Benefits
2020-21 Medical and Dental Plan Summaries
- Allegiance FLEX 125 Medical Spending / Dependent Care Accounts
- Kaiser Permanente
- Regence BlueCross BlueShield of Oregon
- Willamette Dental
- Request Documents
Allegiance FLEX 125 Medical Spending / Dependent Care Accounts
Plan Summary
Beaverton School District
Flexible Benefits Program (Section 125 Plan) Summary
2019-20 Plan Year
November 1, 2019 to October 31, 2020
Administration Fees
Employees will have a total of $4.50/month deducted from their paychecks on a pre-tax basis for participation in the Health Care Spending Account and/or Dependent Care Spending Account.
This fee offsets the costs charged to the District to administer this plan.
Monthly Pre-tax Deductions
An employee is responsible for the monthly amount he/she has designated to have deducted from his/her paycheck for the designated plan year. If an employee’s paycheck does not cover his/her monthly designated deduction(s), then the employee will be required to pay the District directly. Any employee under this circumstance that does not reimburse the District will become inactive on the plan and will be unable to participate until the following election period. Monthly pre-tax deductions will occur as follows for the following employee classifications:
-
Certified Staff
- Temporary Teachers
Temporary teachers are only eligible to participate during the time they are receiving a paycheck from the District. Their plan year ends on July 31, 2020.
- Substitute Teachers
Substitute teachers will have a triple deduction in their June check to cover the summer pre-tax deductions they have designated. Anytime a substitute does not have sufficient funds to cover this deduction, he/she will be required to pay the District the difference in order to continue participation in the plan. The substitute plan year ends September 30, 2020.
- 12-Month Employees/12 paychecks per year
Deductions will be taken once per month.
- Less than 12-month Employees/12 paychecks per year
Deductions will be taken once per month.
- Less than 12-month Employees/10 or 11 paychecks per year
Employees who receive 10 paychecks during the school year will receive a triple deduction in their June check and employees who receive 11 paychecks during the school year will receive a double deduction in their June check in order to remain active on the plan during the summer months. Should an employee not have sufficient funds to cover his/her deduction, then he/she will be required to pay the District directly in order to continue participation in the plan.
- Temporary Classified Employees Who Work Less Than 12 Months
Temporary classified employees may participate in the plan from November 1, 2019 until June 30, 2020.
- Employees on Unpaid Leave
These employees are ineligible to participate in the Section 125 plan.
Making Changes
MAKING A CHANGE IN YOUR MONTHLY PRE-TAX DEDUCTION
You may make a change in your monthly pre-tax deduction for the following qualifying events:
- Birth
- Death
- Adoption
- Marriage
- Divorce
- Change in Employment Status
- Termination of Employment (you or spouse)
You must notify Human Resources within 30 days of the qualifying event in order to make a change in your pre-tax deduction(s). Requests made after the 30-day period are ineligible and the employee will be unable to make a change until the next open enrollment period.
You may make a change in your monthly pre-tax deduction for the following qualifying events:
- Birth
- Death
- Adoption
- Marriage
- Divorce
- Change in Employment Status
- Termination of Employment (you or spouse)
You must notify Human Resources within 30 days of the qualifying event in order to make a change in your pre-tax deduction(s). Requests made after the 30-day period are ineligible and the employee will be unable to make a change until the next open enrollment period.
Filing a Reimbursement
How to File a Reimbursement
For employees participating in either the Health Care Spending Account and/or Dependent Care Spending Account, reimbursement forms can be found on the District intranet or at the Allegiance website: www.askallegiance.com. Please complete the form, attach the appropriate receipts, and mail or FAX directly to Allegiance Benefit Plan for reimbursement.
You may also file for your reimbursement on line through the Allegiance website (as listed above). Directions for on line reimbursement are available on the District intranet.
Important Notice: You must file your reimbursement for expenses incurred during the plan year no later than 90 days after the end of the plan year. For the previous 2018 – 2019 plan year (November 1, 2018 – October 31, 2019), the claim must be received by Allegiance no later than January 31, 2020. Any claims submitted after that date will not be considered.
Questions regarding this program may be directed to Human Resources, at 503-356-4459.
Kaiser Permanente
2020-21 Benefit Changes
2020 KAISER SUMMARY OF BENEFIT CHANGES
Beaverton School District
These changes/enhancements go into effect as of July 1, 2020 except where specifically noted.
