1. When is Open Enrollment?

For the 2008/09 school year, Open Enrollment will be held from September 29, 2008 to October 24, 2008 for the effective date of November 1, 2008.

You may enroll at other times during the year provided it is a qualifying event (e.g. termination of other coverage, newly eligible based on hours worked, acquisition of new dependent, etc.)

2. What constitutes an eligible dependent?

Eligible dependents are as follows:

a. An employee’s legally married spouse, who is not legally separated from the employee, and is not a member on active duty with the Armed Forces;

b. An employee’s unmarried child (including any step child legally adopted child, legally placed foster child, a child for whom legal guardianship is in force, or any other child whom a subscriber has a legal obligation to cover) who is under the age of 19 to age 25 (age varies by student status and plan - contact the Risk Management Office for specific questions), is not covered for benefits by the District as an employee, and is not a member on active duty with the Armed Forces, who is primarily dependent upon the employee for support and maintenance. Coverage is also available for disabled children under certain circumstances.

c. Domestic Partner, defined as a person of the same or opposite sex who is no less than 18 years of age, unmarried and unrelated to the employee, shares a permanent residence with the employee, is financially interdependent with the employee and who has not been a member of another domestic partnership for the prior six months.

d. Domestic Partner’s unmarried child(ren) as described in (b) above.

3. How do I add new dependents?

To add a newly eligible dependent you will need to complete the appropriate enrollment form and provide documentation of the dependents eligibility (e.g. birth certificate, marriage certificate, divorce decree, adoption order, certificate of Domestic Partnership, etc.). Forms can be printed from the Web site, or secured at the District’s Risk Management Office. Completed forms along with supporting documentation must be submitted prior to coverage becoming effective.

Newly eligible dependents must be added within 30 days of their initial eligibility. If not added within 30 days, the dependent will not be eligible until the next Open Enrollment period.

4. Can I cover my dependent while he/she is attending college?

Yes, as long as the dependent is under age 23 to 25 (depending on the plan) and is enrolled as a fulltime student (12 units for an undergraduate student or 6 units for a graduate student).

5. How do I add my Doctor to the provider network?

You can ask your doctor to contact the respective insurance provider as request to be contracted. You may also send a nomination to the respective insurance provider asking that they contact the physician to discuss contracting. This process can be accomplished by using the customer service contact information contained on this Web Site. However, not all providers will be contracted with all insurance providers as each physician and insurance provider reserves the right to make contracting decisions.

6. As a Blue Shield member do I have to use a PPO provider?

No. However, if you receive care from a non-preferred provider you could experience higher out of pocket costs in terms of copayments and/or applicable reimbursements. Additionally, non-preferred providers could “balance bill” you for extra expenses that become your responsibility and not that of Blue Shield or the District.

7. Can I self-refer to a specialist?

It depends on which plan of benefits that you participate in. For example in the Blue Shield plans you are free to self-refer to any specialist at any time. In the Kaiser and Cigna HMO plans you must be referred to the specialist by your Primary Provider. In most situations a specialist will not see or accept a new patient without a referral from a primary care physician regardless of the plan. Specialists have limited time to spend with each patient. Therefore, if a prospective patient self refers, the specialist has no data on symptoms, early diagnosis or preliminary treatment that may have already been provided or attempted. In all the plans, a female employee or dependent may have both a family practice doctor and OB/GYN as primary care providers. Children may elect either a family practice doctor or pediatrician.

8. Do our plans include mail order pharmacy benefits?

No. At the present time, none of the District's plans offer mail order pharmacy benefits.

9. As a Kaiser member, can I submit or drop off enrollment changes directly at the doctor’s office or hospital?

No. The District requires that all enrollment changes be submitted through the Risk Management Office. This avoids eligibility and billing problems. If forms are not submitted through the Risk Management Office, the effective date of your coverage may be delayed.

10. What happens if my dependent college student terminates coverage mid-semester?

Coverage would terminate at the end of the month in which their college enrollment terminates and the dependent would be offered COBRA continuation benefits.