managed Care – Prior Authorizations are REQUIRED on a larger number of services and procedures. A complete list can be found on pages 4 and 5 under Utilization Review in the CUSD Summary Plan Document
6. Prescription Copay Changes – Page 8 of CUSD Summary Plan Document
| DRUG |
CURRENT |
AS OF 9-1-2008 |
| Generic |
$5 |
$6 |
| Preferred Brand Name |
$20 |
$21 |
| Brand Name |
$30 |
$31 |
* All prescription copays will increase by $1 each year starting 9-1-08 * |
7. Mail Order Copay Changes – Page 8 of CUSD Summary Plan Document
| DRUG |
CURRENT |
AS OF 9-1-2008 |
| Generic |
$10 up to 100 day supply |
$12 up to 100 day supply |
| Preferred Brand |
$40 up to 100 day supply |
$42 up to 100 day supply |
| Brand Name |
$60 up to 100 day supply |
$62 up to 100 day supply |
8. Eligibility Waiting Period – All employees hired after September 1, 2007 will now have a 30 day waiting period before being eligible for benefits. The waiting period starts on the first day of the month following the first day of the employee’s assignment and the effective date will be on the first day of the month following the end of the 30 day waiting period. – Page 14 of CUSD Summary Plan Document
9. Lifetime Benefits Eligibility Changes – All employees hired after September 1, 2007 will only be eligible for lifetime benefits after 30 years of service in CUSD and the age of 62. – CUSD Board Policy 6503
10. Lifetime Maximum for Infertility/Obesity treatment – Covered expenses are limited to $5,000 maximum per lifetime. – Page 9 (Infertility) and Page 13 (Obesity) of CUSD Summary Plan Document
11. Eligibility Requirements for Dependents – All dependent children over the age of 19 years must be enrolled in school time, must be claimed as a dependent on the member’s taxes and must be enrolled in school full time in order to be covered under the medical, dental and vision plans. – Page 15 of CUSD Summary Plan Document
12. Optional Buy Up Vision Program – Please keep an eye out during the Online Open Enrollment this fall for an optional vision plan that members can purchase that will provide additional vision benefits for the member and all eligible dependents.
Download a copy of this document here
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