Benefit changes/enhancements:
There are no significant changes to the Kaiser benefits for this year’s renewal.
Please note: These summary changes are listed as a reference only. For a complete list of benefits, limitations and exclusions that apply please refer to the benefits booklet or the group master contract.
Grandfathered Plan Notice
GRANDFATHERED PLAN NOTICE - BSD
Kaiser Permanente plan 2019
Beaverton School District believes this Kaiser group medical plan coverage is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your Kaiser plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at 503-356-4459. You may also contact the U.S. Department of Health and Human Services at www.healthreform.gov
Regence BlueCross BlueShield of Oregon
2020 REGENCE SUMMARY OF BENEFIT CHANGES
PURPLE AND YELLOW MEDICAL PLANS/Beaverton School District
These changes/enhancements go into effect as of July 1, 2020 except where specifically noted.
Benefit changes/clarifications:
Over the counter contraceptives are not covered unless FDA approved. There is also no prescription required for coverage.
Please note: These summary changes are listed as a reference only. For a complete list of benefits, limitations and exclusions that apply please refer to the benefits booklet or the group master contract.
.
Willamette Dental
Willamette Dental
Summary
Beaverton School District
|
BENEFITS |
COPAYS |
|
Annual Maximum |
No Annual Maximum |
|
Deductible |
No Deductible |
|
General & Orthodontic Office Visit |
You pay a $4 Copay per Visit |
|
DIAGNOSTIC AND PREVENTIVE SERVICES |
|
|
Routine and Emergency Exams |
Covered with the Office Visit Copay |
|
X-rays |
Covered with the Office Visit Copay |
|
Teeth Cleaning |
Covered with the Office Visit Copay |
|
Fluoride Treatment |
Covered with the Office Visit Copay |
|
Sealants (per Tooth) |
Covered with the Office Visit Copay |
|
Head and Neck Cancer Screening |
Covered with the Office Visit Copay |
|
Oral Hygiene Instruction |
Covered with the Office Visit Copay |
|
Periodontal Charting |
Covered with the Office Visit Copay |
|
Periodontal Evaluation |
Covered with the Office Visit Copay |
|
RESTORATIVE DENTISTRY |
|
|
Fillings |
Covered with the Office Visit Copay |
|
Porcelain-Metal Crown |
You pay a $70 Copay |
|
PROSTHODONTICS |
|
|
Complete Upper or Lower Denture |
You pay a $80 Copay |
|
Bridge (per Tooth) |
You pay a $70 Copay |
|
ENDODONTICS AND PERIODONTICS |
|
|
Root Canal Therapy – Anterior |
You pay a $30 Copay |
|
Root Canal Therapy – Bicuspid |
You pay a $60 Copay |
|
Root Canal Therapy – Molar |
You pay a $80 Copay |
|
Osseous Surgery (per Quadrant) |
You pay a $40 Copay |
|
Root Planning (per Quadrant) |
You pay a $20 Copay |
|
ORAL SURGERY |
|
|
Routine Extraction (Single Tooth) |
Covered with the Office Visit Copay |
|
Surgical Extraction |
Covered with the Office Visit Copay |
|
ORTHODONTIA TREATMENT |
|
|
Pre-Orthodontia Treatment |
You pay a $150 Copay** |
|
Comprehensive Orthodontia Treatment |
You pay a $400 Copay |
|
MISCELLANEOUS |
|
|
Local Anesthesia |
Covered with the Office Visit Copay |
|
Dental Lab Fees |
Covered with the Office Visit Copay |
|
Nitrous Oxide |
Covered with the Office Visit Copay |
|
Specialty Office Visit |
You pay a $30 Copay per Visit |
|
Out of Area Emergency Care Reimbursement |
You pay charges in excess of $100 |
*Most service copayments are waived after completion of the 3rd incentive year. Office visit and orthodontia payments are permanent.
**Copay credited towards the Comprehensive Orthodontia Treatment copay if patient accepts treatment plan.
Underwritten by Willamette Dental Insurance, Inc.
This plan provides extensive coverage of services and supplies to prevent, diagnose, and treat diseases or conditions of the teeth and supporting tissues. Presented are just some of the most common procedures covered in your plan. Please see the Certificate of Coverage for a complete plan description, limitations, and exclusions.
