Frequently Asked Benefit Questions
Q. Will there be a deduction taken from my paycheck for my benefit coverage?
A. The district provides a set annual contribution amount towards your benefits based on your medical coverage tier (Employee only, Employee+1, Employee+2 or more, Waive). The district contribution amount is applied towards your medical, dental, and vision coverage. Please refer to the “Health Plan Options and Costs” sheet (available on the Welcome tab) specific to your employee group for more detailed information. The long-term disability coverage is fully paid by the district. Voluntary plans (i.e. flexible spending accounts, life insurance, AD&D) are fully paid by the employee.
Q. What documentation will I need to submit to add a dependent?
A. In addition to their basic information:
- Child dependent - birth certificate
- Spouse - marriage certificate
- Domestic Partner – Affidavit of Domestic Partnership and must meet all of the qualifications of a domestic partner under the state of California.
Q. What is the difference between an HMO and a PPO?
HMO - The Health Maintenance Organization (HMO) plans provide health care from specific doctors and hospitals under contract with the plan. You pay co-payments for some services, but you have no deductible, no claim forms, and a geographically restricted service area.
PPO - These plans operate as preferred provider organizations (PPOs). A PPO is similar to a traditional "fee-for-service" plan, but you must use the doctors in the PPO provider network or pay higher co-insurance (percentage of charges). You must usually meet an annual deductible before some benefits apply. You're responsible for a certain co-insurance amount and the plan pays the balance up to the allowable amount.
Q. How do I choose my medical and dental plans to ensure that I select the best plan(s)?
A. First review the informational materials in your benefits packet and on the district website to evaluate which plans would meet you/your family’s current medical and dental needs. Some individuals prefer the convenience of having a co-payment and decide to choose an HMO plan. Others prefer to pay deductibles and coinsurance for the flexibility of going to participating and non-participating providers and therefore enroll in PPO plans. Regardless of which plans you choose, keep in mind that all of the plans, whether they are HMO or PPO, are designed to provide comprehensive health coverage to you and your family.
Q. When will I receive my benefit identification cards?
A. Medical plan and Delta Care HMO identification cards will arrive in 2-3 weeks from the date that you complete your enrollments in SmartBen. Delta Dental (PPO) and VSP – Cards are not issued by these carriers. Please provide your health care practitioners with your social security and your group number.
Q. What if I’m not happy with the medical and/or dental plan? May I change my plans?
A. The opportunity to change our plans is offered during our open enrollment period which is held in the fall each year. Changes made during open enrollment will be for a January 1 effective date.
Q. May I extend my benefit coverage if I leave the District?
A. Yes, you have the option to continue your health care coverage through COBRA. Details on COBRA are mailed to your home address by our COBRA Administrator, Employee Benefits Corporation (EBC).