Human Resources

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Benefits Summary

2013-2014 Benefits Summary   

The benefits information presented in this document is a summary only and does not confer any rights; please refer to your negotiated agreements for specifics. The information is subject to change without notice. For more information, please read the plan descriptions provided by your benefits providers or contact them directly.

Select a link below for direct access or scroll for more information.


Dependent Coverage
Life Insurance
Income Protection
Waiving Benefits/Cash-In-Lieu
Blue Cross PPO 100% (Summary of Benefits and Coverage)
Blue Cross PPO 80% (Summary of Benefits and Coverage)

Blue Shield HMO (Summary of Benefits and Coverage)
Delta Dental Premier
Delta Dental PPO
GoldenWest Dental

 

 

REMINDERS:

DEPENDENT COVERAGE

• When adding a spouse to your insurance, a copy of the marriage license or certificate of marriage is required.

• When adding a child to your insurance, a copy of the birth certificate is required.

• Dependent children may be covered from age 19 to age 26 who are not currently enrolled in their own employer sponsored health plan.  The dependent will remain eligible for coverage until the month of his/her 26th birthday, regardless of IRS dependent status or full-time student status.  A copy of their birth certification will be required for enrollment.


DISTRICT ALLOCATION--Santa Barbara City College offers a cafeteria-style plan in which employees are given a District allowance and may choose from a number of insurance programs. Changes may be made only once a year during the District's Open Enrollment period. The benefit allowance is determined by family status as follows:

Certificated Faculty, College Administrators,
Permanent Classified & Confidential Employees
Coverage Category 2013-2014 District Allowance
Medical Waiver $ 2,000
Single $ 7,861
Two-Party $ 15,176
Family $ 21,325

 

Employees are responsible for any insurance premiums in excess of the District allowance. In some cases the District allocation is more than is required to participate in the mandatory coverage; any unused allowance reverts to the District. All employees must take Life Insurance, Income Protection, Medical and Dental insurance. Medical and Dental insurance are the only benefits which may be waived with proof of comparable coverage as a dependent on another plan. NOTE: Employees who are waiving medical benefits may not elect Delta Dental coverage; they may only elect Golden West dental coverage.

MUTUAL OF OMAHA - GROUP LIFE INSURANCE

Basic life coverage is mandatory. The basic life coverage provides term group life insurance, with accidental death and dismemberment (AD&D) benefits. Basic life coverage provides $50,000 of coverage for the employee, $1,500 for the spouse and $1,500 for each dependent over 6 months of age. When an employee reaches age 70, the face value of the basic life insurance and AD&D benefit is reduced by 50%, and continues to be reduced by 50% every five years.

Dependent children may be covered from age 21 to age 25 provided they are a full-time student (12 or more units).

If an employee leaves the District, the employee may elect to convert their basic life coverage by completing an application form within 31 days of losing coverage through the District. The former employee will be billed directly by the insurance carrier.

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MUTUAL OF OMAHA - INCOME PROTECTION PLAN
(also known as Long-Term Disability)

Long-term disability insurance is mandatory and provides income protection insurance based upon 66 2/3 percent of base monthly salary up to a maximum of $5,000 per month. This plan becomes effective after a 90-day waiting period after date of disability.

MEDICAL WAIVERS & CASH-IN-LIEU

• Employees who are waiving medical coverage and who will be retiring between now and June 30, 2014 MUST enroll in the District medical plan during the Open Enrollment period that ends August, 2013.

 

• Employees who waive their District benefits and subsequently lose coverage due to loss of a spouse's employment or other qualifying event, must inform Human Resources within 30 days of the loss of coverage. Otherwise, they may not enroll in the District's plans until the following Open Enrollment period.

 

Cash-in-lieu: if the total cost of the mandatory benefits is less than the District's maximum allocation, then the remainder shall be relinquished to the District, except for those who are waiving coverage. If you waive medical insurance, you will receive cash-in-lieu of $2,000, minus the cost of the mandatory life and disability insurance and minus the cost of Golden West dental, if elected. If you are choosing the waiver, you must signify your acceptance of the Section 125 Flexible Benefits option as well (NOTE: you do not need to establish a Section 125 account).

The following procedure shall be followed for all employees who wish to apply for a medical waiver:

1. Fill out and sign the waiver section on the benefits enrollment form.

2. Medical and Dental insurance are the only benefits which may be waived with proof of comparable coverage as a dependent on another plan. Evidence of enrollment in a comparable plan will be required and the burden of proof regarding evidence of enrollment and comparability shall lie with the employee. Human Resources reserves the right to ask for a copy of the alternate plan.