​​​​Exclusions
Bridges, crowns, dentures or any prosthetic devices requiring multiple treatment dates or fittings if the prosthetic item is installed or delivered more than 60 days after termination of coverage.
The completion or delivery of treatments, services, or supplies initiated prior to the effective date of coverage. Dental implants, including attachment devices, maintenance, and dental implant-related services.
Endodontic services, prosthetic services, and implants that were provided prior to the effective date of coverage.
Endodontic therapy completed more than 60 days after termination of coverage.
Exams or consultations needed solely in connection with a service not listed as covered.
Experimental or investigational services or supplies and related exams or consultations.
Full mouth reconstruction, including the extensive restoration of the mouth with crowns, bridges, or implants; and occlusal rehabilitation, including crowns, bridges, or implants used for the purpose of splinting, altering vertical dimension, restoring occlusions or correcting attrition, abrasion, or erosion.
General anesthesia, moderate sedation and deep sedation.
Hospitalization care outside of a dental office for dental procedures, physician services, or facility fees.
Nightguards. Orthognathic surgery. Personalized restorations.
Plastic, reconstructive, or cosmetic surgery and other services or supplies, which are primarily intended to improve, alter, or enhance appearance.
Prescription and over-the-counter drugs and pre- medications.
Provider charges for a missed appointment or appointment cancelled without 24 hours prior notice.
Replacement of lost, missing, or stolen dental appliances; Replacement of dental appliances that are damaged due to abuse, misuse, or neglect.
Replacement of sound restorations.
Services and related exams or consultations that are not within the prescribed treatment plan and/or are not recommended and approved by a Willamette Dental Group dentist.
Services and related exams or consultations to the extent they are not necessary for the diagnosis, care, or treatment of the condition involved.
Services by any person other than a licensed dentist, denturist, hygienist, or dental assistant.
Services for the diagnosis or treatment of temporomandibular joint disorders.
Services for the treatment of an injury or disease that is covered under workers’ compensation or that are an employer’s responsibility.
Services for treatment of injuries sustained while practicing for or competing in a professional athletic contest.
Services for treatment of intentionally self-inflicted injuries. Services for which coverage is available under any federal, state, or other governmental program, unless required by law.
Services not listed as covered in the contract. Services where there is no evidence of pathology, dysfunction, or disease other than covered preventive services.
Limitations
If alternative services can be used to treat a condition, the service recommended by the Willamette Dental Group dentist is covered.
Services listed in the contract, which are provided to correct congenital or developmental malformations which impair functions of the teeth and supporting structures will be covered if primarily for the purpose of controlling or eliminating infection, controlling or eliminating pain, or restoring function.
Crowns, casts, or other indirect fabricated restorations are covered only if dentally necessary and if recommended by the Willamette Dental Group dentist.
When initial root canal therapy was performed by a Willamette Dental Group dentist, the retreatment of such root canal therapy will be covered as part of the initial treatment for the first 24 months. When the initial root canal therapy was performed by a non-participating provider, the retreatment of such root canal therapy by a Willamette Dental Group dentist will be subject to the applicable copayments.
The services provided by a dentist in a hospital setting are covered if medically necessary; pre-authorized by a Willamette Dental Group dentist; the services provided are the same services that would be provided in a dental office; and applicable copayments are paid.
The replacement of an existing denture, crown, inlay, onlay, or other prosthetic appliance is covered if the appliance is more than 5 years old and replacement is dentally necessary.
List of Providers
Request Documents
2020-21 Health Insurance Rates
- Cobra Rates
- Domestic Partner Taxable Rates
- Employee Health Care Premiums
- Retired Employee Health Care Premiums
- Substitute (Certified Regular) Health Care Premiums
- Substitute (Certified Deployable) Health Care Premiums
Cobra Rates
Beaverton School District
COBRA Rates
July 1, 2020 - June 30, 2021
Domestic Partner Taxable Rates
Beaverton School District
Domestic Partner Taxable Income
Effective July 1, 2020
Medical Plans Fair market values
(Values are added to monthly taxable income.)
Dental Plans fair market values
(Values are added to monthly taxable income.)
Employee Health Care Premiums
Employee Monthly Medical and Dental Payroll Deduction Rates
July 1, 2020 - June 30, 2021
The monthly payroll deductions below cover the employee and all eligible dependents.
