Overview

Frequently Asked Questions About CUSD's Benefit Package

1. New Provider Networks
a. In California the new provider network is the Prudent Buyer Network. The directory for the Prudent Buyer Network can be found here on the CUSD Website:

http://www.cusd.com/benefits/Prudent%20Buyer%20Directory.pdf

b. Outside California (remaining 49 states) the provider network is the First Health Network. The link to the directory for the First Health Network can be found here on the CUSD Website:

http://www.cusd.com/benefits/providers.htm

2. Medical Office Visit Copay of $25 for each visit or service billed to the Health Plan.

3. Chiropractic Office Visit Copay of $13 for each chiropractic office visit. – Page 7 of CUSD Summary Plan Document

4. Emergency Room Copay on the second visit and each subsequent visit in a calendar year. – Page 5 of CUSD Summary Plan Document

5. Managed Care – Prior Authorizations are REQUIRED on a larger number of services and procedures. A complete list can be found on pages 4 and 5 under Utilization Review in the CUSD Summary Plan Document

6. Prescription Copay – Page 8 of CUSD Summary Plan Document

7. Mail Order Copay** – Page 8 of CUSD Summary Plan Document

*All prescription copays will increase by $2 each year

**CUSD employees can also pick up and/or drop mail order prescriptions off at a local CVS Pharmacy.

8. Eligibility Waiting Period – All employees hired after September 1, 2007 will now have a 30 day waiting period before being eligible for benefits. The waiting period starts on the first day of the month following the first day of the employee’s assignment and the effective date will be on the first day of the month following the end of the 30 day waiting period. – Page 14 of CUSD Summary Plan Document

9. Lifetime Benefits Eligibility Changes – All employees hired after September 1, 2007 will only be eligible for lifetime benefits after 30 years of service in CUSD and the age of 62. – CUSD Board Policy 6503

10. Lifetime Maximum for Infertility/Obesity treatment – Covered expenses are limited to $5,000 maximum per lifetime. – Page 9 (Infertility) and Page 13 (Obesity) of CUSD Summary Plan Document

11. Eligibility Requirements for Dependents – All dependent children over the age of 19 years must be enrolled in school, must be claimed as a dependent on the member’s taxes and must be enrolled in school full time in order to be covered under the medical, dental and vision plans. – Page 15 of CUSD Summary Plan Document

12. Optional Buy Up Vision Program – Please keep an eye out during the Online Open Enrollment this fall for an optional vision plan that members can purchase that will provide additional vision benefits for the member and all eligible dependents.