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ANTHEM BLUE CROSS PPO 100% (SISC III)
"Classic / Legacy" Prudent Buyer Plan
Please refer to the Anthem Blue Cross PPO 100% plan description.  Limitations and exclusions apply. 

Visit www.anthem.com/ca/sisc for a list of providers; create a user name and password and have access to your benefits online. Anthem Blue Cross can be reached at (800) 322-5709.

MEDICAL BENEFIT PLAN CHANGES EFFECTIVE APRIL 1, 2014

• Prescription coverage, effective April 1, 2014, is administered by Navitus Health Solutions (www.navitus.com).  Navitus Rx BIN Number is 610602.  Navitus Rx PCN number is NVT.


Generic Substitution
All plans have automatic generic substitution. If a brand name medication has a generic available, the pharmacy or mail order facility will automatically fill the prescription with a generic when the brand name is not medically necessary. If the physician or member requests to have a brand name medication dispensed when it is not medically necessary, the member will pay the difference in the cost of the brand and generic medication plus the generic co-pay. There is a clinical review process through which it is possible to have a determination made as to whether or not a brand name drug is medically necessary. The member's physician may contact Medco to initiate the review process. If approved as medically necessary, the member will pay the brand co-pay.

Navitus by Mail Pharmacy Service
All Navitus cardholders may use the Navitus by Mail Pharmacy Service for their maintenance medications. The member may purchase a 90-day supply of maintenance medications and have them delivered directly to their home (or alternate address). Note: Not all prescriptions can be filled by mail order.

Costco $0 Co-Pay Program for Generic Drugs
To take advantage of the $0 co-pay for generic drugs you need to do the following: 1) Take your prescription for a generic medication to a Costco Pharmacy, 2) Present the pharmacist with your insurance card, 3) Get your generic medication with a $0 co-pay (excluding some narcotic pain medications and some cough medications).

Visit www.navitus.com for more information. Navitus can be reached at (866)333-2757.

VISION BENEFITS - MEDICAL EYE SERVICES (MES)
Please refer to the MES vision summary of benefits. 

Visit www.mesvision.com for a list of providers. MES can be reached at (800) 877-6372.

ANTHEM BLUE CROSS PPO 80% (SISC III)
Please refer to the Anthem Blue Cross PPO 80% plan description.  Limitations and exclusions apply. 

Visit www.anthem.com/ca/sisc for a list of providers; create a user name and password and have access to your benefits online. Anthem Blue Cross can be reached at (800) 322-5709.

MEDICAL BENEFIT PLAN CHANGES EFFECTIVE APRIL 1, 2014

  • Prescription drug coverage, effective April 1, 2014 is Navitus Health Solutions (866-333-2757).  Navitus Rx BIN Number is 610602.  Navitus Rx PCN Number is NVT.  

Generic Substitution

All plans have automatic generic substitution. If a brand name medication has a generic available, the pharmacy or mail order facility will automatically fill the prescription with a generic when the brand name is not medically necessary. If the physician or member requests to have a brand name medication dispensed when it is not medically necessary, the member will pay the difference in the cost of the brand and generic medication plus the generic co-pay. There is a clinical review process through which it is possible to have a determination made as to whether or not a brand name drug is medically necessary. The member's physician may contact Medco to initiate the review process. If approved as medically necessary, the member will pay the brand co-pay.

Navitus by Mail Pharmacy Service
All Navitus cardholders may use the Navitus by Mail Pharmacy Service for their maintenance medications. The member may purchase a 90-day supply of maintenance medications and have them delivered directly to their home (or alternate address). Note: Not all prescriptions can be filled by mail order.

Costco $0 Co-Pay Program for Generic Drugs
To take advantage of the $0 co-pay for generic drugs you need to do the following: 1) Take your prescription for a generic medication to a Costco Pharmacy, 2) Present the pharmacist with your insurance card, 3) Get your generic medication with a $0 co-pay (excluding some narcotic pain medications and some cough medications).

Visit www.navitus.com for more information. 

 

VISION BENEFITS - MEDICAL EYE SERVICES (MES)

Please refer to the MES vision summary of benefits. 

Visit www.mesvision.com for a list of providers. MES can be reached at (800) 877-6372.

