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Plan elections are effective October 1 through September 30. All amounts accumulated January 1 through September 30 will carryover to your new plan effective October 1. Amounts applied to your deductible on a non-HSA plan for services between October 1 and December 31 will carry forward to the following year's deductible. All plan limits (deductibles, out of pockets, and visit limitations) run on a calendar year basis and reset each January 1. Each employer and/or bargaining unit has created a menu of plans from which you may select your coverage effective October 1 through September 30. You may select a plan from that menu if you are ...
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Important Surgery Benefit Limitations on Anthem PlansMedical costs continuing to skyrocket ... skyrocketing costs lead to continual increases in the cost of coverage (premiums) as well as out of pocket costs. In order to control these costs and ensure high-quality outcomes, the following surgeries are restricted to facilities with certain Anthem designations : Hip or Knee Replacement and Cervical/Lumbar Spinal Fusion: Blue Distinction+ Bariatric Surgery: Blue Distinction or Blue Distinction+ For more information on facility designations, click here. When performed at a network ambulatory surgery center (ASC), your share of facility charges for the following procedures will not exceed your out of pocket limits: arthroscopy, cataract surgery, colonoscopy, and upper GI endoscopy. When performed outside of a network ASC, your may be responsible for costs beyond your plan's out of pocket limits. Click here for information specific to Butte County or call 877-379-4844 for additional locations. |
HEALTH SAVINGS ACCOUNTS
American Fidelity (AmFid) is the preferred HSA Bank Account administrator through Butte Schools Self-Funded Programs (BSSP) and your employer. HSA accounts for employees of Bangor, Butte College, OUHSD, Palermo and Paradise will remain with Optum Bank.
American Fidelity (AmFid) is the preferred HSA Bank Account administrator through Butte Schools Self-Funded Programs (BSSP) and your employer. HSA accounts for employees of Bangor, Butte College, OUHSD, Palermo and Paradise will remain with Optum Bank.
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Health Savings Accounts (HSAs) are a great financial tool to help you save money on your out of pocket medical costs. HSAs are available to any employee EXCLUSIVELY covered under an HSA-eligible plan. BSSP plans which are HSA-eligible have "HSA" in the plan title.
Note: If you are double-covered, you must be exclusively covered under HSA-qualified plans. If you have other medical coverage, either within or outside of BSSP, and that other coverage is not HSA-qualified, you may not participate in an HSA through BSSP. What is an HSA? An HSA is simliar to a flexible spending account (FSA) or unreimbursed medical account (UMA) under your employer's Section 125 plan and offers the same federal income tax benefits. Unlike an FSA or UMA, unspent dollars deferred to a HSA rollover each year and are portable to another employer or at retirement; there is no "use or lose" provision to unspent HSA dollars. Why choose an HSA? An HSA enables you to pay and save federal tax-free for qualified medical expenses, now and in the future.
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An HSA enables you to pay and save federal tax-free for qualified medical expenses, now and in the future. Informational Videos |
In addition to comprehensive medical and prescription coverage, your BSSP medical plan is bundled with a number of additional benefits.
Health and wellness centers
The Health and Wellness Centers (HWC) in Chico and Oroville are dedicated to providing urgent, primary and preventive care solely to employees, retirees and family members covered by one of BSSP's Anthem medical plans. Read more ...
MDLIve (virtual office visit)
Anthem medical plans include access to MDLive. Video- or telephone-based office visits are just $5 ($40 on a non-HSA plan) and are available 24/7/365.
When should I use MDLive?
•When the HWC is not available (late evenings, Sundays, holidays, etc.)
•Instead of going to ER or another urgent care center for a non- emergency issue
•If your primary doctor is not available
•When traveling and in need of medical care
To register, call 888-632-2738 or go online to www.mdlive.com/sisc. Members will need their Anthem Member ID number as well as the name, address and phone number of the person who needs assistance.
When should I use MDLive?
•When the HWC is not available (late evenings, Sundays, holidays, etc.)
•Instead of going to ER or another urgent care center for a non- emergency issue
•If your primary doctor is not available
•When traveling and in need of medical care
To register, call 888-632-2738 or go online to www.mdlive.com/sisc. Members will need their Anthem Member ID number as well as the name, address and phone number of the person who needs assistance.
Carrum health (surgery benefit)
Carrum Health is a special surgery benefit that provides exclusive access to California's top-rated hospital and doctors at Scripps Health in San Diego for a significantly improved patient experience over many local or regional hospitals.
What procedures are eligible?
To get started, visit Carrum Health's website at carrum.me/sisc or by calling 888-855-7806.
What procedures are eligible?
- Knee replacement
- Hip replacement
- Cervical spinal fusion
- Lumbar spinal fusion
- PERSONALIZED support throughout your journey
- TOP QUALITY hospitals and doctors in California
- $0 (non-HSA plans) or plan deductible (HSA plans) out of pocket costs
To get started, visit Carrum Health's website at carrum.me/sisc or by calling 888-855-7806.