FULL TIME EMPLOYEE (.75 to 1.0 FTE) |
EMPLOYEEMONTHLY PREMIUM |
|---|---|
Regence Blue Cross – Purple Medical PlanWith No DentalWITH PURPLE DENTALWith Willamette Dental |
$ 36.55$148.05$179.45 |
Blue Cross – Yellow Medical PlanWith No DentalWith Yellow DentalWith Willamette Dental |
$ 0$ 0$ 0 |
Kaiser Permanente Medical PlanWith No DentalWith Purple DentalWith Willamette Dental |
$ 0$ 0$ 0 |
Dental OnlyPurple DentalWillamette Dental |
$ 0$ 0 |
PART TIME EMPLOYEE (.50 TO .74 FTE) |
EMPLOYEEMONTHLY PREMIUM |
|---|---|
|
Regence Blue Cross – Purple Medical Plan
With No Dental
WITH PURPLE DENTAL
With Willamette Dental
|
$ 899.55$1,011.05$1,042.45 |
|
Blue Cross – Yellow Medical Plan
With No Dental
WITH YELLOW DENTAL
With Willamette Dental
|
$751.72$794.60$823.17 |
|
Kaiser Permanente Medical Plan
With No Dental
WITH PURPLE DENTAL
With Willamette Dental
|
$731.17 $786.92 $802.62 |
|
Dental Only*
Purple Dental
WILLAMETTE DENTAL
|
$ 55.75 $ 71.45 |
*Part-time, Classified employees electing a dental plan only will not be deducted a monthly premium.
The District maximum contribution for insurance is $1726.00 per month for full-time benefited employees and $863.00 per month for part-time.
Retired Employee Health Care Premiums
Beaverton School District
Rates for All Retirees
July 1, 2020 - June 30, 2021
Medical
Dental
Substitute (Certified Regular) Health Care Premiums
Beaverton School District
Substitute Teacher Rates
July 1, 2020 - June 30, 2021
Kaiser Medical
(employee monthly payroll deduction)
Dental
(employee monthly payroll deductions)
Substitute (Certified Deployable) Health Care Premiums
Beaverton School District
Deployable Substitute Rates
July 1, 2020 - June 30, 2021
Kaiser Medical
(employee monthly payroll deduction)
Dental
(employee monthly payroll deduction for employee and all dependents)
Deployable Substitutes are responsible for the medical premium cost of adding family members and for the full premium dental costs.
If enrolled in a medical and dental plan, add the two deduction amounts to obtain the total monthly deduction.
Federal Notices
- Medicare Creditable Coverage
- Children's Health Insurance Program - CHIPs
- Early Retiree Reinsurance Program - ERRP
- HIPPA Special Enrollment Rights Notice
- Lifetime LImits and Women's Health Cancer Rights Act
- Newborn's and Mother's Health Protection Act Notice
- Women's Preventive Health Care
Medicare Creditable Coverage
Important Notice from Beaverton School District About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Kaiser or with either one of the Regence Blue Cross Plans and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Beaverton School District has determined that the prescription drug coverage offered
by Kaiser and both of the Regence Blue Cross plans are, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th.
However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current Kaiser and Blue Cross coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current Kaiser or Blue Cross coverage, be aware that you and your dependents will be able to get this coverage back during an open enrollment period.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with Kaiser or Blue Cross and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to join.