  • ADDITIONAL ANTHEM BLUE CROSS 100% & 80% PLAN FEATURES

BlueCard WorldWide
For information on how to access your benefits when traveling outside of California and abroad, please call (800) 810-2583.

Health Smarts / ConditionCare
Your plan includes Condition Management (Asthma, Diabetes, Heart Failure, Coronary Artery Disease, Chronic Obstructive Pulmonary Disease), Online Health Assessment, and Health Screening Events, when available, to help you better understand and manage specific chronic health conditions and improve your overall quality of life. It is not a substitute for your physician's care.  For more information, please visit http://sisc.kern.org/healthsmarts/.

You may be identified for participation through paid claim history, hospital discharge reports, physician referral, or case management. You may request to participate by calling (800) 621-2232. This program is voluntary, confidential and offered at no cost to all members.

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BLUE SHIELD CUSTOM ACCESS+ HMO
Please refer to the Blue Shield evidence of coverage.  Limitations and exclusions apply. 

Visit www.blueshieldca.com for a list of providers; create a user name and password and have access to your benefits online. Blue Shield can be reached at (800) 424-6521.

MEDICAL BENEFITS
Please refer to the Blue Shield summary of benefits.

PRESCRIPTION BENEFITS
Effective April 1, 2014, prescription coverage is administered by Navitus Health Solutions (www.navitus.com).  Navitus Rx BIN Number is 610602.  Navitus Rx PCN Number is NVT.

CHIROPRACTIC AND ACUPUNCTURE BENEFITS
Please refer to the Blue Shield chiropractic and acupuncture summary of benefits

Visit www.ashcompanies.com for a list of providers. ASH can be reached at (800) 678-9133.

VISION BENEFIT PLAN CHANGES EFFECTIVE OCTOBER 1, 2012 - MEDICAL EYE SERVICES (MES)
Please refer to the MES vision rider

Visit www.mesvision.com for a list of providers. MES can be reached at (800) 877-6372.

DELTA DENTAL PREMIER PLAN 1
Please refer to the Delta Dental Premier plan description,  Limitations and exclusions apply.

Visit www.deltadentalins.com - Create a one-time registration to log in. You will be able to locate a provider, verify your eligibility, check your benefits for covered services, view maximums and deductible information, print an ID card and check the status of a claim. Delta Dental can be reached at (866) 499-3001.

DELTA DENTAL PPO
Please refer to the Delta Dental PPO plan description,  Limitations and exclusions apply.

For more information regarding orthodontic benefits, please refer to Understanding Orthodontic benefits document.  Retirees on the Delta Dental PPO plan are not eligible for the orthodontic benefits.

Visit www.deltadentalins.com - Create a one-time registration to log in. You will be able to locate a provider, verify your eligibility, check your benefits for covered services, view maximums and deductible information, print an ID card and check the status of a claim. Delta Dental can be reached at (866) 499-3001.

GOLDEN WEST DENTAL - TRUE ADVANTAGE PPO
Please refer to the True Advantage PPO plan description and True Advantage PPO benefits summary.  Limitations and exclusions apply.

Orthodontia is a covered benefit as long as treatment is provided by a Golden West (HMO) Orthodontist. Plan benefits include 24 months of standard orthodontic treatment and an additional 6 months of retention. Treatment extending beyond these time periods will be subject to additional charges. Treatment in progress at inception of eligibility is not covered.  Please refer to the Golden West (HMO) orthodontic benefits summary.

Visit www.goldenwestdental.com for a list of providers. Golden West can be reached at (877) 496-0068.

VOLUNTARY PROGRAMS OFFERED TO SBCC EMPLOYEES

MUTUAL OF OMAHA - VOLUNTARY TERM LIFE INSURANCE

Eligibility: All permanent full-time employees have the opportunity to enroll in voluntary term life insurance within 31 days of their date of hire. If applied for after 31 days, evidence of insurability is required.

 

AMERICAN FIDELITY ASSURANCE COMPANY - SECTION 125 FLEXIBLE BENEFITS PLAN ADMINISTRATOR
For more information, please visit www.afadvantage.com.

•  Effective January 1, 2011, you will not be able to use your health care flexible spending account (FSA) to purchase over-the-counter medications unless you have a prescription from your physician.  In prior years, the IRS allowed you to include these non-prescription medications in your health care spending account reimbursement plan.

For additional information on any of the benefits mentioned on this page, please contact Sharon Remacle in Human Resources at extension 2713.

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