TELADOC MEDICAL EXPERTS formerly Advance medical (EXPERT MEDICAL opinion SERVICES)
If you're faced with questions like "How can I be sure of my diagnosis?", "Do I have the best treatment plan?" or "Where can I get a reliable medical opinion?" then Teladoc Medical Experts is a service for you.
Teladoc Medical Experts matches patients to the leading doctors on their specific conditions, who work with you to be sure of your diagnosis and recommend the best path for treatment.
Ask them anything. It’s free, it’s easy, it’s 100% confidential. Call 800-835-2362 or visit Teladoc.com/SISC for more information.
Teladoc Medical Experts matches patients to the leading doctors on their specific conditions, who work with you to be sure of your diagnosis and recommend the best path for treatment.
Ask them anything. It’s free, it’s easy, it’s 100% confidential. Call 800-835-2362 or visit Teladoc.com/SISC for more information.
Wellbeats
Wellbeats is available to everyone enrolled in a BSSP medical plan. All family members age 18 and over are eligible for their own account. The
Wellbeats benefit is much more than a virtual gym with on-demand videos in many aspects of personal wellness. Everything is available on demand, 24-7-365 whenever you have internet access at www.wellbeats.com.
Wellbeats benefit is much more than a virtual gym with on-demand videos in many aspects of personal wellness. Everything is available on demand, 24-7-365 whenever you have internet access at www.wellbeats.com.
Employee Assistance Plan (EAP)
No-cost mental health, legal and financial counseling services as well as many additional resources. Read more ...
HINGE HEALTH (DIGITAL PHYSICAL THERAPY)
Experiencing chronic pain? Hinge Health is here to help.
Hinge Health is a pioneering digital therapy program to help you conquer chronic back or joint pain, without drugs or surgery. It can be done at home - no need to schedule PT appointments. The average participant reports a 60% pain reduction by the end of the program.
Each element of the program is delivered digitally, and includes:
To get started, visit Hinge Health or call 855-902-2777.
This benefit is not available CompanionCare or Kaiser members.
Hinge Health is a pioneering digital therapy program to help you conquer chronic back or joint pain, without drugs or surgery. It can be done at home - no need to schedule PT appointments. The average participant reports a 60% pain reduction by the end of the program.
Each element of the program is delivered digitally, and includes:
- Personalized exercise therapy to improve strength and mobility. You'll receive tailored stretching and strengthening activities delivered through Bluetooth-connected motion sensors and tablet, providing you with real-time feedback.
- Unlimited 1-on-1 health coaching to support you throughout the program, and keep you motivated.
- Interactive educational content every week on how to manage your specific condition, your treatment options, common misconceptions, and more.
To get started, visit Hinge Health or call 855-902-2777.
This benefit is not available CompanionCare or Kaiser members.
city of hope (oncology center of excellence prorgram)
What is the Oncology Center of Excellence?
In partnership with Contigo Health, the Oncology Center of Excellence Program is a specialized health care program that enables members to obtain expert care and support from the National Cancer Institute (NCI) designated Center of Excellence, City of Hope. The National Cancer Institute has designated City of Hope as a comprehensive cancer center, an honor reserved for only 50 institutions nationwide.
What's covered under the Oncology Center of Excellence?
Program elements include:
How much will the program cost?
If you are enrolled in a non-HSA plan, program services are paid at 100% and your deductible does not apply. If you are enrolled in an HSA plan, your program services are covered at 100% after meeting your deductible per IRS guidelines.
If I travel to an Oncology Center of Excellence, will my travel expenses be covered?
Transportation, lodging, and a daily stipend for meals/expenses for you and a companion will be covered and coordinated through Contigo Health. Per IRS guidelines, a portion of the travel expenses covered may be treated as taxable income. Please check with your tax accountant about this topic.
Will I have access to clinical trials?
Yes. All patients will be evaluated for clinical trials for which they may be suitable candidates. City of Hope aggressively pursues ways to help their patients right now – not years from now. That focus puts City of Hope among the worldwide leaders in administering clinical trials. City of Hope is currently conducting more than 500 clinical trials, enrolling more than 6,200 patients.
Does everyone with a cancer diagnosis need to use the Oncology Care Program?
No, this program is optional and is not required. The Oncology Center of Excellence program was created to help with navigating a diagnosis and treatment, but you are not required to use the program. This program is available for eligible members who are looking for a program that provides assistance with navigating the process.
How do members access this benefit?
Call Contigo Health at (877) 220-3556. The Cancer Patient Advocate Nurses are available from 6am-6pm Pacific Time, M-F. You can also submit an online intake form by visiting contigohealth.com/sisc.
Do eligible members need a prior authorization from Anthem to access this benefit?
No, carrier authorizations are not needed for the Oncology Centers of Excellence Program. Contigo Health may require you to complete an authorization for treatment form.