For More Information About This Notice Or Your Current Prescription Drug Coverage…
Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Kaiser or Blue Cross changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the "Medicare & You" handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the "Medicare & You" handbook for their telephone number) for personalized help
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Date: October 18, 2018
Name of Entity/Sender: Beaverton School District
Contact: Debbie Johnson, Health Resource Coordinator
Address: 16550 SW Merlo Rd., Beaverton, OR 97003
Phone Number: 503-356-4459
Children's Health Insurance Program - CHIPs
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1- 877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2018. Contact your State for more information on eligibility –
|
ALABAMA – Medicaid |
FLORIDA – Medicaid |
|
Website: http://myalhipp.com/ Phone: 1-855-692-5447 |
Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268 |
|
ALASKA – Medicaid |
GEORGIA – Medicaid |
|
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: |
Website: http://dch.georgia.gov/medicaid - Click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507 |
|
ARKANSAS – Medicaid |
INDIANA – Medicaid |
|
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447) |
Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone 1-800-403-0864 |
|
COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) |
IOWA – Medicaid |
|
Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711 CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711 |
Website: http://dhs.iowa.gov/ime/members/medicaid-a-to- z/hipp Phone: 1-888-346-9562 |
|
KANSAS – Medicaid |
NEW HAMPSHIRE – Medicaid |
|
Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512 |
Website: https://www.dhhs.nh.gov/ombp/nhhpp/ Phone: 603-271-5218 Hotline: NH Medicaid Service Center at 1-888-901- 4999 |
|
KENTUCKY – Medicaid |
NEW JERSEY – Medicaid and CHIP |
|
Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 |
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 |
|
LOUISIANA – Medicaid |
NEW YORK – Medicaid |
|
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447 |
Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831 |
|
MAINE – Medicaid |
NORTH CAROLINA – Medicaid |
|
Website: http://www.maine.gov/dhhs/ofi/public- assistance/index.html Phone: 1-800-442-6003 TTY: Maine relay 711 |
Website: https://dma.ncdhhs.gov/ Phone: 919-855-4100 |
|
MASSACHUSETTS – Medicaid and CHIP |
NORTH DAKOTA – Medicaid |
|
Website: http://www.mass.gov/eohhs/gov/departments/masshe alth/ Phone: 1-800-862-4840 |
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid Phone: 1-844-854-4825 |
|
MINNESOTA – Medicaid |
OKLAHOMA – Medicaid and CHIP |
|
Website: http://mn.gov/dhs/people-we- serve/seniors/health-care/health-care- programs/programs-and-services/medical- assistance.jsp Phone: 1-800-657-3739 |
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 |
|
MISSOURI – Medicaid |
OREGON – Medicaid |
|
Website: https://www.dss.mo.gov/mhd/participants/pages/hipp. htm Phone: 573-751-2005 |
Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075 |
|
MONTANA – Medicaid |
PENNSYLVANIA – Medicaid |
|
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HI PP Phone: 1-800-694-3084 |
Website: http://www.dhs.pa.gov/provider/medicalassistance/he althinsurancepremiumpaymenthippprogram/index.ht m Phone: 1-800-692-7462 |
|
NEBRASKA – Medicaid |
RHODE ISLAND – Medicaid |
|
Website: http://www.ACCESSNebraska.ne.gov Phone: (855) 632-7633 Lincoln: (402) 473-7000 Omaha: (402) 595-1178 |
Website: http://www.eohhs.ri.gov/ Phone: 855-697-4347 |
|
NEVADA – Medicaid |
SOUTH CAROLINA – Medicaid |
|
Medicaid Website: https://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900 |
Website: https://www.scdhhs.gov Phone: 1-888-549-0820 |
|
SOUTH DAKOTA - Medicaid |
WASHINGTON – Medicaid |
|
Website: http://dss.sd.gov Phone: 1-888-828-0059 |
Website: http://www.hca.wa.gov/free-or-low-cost- health-care/program-administration/premium-payment- program Phone: 1-800-562-3022 ext. 15473 |
|
TEXAS – Medicaid |
WEST VIRGINIA – Medicaid |
|
Website: http://gethipptexas.com/ Phone: 1-800-440-0493 |
Website: http://mywvhipp.com/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447) |
|
UTAH – Medicaid and CHIP |
WISCONSIN – Medicaid and CHIP |
|
Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669 |
Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.p df Phone: 1-800-362-3002 |
|
VERMONT– Medicaid |
WYOMING – Medicaid |
|
Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427 |
Website: https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531 |
|
VIRGINIA – Medicaid and CHIP |
|
|
Medicaid Website: http://www.coverva.org/programs_premium_assistance. cfm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.coverva.org/programs_premium_assistance. cfm CHIP Phone: 1-855-242-8282 |
|
To see if any other states have added a premium assistance program since January 31, 2018, or for more information on special enrollment rights, contact either:
U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/agencies/ebsa www.cms.hhs.gov
1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.
OMB Control Number 1210-0137 (expires 12/31/2019)
Early Retiree Reinsurance Program - ERRP
REQUIRED FEDERAL NOTICE—PLEASE READ
No action is required of you at this time. Please read this notice carefully and keep it where you can find it. You are responsible for sharing this notice to current and future family members that are enrolled in your Beaverton School District medical plans.
You are receiving the Early Retiree Reinsurance Program (ERRP) notice as a requirement under federal law. The money received under the federal program described in this notice will be used to offset future rate increases from our health plans until the program expires. This notice does not impact your eligibility for coverage under the Beaverton School District medical plans.
