Open Enrollment
PUSD’S ANNUAL OPEN ENROLLMENT IS HAPPENING NOW!
Annual Open Enrollment is scheduled from Monday, October 23, 2023, through Friday, November 3, 2023 at 5:00 p.m. with a January 1, 2024 effective date.
Open Enrollment is the once-a-year opportunity to enroll in your benefit plan choices and add or drop dependents.
You will need to take action during Open Enrollment if any of the following apply to you:
- Would like to change your plan elections, including changing your medical and/or dental carrier
- Enroll or continue participation in the Opt-Out/Waiver program and receive cash in lieu of benefits for plan year 2024
- Add or drop dependents
- Participate in a Healthcare or Dependent Care FSA plan for plan year 2024
- Enroll in voluntary plan such as MetLife Legal, American Fidelity, or Supplemental Life Insurance
What’s New For 2024
Anthem Blue Cross and EmpiRX Members Only
The prescription drug plan associated with your Anthem medical plan, EmpiRx, has made improvements to better
meet the District’s employees and their family’s needs:
The prescription drug plan associated with your Anthem medical plan, EmpiRx, has made improvements to better
meet the District’s employees and their family’s needs:
- Retail 90 Day Benefit (effective 10/1/2023) - For your convenience, long-term maintenance medications can now be filled at your pharmacy for a 90 day supply at a retail pharmacy for 2x copays (mail order is already available for these medications). Participating pharmacies include Rite Aid, CVS, Walgreens, Walmart, and Costco.
For a complete list go to www.empirxhealth.com.You will need a prescription from your doctor that
allows for a 90 day supply. - Many clinical reviews, that include prior authorization and step therapy, will be changed from a 1-year approval to a 2-year approval.
- bWell Copay Assistance Program (effective November 1, 2023). This program applies to a small number of employees and/or their family members. Specialty medications (for cancer, multiple scelrosis, etc.) are expensive. The bWell copay assistance program provides an opportunity to receive copay assistance from the drug manufacturer (if eligible the member would have no copay). EmpiRx Health Specialty Coordinators will assist this small group of employees/family members with enrollment in the program. It does require a specified Specialty Pharmacy must be used; however, it is a voluntary program.
Expanded Access to Mental Health Resources
Anthem and Kaiser recognize that the need for Mental Health resources has increased dramatically in the past few years, especially since the COVID-19 pandemic. Both are offering more robust access to mental health care provider networks.
Anthem Blue Cross Members
Virtual care offers easy access to Therapists and Psychiatrists. Therapy visits online allow you to get the same level of care as an in-person visit, but on your own time, and from wherever you feel most comfortable. Psychiatrists are available by appointment and can prescribe medication when talk therapy isn’t enough. All you need is your smartphone, tablet, or computer.
Virtual care offers easy access to Therapists and Psychiatrists. Therapy visits online allow you to get the same level of care as an in-person visit, but on your own time, and from wherever you feel most comfortable. Psychiatrists are available by appointment and can prescribe medication when talk therapy isn’t enough. All you need is your smartphone, tablet, or computer.
Download the Sydney Health app today to get started. Or sign up at anthem.com/ca.
- Search and review our providers, their education, experience, and approach to treatment. Find one that works best for you.
- Schedule your convenient appointment online. Appointments are available weekdays, evenings, and weekends, and typically take about 45 minutes.
- Have your visit. At your appointment, you will talk with your provider about your concerns, symptoms, and care.
Choose from an appointment with a therapist for one-on-one care and counseling, or a psychiatrist for ongoing medication management. Schedule future visits with the same therapist or find one whose experience may be a better fit for you.
Anthem HMO members have a $0 copay whereas Anthem PPO members have a $5.00 copay for these covered virtual visits.
Reminder: Virtual appointments can also be used to visit with a doctor for common health conditions. Doctors are available on demand 24/7, without an appointment or long wait times.
Kaiser
Mental Health and emotional wellness are important parts of your total health. Kaiser has created a cohesive
experience for members to ensure members get the appropriate mental health care appointments and care they need.
Mental Health and emotional wellness are important parts of your total health. Kaiser has created a cohesive
experience for members to ensure members get the appropriate mental health care appointments and care they need.
- For mental health care appointments, call 1-833-KP-WITH-U
- Kaiser members do not need a referral to access mental health services
Available Monday through Friday, 8:00 a.m. to 5:30 p.m.
Behavioral Health Line & Mental Health Crisis Line for Kaiser Southern California:
- Available 24/7
- The Mental Health Crisis Line for Kaiser Southern California is 800-900-3277
- With this number, members can get help 24 hours a day, 7 days a week
This number will help with access to mental health, crisis, intervention, guidance, and more.
Delta Dental Enhanced Benefits
Currently, only dependent children are eligible for the $1,000 lifetime orthodontia benefit. Effective January 1, 2024 adults will also be eligible for the same benefit.
Currently, only dependent children are eligible for the $1,000 lifetime orthodontia benefit. Effective January 1, 2024 adults will also be eligible for the same benefit.
SmileWay Wellness benefit is new enhanced coverage for Delta Dental members with certain chronic medical conditions that may benefit from additional teeth and gum cleanings. To see if you qualify and opt into the
benefit, visit www1.deltadentalins.com/smileway.
benefit, visit www1.deltadentalins.com/smileway.
Employee Assistance Program Change
The employee assistance program (EAP) provided by Employee Assistance Service for Education (EASE) is now
contracted with Evernorth. Please see page 41 for details and contact information.
Important Reminders
Opt-Out/Waiver Option
For employees currently opting out of the PUSD Basic Health Insurance Package and receiving Opt-Out Cash, it
is required that you log into BenefitBridge and select such coverage on an annual basis.
The Opt-Out/Waiver Option will NOT roll over from the 2023 plan year (the dollar amount varies per bargaining unit agreements). Failure to elect the Opt-Out option will result in auto-enrollment of Kaiser, Delta Dental, and EyeMed Vision for yourself only. Any dependents previously covered on dental and/or vision will be terminated. Note:
Waiver applies to those employees who do not qualify for cash back but may still waive their medical coverage
due to their participation in a government exchange plan, individual policies, Medicare, Medi-Cal, or Tri-Care (for
PFT members only).
Waiver applies to those employees who do not qualify for cash back but may still waive their medical coverage
due to their participation in a government exchange plan, individual policies, Medicare, Medi-Cal, or Tri-Care (for
PFT members only).
The Standard
The Standard offers an annual opportunity for employees currently enrolled in voluntary life to increase their term
life policy by $10,000 (not to exceed $250,000 or 5 times their annual salary) with guaranteed issue. Amounts above
$10,000 are subject to underwriting.
Healthcare Flexible Spending Account
Healthcare FSA maximum is increasing to $3,050 annually. You must enroll annually in Healthcare and/or
Dependent Care FSAs as elections do not automatically roll over. See page 42 for more details on the flexible
spending accounts.
Questions?
Please check your email and the Benefits website often.