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All current employees will be automatically rolled over into a corresponding PPO plan (see table below). Everyone currently enrolled in the District's HMO or PPO plan will be automatically rolled over to the new PPO 1 plan on September 1, 2009. Anyone currently enrolled in the HSA plan will be rolled over to the new PPO 3-HSA plan. In all cases, if employees also included dependents on the plan this year, their dependent coverage will also roll-over to next year.

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Those employees who would like to change their coverage (such as add dependents or change to a different plan) will need to complete a new enrollment form and should attend an open enrollment fair. Employees with dependents are especially encouraged to evaluate the new options. While no employee will be automatically rolled into PPO 2, employees with dependents may wish to consider this new option. Employees should carefully weigh both the differences in monthly premiums as well as the differences in benefits for all plans. BlueCross representatives will be present to assist employees in answering any questions and completing new enrollment forms.

Because of the new plan options available, even employees that do not anticipate making any changes are encouraged to attend an open enrollment fair to learn more about the plans from BlueCross representatives. Also, open enrollment fairs allow the opportunity to learn about other benefit options, such as dental, supplemental life, cancer, vision, and disability insurance. In addition, please note that employees participating in medical expense reimbursement or child care reimbursement must re-enroll every year.

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Each employee will receive a notice in the annual open enrollment mailing offering the option of accepting the new plan enrollment. Each employee must sign, date, and return the notice to the Austin ISD Benefits Office by 4pm on July 31, 2009. Employees who want to make changes should attend an open enrollment fair or contact the AISD Benefits Office.

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More detailed information can be found online at www.austinisd.org/benefits, including rates, plan comparisons, out-of-pocket cost scenarios, and open enrollment fair dates. This website will continue to be updated as more information becomes available.

For specific enrollment questions, call:
Classified Employees:414-2296
Professional Employees:414-2185

For specific questions about health benefits under the new plans, call:
Blue Cross Blue Shield Open Enrollment Hotline: 866-733-5884 (toll free) Monday through Friday, 8am - 6pm.

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Office visit copays, deductibles, out of pocket maximums and coinsurance percentages are different. The actual services that are covered or excluded are the same under all 3 PPO plans. See Health Insurance Plan Comparisons (left pane) for more details.

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PCP designation is not required under a PPO plan

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No referrals are required under a PPO plan.

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The calendar year deductible is the first amount of money you or your covered dependents will pay each year before Blue Cross begins to pay claims on eligible expenses. If you have family coverage, family members combine expenses to reach the family deductible. No one person would ever pay more than the amount of an individual deductible - in other words you wouldn't have to satisfy the entire amount yourself under PPO 1 and PPO 2. This is not the case under the PPO 3 (HSA) plan. If you have family coverage under the PPO 3 (HSA) plan Blue Cross would not begin to pay claims until the entire family deductible had been met either by one person or a combination of family members.

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Under PPO 1 and PPO 2 as charges are applied towards the deductible they accrue towards an individual deductible for that specific person and also towards the deductible for the entire family. Once the individual deductible has been met, the member who met their deductible and Blue Cross will share in the payment of expenses. Once the family as a whole has met the family deductible, the entire family would share in the payment of expenses with Blue Cross.

Under the PPO 3 (HSA) plan, the member and Blue Cross will not begin to share in the payment of expenses until the entire family deductible has been met by either one person or a multiple of covered members in the family.

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The PPO plans include a 3 month deductible carryover. Any amount of your deductible met in October, November or December carries over to the following calendar year. All deductibles start over at $0 on January 1st unless the carry over provision applies to you.

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Once the deductible is met then coinsurance applies. For example PPO 2 plan pays 80% in network and the member "coshare" is 20%.

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It is a cap on the amount of out of pocket expenses you will be subject to. Once the out of pocket maximum is met then the plan pays 100% for the remainder of the calendar year. All copays and per hospital admission deductibles will continue to apply once you are at 100% coverage.

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Office visit copays and Rx copays and Per Hospital Admission Deductibles.

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A "Per Hospital Admission Deductible" is a deductible that you must pay each time you have an inpatient hospital admission.

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Blue Cross will send you an Explanation of Benefits (EOB) which will detail the name of the provider who provided the service to you, their total billed charges, the allowable amount as determined by Blue Cross, the amount paid to the provider and any amount payable by the member.

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Mammograms are covered at 100% unless billed by the doctor in an office setting then the office visit copay applies. Routine mammograms are subject to once every 12 months.

