Employee Health Benefits

CalPERS Health Benefit Information

New employees are given an information packet that provides descriptions of the health plans Turlock Unified School District offers their employees.  Enrollment forms for dental, vision and medical are enclosed in the packet – a form is also required in case you decide to opt out of the District medical plan.  Please read the information carefully before making your choice.  You may wish to call your present physician or dentist to see if he/she is a provider for District plans, as it may help you make your decision as to which plan to select.

MEDICAL PLANS

Our medical insurance is purchased through the California Public Employees’ Retirement System (CalPERS – www.calpers.ca.gov).  Offered plans are:

  • HMO plans - Blue Shield of California and Kaiser Permanente.
  • PPO plans offered are PERS Select, PERS Choice and PERS Care, all of which are administered under Anthem Blue Cross

All PPO plans have a $500 per calendar year deductible for up to two family members.  The premium costs differ according to the number of family members insured. 

DENTAL

The District offers four dental plans:

Delta Dental Incentive, United Healthcare-PUD, Delta Dental (PPO), and Delta DentalCare DHMO.  Dental insurance is mandatory as our group requires 100% participation.  The Delta Dental Incentive and the United Healthcare plans cover your entire family at a composite rate (no change of premiums for Single through Family).  The Delta Preferred PPO and the DentalCare DHMO plans both have a three-tier rate structure, and are billed according to the number of family members covered. 

VISION

Vision Service Plan (VSP) is our vision insurance carrier.  The plan requires all new benefit eligible employees to carry this insurance with the option for family coverage at a higher premium.

The Benefit Selection Sheet lists the cost of all plans.  After making your choice, you must come to the payroll office at the District Office, (upstairs, room 214) to complete enrollment forms for medical (to enroll or decline), dental and vision insurance. You can determine your approximate cost by completing the Benefit Selection Sheet. 

Medical, dental and vision premiums generally increase January 1st of each year.  Your payroll deduction will be automatically adjusted when this occurs.  If you do not apply for medical coverage at the time you are employed, you may sign up during the open enrollment period which occurs annually. This enrollment period will normally coincide with CalPERS’ open enrollment period, usually ending early October with a January 1steffective date.  

Medical insurance is optional, and in the event you decide to decline medical coverage, any left-over monies from your benefit package will be paid to you as taxable income. 

If you have a payroll deduction due to health insurance expenses, you may choose to enroll in a premium conversion plan - the IRC Section -125 Plan.  All new employees are required to meet with a representative from American Fidelity to either elect or sign-off the Section-125 Plan.   

Under the Internal Revenue Code, your deduction for medical premiums is tax exempt; payroll will subtract your medical payroll deduction from your gross income prior to calculating taxes.  This will increase your net pay since you will not be paying Federal or State income tax, or Social Security tax if applicable, on your payroll deduction.  If you choose not to sign up for the IRC-125 plan, your payroll deduction will be subtracted from your NET pay.  Under the IRC-125 Plan we also offer expense reimbursement accounts through American Fidelity Assurance Company.  This program allows you to establish an account to reimburse dependent care and/or medical expenses on a tax-exempt basis.  The district MUST have your completed American Fidelity forms stating your choice to participate in the plan.  Please ask about making an appointment with American Fidelity when you enroll in the health plans. 

Under the IRC-125 Plan, the benefit elections made during the enrollment period will remain in effect for the plan year (calendar year).  Internal Revenue Code Section-125 prohibits changing health benefit coverage levels during a plan year without a change in family status affecting your need for a benefit.  These changes are called “qualifying events” and the event must be consistent with the change in family status that has occurred.  The following circumstances are examples of events that qualify as a change in family status: marriage or divorce; birth or adoption of a child; death of a dependent child or spouse; a change in the employment status of the employee or spouse such as the termination or commencement of employment; or going from part time to full time or full time to part time.  You will be required to offer proof of your change in status.   

When a qualifying event occurs, you have only 30 days to report this change to your employer. 

Your coverage is effective on the first of the following month, normally within 30 days after your employment starts.  If you have any questions, please contact the payroll department at 667-0645 (ext 2414). 

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Health Benefit FAQ's

Q:  What is the difference between the four dental plans?

A:  Delta Dental’s Incentive plan has varying coverage; 70% coverage for the first year of participation, 80% for the second, 90% for the third and 100% from then on with a cap of $1,200 maximum per year per person if provided by a Delta Dental PPO Dentist, and $1,000 if provided by other dentists.  Each family member has his or her own percentage of coverage.  Ninety-eight percent of the dentists in California participate in this plan.  Orthodontics is not covered under this plan. 

The Delta Dental (PPO) provides $2,000 annual maximum coverage per patient per year.  It also includes a $2,000 lifetime per patient orthodontic benefit for both children and adults.  This plan has a three-tier premium rate structure according to the number of family members insured.  Not all dentists are part of Delta’s PPO network.  You should contact your dentist to determine if he/she is a participant in this plan.  If your dentist is a participant in the Delta Premier Plan, but not in the PPO plan, this plan would pay 60% of the Delta approved fee for most services.

The United Healthcare (UHC) Plan (also called Pacific Union Dental / PUD) covers orthodontics as stated in their brochure, but you must use their network orthodontist.  UHC has 100% coverage from the initial effective date, however, certain procedures have co-payments as listed in their brochure and you must use a UHC network dentist.  There are only a few participating dentists in this plan; you will have minimal control over your selection of dentists and you may encounter significant difficulty in arranging prompt appointments.

The Delta DentalCare DHMO plan provides unlimited coverage and does include orthodontics.  There are co-payments for some types of services.  This plan has a three-tier premium rate structure.  You must visit a dentist or orthodontist in the Delta DentalCare DHMO network; very few dentists are members of this plan.  You will have minimal control over your selection of dentists and you may encounter significant difficulty in arranging prompt appointments.

Dental wallet cards will be issued for the UHC and Delta DentalCare DHMO plans only.  The group plan number for the plan you have chosen appears on your copy of the Benefit Selection Sheet.  Three of our plans are Delta Dental plans (Premier, PPO and Delta DentalCare DHMO).  You may inquire online at www.deltadental.com – this web site will allow you to check on your eligibility and also to search for a dentist that accepts your plan.

Q:  How are prescriptions covered?

A:  Prescriptions are covered only through the health plan you choose.  Prescriptions written by anyone other than your primary care doctor may not be covered by our health plans.

Q:  How do I use my Vision Service Plan insurance?

A:  Enclosed you will find a list of VSP eye doctors, or you can search for a VSP eye doctor online at www.vsp.com.  This web site will also allow you to verify eligibility for yourself and family members.  Wallet cards are not issued for the vision plan.  Using your social security number, your eye doctor’s staff will contact VSP to receive authorization to provide service – no forms are necessary.  If you do not use a VSP doctor, you will be required to prepay services and submit the paid invoices to VSP for reimbursement.