NOTICE ABOUT THE EARLY RETIREE REINSURANCE PROGRAM
You are a plan participant, or are being offered the opportunity to enroll as a plan participant, in an employment-based health plan that is certified for participation in the Early Retiree Reinsurance Program. The Early Retiree Reinsurance Program is a Federal program that was established under the Affordable Care Act. Under the Early Retiree Reinsurance Program, the Federal government reimburses a plan sponsor of an employment-based health plan for some of the costs of health care benefits paid on behalf of, or by, early retirees and certain family members of early retirees participating in the employment-based plan. By law, the program expires on January 1, 2014.
Under the Early Retiree Reinsurance Program, your plan sponsor may choose to use any reimbursements it receives from this program to reduce or offset increases in plan participants’ premium contributions, co-payments, deductibles, co-insurance, or other out-of-pocket costs. If the plan sponsor chooses to use the Early Retiree Reinsurance Program reimbursements in this way, you, as a plan participant, may experience changes that may be advantageous to you, in your health plan coverage terms and conditions, for so long as the reimbursements under this program are available and this plan sponsor chooses to use the reimbursements for this purpose. A plan sponsor may also use the Early Retiree Reinsurance Program reimbursements to reduce or offset increases in its own costs for maintaining your health benefits coverage, which may increase the likelihood that it will continue to offer health benefits coverage to its retirees and employees and their families.
If you have received this notice by email, you are responsible for providing a copy of this notice to your family members who are participants in this plan.
District Goal for 2010-15: All students will show continuous progress toward their personal learning goals, developed in collaboration with teachers and parents, and will be prepared for post-secondary education and career success.
The Beaverton School District recognizes the diversity and worth of all individuals and groups. It is the policy of the Beaverton School District that there will be no discrimination or harassment of individuals or groups based on race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, marital status, age, veterans' status, genetic information or disability in any educational programs, activities or employment.
HIPPA Special Enrollment Rights Notice
Special Enrollment Rights Notice
Under the special enrollment provisions of HIPAA, you may be eligible, in certain situations, to enroll in a Beaverton School District medical plan during the year, even if you previously declined coverage. This right extends to you and all eligible family members.
** You will be eligible to enroll yourself (and eligible dependents) if, during the year you or your dependents have lost coverage under another plan because:
*Coverage ended due to termination of employment, divorce, death, or a reduction in hours that affected benefits eligibility;
*Employer contributions to the plan stopped;
*The plan was terminated;
*COBRA coverage ended; or
*The lifetime maximum for medical benefits was exceeded under the existing medical coverage option.
You must notify the plan within 30 days of the loss of coverage in order to enroll on the Beaverton School District medical plan during the year.
Otherwise, you will need to wait until the plans open enrollment period.
**If you gain a new dependent during the year as a result of marriage, birth, adoption or placement for adoption, you may enroll that dependent , as well as yourself and any other eligible dependents , in the plan again, even if you previously declined medical coverage.
You must notify the plan within 30 days of the event in order to enroll on the Beaverton School District medical plan during the year. Otherwise, you will need to wait until the plans open enrollment period. Coverage will be retroactive to the date of the birth or adoption for children enrolled during the year under these provisions.
**Effective April 1, 2009, you will be eligible to enroll yourself and eligible dependents
if either of two events occur:
*You or your dependent loses Medicaid or Children's Health Insurance Program (CHIP) coverage because you are no longer eligible.
*You or your dependent qualifies for state assistance in paying your employer group medical plan premiums.
Regardless of other enrollment deadlines , you will have 60 days from the date of the Medicaid/CHIP event to request enrollment in the Beaverton School District medical plan.
Please note that special enrollment rights allow you to either:
*Enroll in your current medical coverage; or
*Enroll in any medical plan benefit option for which you and your dependents are eligible.
Lifetime LImits and Women's Health Cancer Rights Act
REQUIRED FEDERAL NOTICES-PLEASE READ
Lifetime Limit No Longer Applies
The lifetime limit on the dollar value of benefits under the Beaverton School District Regence group medical plans no longer applies.
For more information, contact the District's Health Resource Coordinator, Debbie Johnson, RN, at (503) 356-4459 or debbie johnson-HR @bcaverton.k12.or.us
Women' s Health and Cancer Rights Act of 1998 (WHCRA)
WHCRA includes important protections for breast cancer patients who choose to have breast reconstruction in connection with a mastectomy.