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Up to age 6, immunizations are covered at 100%, no copay required. Age 6 and above, the office visit copay will apply.

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No.

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When utilizing in network providers, you will be required to pay an office visit copay at the time you are diagnosed as pregnant. Generally, all other charges are applied towards the deductible and coinsurance at the time of delivery.

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If you are in your 3^rd trimester you will need to complete a transition of care form for approval to continue seeking treatment from an out of network physician on an in network basis.

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Dependent children are covered for maternity benefits.

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No, the newborn is covered for the first 31 days. If you want to continue coverage for your newborn after the first 31 days, you must complete the appropriate paperwork through the Benefits Office within 30 days of the date of birth.

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PPO 1 has a $20 copay and PPO 2 has a $25 copay. There are no office visit copays under the PPO 3 (HSA).). All charges (except for preventive care) accrue towards the calendar year deductible. Preventive care services are covered at 100%. For a list of services, please review the PPO 3 (HSA) detailed schedule of benefits provided by Blue Cross.

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A. Diagnostic testing such as MRI, Catscan, Petscan, Nuclear Medicine are subject to deductible & coinsurance. A routine X-ray or Lab work is covered under the office visit copay when performed in the office. If you are sent outside the office for a routine X-ray or Lab work, then the services are covered at 100%.

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Routine hearing exams are covered under preventive care subject to office visit copay.

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These services are covered under Physical Medicine Services subject to deductible & coinsurance with a $1500 calendar year benefit maximum. Under the PPO plans there is not a limitation on the number of visits, but rather a calendar year maximum that will be paid by Blue Cross. Once the $1500 maximum has been met, no further benefits for these services are available until January 1.

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Yes, Testing is covered under the office visit copay. Injections and Serum are covered under the deductible and coinsurance.

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Have your Blue Cross member ID card with you when you travel. You can contact the 800# on your ID card to confirm PPO providers in the area or go to the closest emergency room in your area.

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Yes, the Blue Extras Discount Program that includes Davis Vision is still available under all three PPO plans.

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Home Health Care is covered with a $10,000 calendar year maximum. After Blue Cross has paid $10,000 in claims, the calendar year maximum will have been met and no further benefits are available for this member for this service until January 1.

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The lifetime maximum is per covered individual. The lifetime maximum under any of the PPO plans is $2,000,000. Once Blue Cross has paid out $2,000,000 in claims, the lifetime maximum will have been met and no further benefits are available for the member. If you are currently covered under the HMO plan, your lifetime maximum will be $2,000,000 since the current HMO plan lifetime maximum is unlimited. If you are currently covered under the PPO or HSA plan any payments applied towards the current $2,000,000 lifetime maximum will carry over and be applied towards the $2,000,000 lifetime maximums under PPO 1, PPO 2 or PPO 3 (HSA).

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Yes, Certain Diagnostic Procedures and all surgical servicesservices such as the removal of a mole.

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The Emergency Room copay only applies towards the facility charges. All other charges are subject to deductible and coinsurance.

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If you are an existing member on the HMO plan pre-existing will be waived upon enrollment in one of the PPO plans. If you are a new member or you are adding dependents for the first time, you will be subject to a pre-existing limitation. Credit for prior coverage will be applied as long as there is no more than a 63 day lapse in coverage. You will be required to submit a Certificate of Creditable coverage detailing your prior coverage.

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Yes, there is a one time $50 prescription drug deductible and then copays apply once the deductible is met. The calendar year deductible will revert back to $0 on January 1.

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Yes, you will be subject to the copay plus the difference in the amount between the generic and name brand prescription.

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Yes, a form is required to be completed and submitted for approval for dependents over the age of 25 and disabled. This form is available through the Benefits Department.

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No, domestic partner coverage is not available.

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Yes, you may cover your common law spouse if you are able to provide a Certificate of Common Law Marriage that is notarized by the County Clerk's office.

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Yes, loss of coverage is considered a qualifying event. You have 30 days from the date of event to add a spouse or dependent to your coverage. If you miss this opportunity to enroll your dependent you will have to wait until the next open enrollment period. Forms are available through the Benefits Office to add dependents.

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You can only drop the medical coverage during open enrollment or if you encounter a qualifying event during the plan year. You will have 30 days from the date of the qualifying event (including but not limited to birth, adoption, death, divorce, change in job status) to make any changes to your coverage. Forms are available through the Benefits Office to make changes.