The coverage outlines below is included in your Regence and Kaiser medical plan:
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Reconstruction of the breast on which the mastectomy was performed
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Surgery and reconstruction of the other breast to produce a symmetrical appearance
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Prosthesis and treatment of physical complications of all stages of mastectomy,including lymphademas
The attending physician and the patient will determine the manner of treatment.
All coverage is subject to any deductibles, copayments, and/or coinsurance according to the provisions of your health insurance benefits and federal requirem ents. Please see your benefits booklet for additional information.
Newborn's and Mother's Health Protection Act Notice
Newborn's and Mothers' Health Protection Act Notice
Maternity Benefits
Under Federal and state law you have certain rights and protections
regarding your maternity benefits under the Plan.
Under federal law known as the "Newborns' and Mothers' Health Protection Act of 1996" (Newborns' Act) group health plans and health insurance issuers generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery , or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Women's Preventive Health Care
Women's Preventive Health Care
Under the Affordable Care Act passed in 2010, Regence currently covers women's preventive health care services such as mammograms, screenings for cervical cancer and other services al no cos! share. On August 1, 2011, the Department of Health and Human Services (HHS) adopted additional guidelines for women's preventive services that will also be covered at 100% and not subject to deductible. These guidelines, detailed below, will apply lo your plan as it renews on or after
August 1, 2012.
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Type of Preventive Service What is Covered |
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Contraceptive Methodsand Counseling
When a plan does not provide a Pharmacy benefit, contraceptive medications will be added to the existing Preventive only Rx plan. |
The following medications and products are covered under Preventive Care: .• Generic contraceptive pills. Generic injectables and formulary brand patches. • Implants, cervical caps, and IUDs are covered under the Preventive Care Medical benefit. Diaphragms are covered under Preventive Care (Medical or Pharmacy). • Insertion of a device is covered under Preventive Care. Removal is covered at . regular plan benefits if a Family Planning benefit applies. Generic emergency contraception products.
Contraceptive products require a prescription for coverage. Generic contraceptive medications are covered. Other medications or products used for contraception are covered under regular plan benefits (if pharmacy benefit-s apply). When no generic exists, a formulary brand is covered. If a generic becomes available, the formulary brand will no longer be covered under Preventive care. Members can get the most value for their health care dollars with preferred medications. Learn more at regencerx.com/learn/covered.
Over-the-counter products are not covered. |
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Sterilization is covered. |
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Education and training on contraceptive methods are covered under Preventive Care. |
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Well-Woman Visits |
Preventive care visits for adult women are covered under Preventive Care. |
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Breast-Feeding Support, Supplies and Counseling |
Manual and electric breastfeeding pumps are covered under Preventive Care when purchased or rented from a licensed provider. Off-the-shelf pumps from a retail outlet are not covered. Hospital-grade pumps are not covered. |
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The initial breastfeeding supplies provided with a breastfeeding pump are covered under Preventive Care. |
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Lactation support and counseling are covered under Preventive Care when provided by a licensed provider. |
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Screening for GestationalDiabetes |
Screening is covered under Preventive Care for pregnant women between 24 and 28 weeks of gestation and the first prenatal visit for pregnant women at high risk for diabetes. |
HPV Testing |
Screening is covered under Preventive Care for women from age 30, every 3 years. |
|
Counseling for Sexually Transmitted Infections |
Counseling during well-women visits on an annual basis for all sexually active women will be covered under Preventive Care. |
Counseling and Screeningfor HIV |
Screening and counseling during well-women visits for all sexually active women will be covered under Preventive Care. |
Counseling and Screeningfor Interpersonal and Domestic Violence |
Screening and counseling during well-women visits will be covered. |
You'll find more detailed information on other covered preventive services on our Preventive Care Brochure, including additional screenings, tests and counseling for adults, and child and adolescent immunizations. This brochure can be viewed online al http://www.regence.com/transparency/coverage-on-preventive-services.jsp.
Health insurers continue to receive information from the U.S. Department of Health and Human Services regarding the new law. Therefore, this information is subject to change. The information provided in this document should not be construed as legal advice.
Revised 9-13-12
Regence BlueCross BlueShield of Oregon is an independent licensee of the Blue Cross and Blue Shield Association