In partnership with Contigo Health, the Oncology Center of Excellence Program is a specialized health care program that enables members to obtain expert care and support from the National Cancer Institute (NCI) designated Center of Excellence, City of Hope. The National Cancer Institute has designated City of Hope as a comprehensive cancer center, an honor reserved for only 50 institutions nationwide.
What's covered under the Oncology Center of Excellence?
Program elements include:
- An expert in-person or virtual evaluation at a recognized Center of Excellence, by a multidisciplinary cancer-focused clinical team led by an oncology expert specializing in the patient’s particular type of cancer.
- Treatment options that may not be available in the member’s local community.
- Navigation and advocacy support provided by the Contigo Health care management team every step of the way.
- 12 month follow up, to assist the patient with decision support or other resources available in the member’s local community.
How much will the program cost?
If you are enrolled in a non-HSA plan, program services are paid at 100% and your deductible does not apply. If you are enrolled in an HSA plan, your program services are covered at 100% after meeting your deductible per IRS guidelines.
If I travel to an Oncology Center of Excellence, will my travel expenses be covered?
Transportation, lodging, and a daily stipend for meals/expenses for you and a companion will be covered and coordinated through Contigo Health. Per IRS guidelines, a portion of the travel expenses covered may be treated as taxable income. Please check with your tax accountant about this topic.
Will I have access to clinical trials?
Yes. All patients will be evaluated for clinical trials for which they may be suitable candidates. City of Hope aggressively pursues ways to help their patients right now – not years from now. That focus puts City of Hope among the worldwide leaders in administering clinical trials. City of Hope is currently conducting more than 500 clinical trials, enrolling more than 6,200 patients.
Does everyone with a cancer diagnosis need to use the Oncology Care Program?
No, this program is optional and is not required. The Oncology Center of Excellence program was created to help with navigating a diagnosis and treatment, but you are not required to use the program. This program is available for eligible members who are looking for a program that provides assistance with navigating the process.
How do members access this benefit?
Call Contigo Health at (877) 220-3556. The Cancer Patient Advocate Nurses are available from 6am-6pm Pacific Time, M-F. You can also submit an online intake form by visiting contigohealth.com/sisc.
Do eligible members need a prior authorization from Anthem to access this benefit?
No, carrier authorizations are not needed for the Oncology Centers of Excellence Program. Contigo Health may require you to complete an authorization for treatment form.
vida health (Digital health coaching)
Vida is an app-based service that provides access to a virtual care platform that treats a full range of lifestyle, chronic and behavioral conditions via a digital coaching app on your smart phone or tablet.
The program includes a health coach who can help members:
To get started, visit www.vida.com/sisc.
The program includes a health coach who can help members:
- manage chronic medical conditions
- cope with stress, anxiety and depression
- lose weight
- improve sleep
- and much more
- Their own dedicated health coach or therapist
- A health plan that is customized to meet their unique goals and lifestyle
- Personalized lessons, tips and tools
- Access to Vida’s secure mobile app and website so they can message or chat with their coach — anytime, anywhere
- Smart devices like a scale, an activity tracker, and a blood pressure cuff that sync with Vida so the member can, along with their coach, easily track their progress.
To get started, visit www.vida.com/sisc.
Maven (free virtual maternity and postpartum support)
Maven offers 24/7 virtual access to one-on-one maternity and postpartum support at no cost during pregnancy and up to one year postpartum for covered employees and spouses/partners. Members are matched with a Care Advocate who connects them to trustworthy maternity and postpartum content delivered by doctors, specialists, coaches and other maternity providers. Care is specific to the issues new parents may be experiencing and include:
Pregnancy Support
Pregnancy Support
- Midwives
- OB-GYNs
- Doulas
- Birth Planning
- Prenatal Nutritionists
- Mental Health Specialists
- Loss Support
- Infant Care Advice
- Pediatricians
- Lactation Counseling
- Infant Sleep Coach
- Emotional Support
- Back-to-Work Support
- Career Coaching
- Enroll in the Maven program during their first or second trimester
- Have an intro call with a Care Advocate
- Have two appointments with Maven providers during pregnancy
- Complete the exit survey when their baby is born
Each full-time employee must select a medical, dental and vision plan.
Dental and Vision: Double coverage for dental and vision benefits does provide the full benefit available under each plan, resulting in a double benefit.
Medical: Standard coordination of benefits for double coverage under medical provides the richest benefit of each plan, but does not result in double benefit.
Double-BSSP Medical: Where both spouses are full-time employees required to enroll in a BSSP medical plan, BSSP provides a 25% premium discount when both spouses are covered as employees and each other's dependent under a BSSP composite-rate medical plan. BSSP recommends one spouse enroll in the Waiver Fee, which is equal in cost to minimum plan available. Enrollment in the Waiver Fee will allow the employee to be primarily covered under the spouse’s coverage and avoid confusion regarding primary and secondary coverage as well as delays in processing claims through double coverage.
Dental and Vision: Double coverage for dental and vision benefits does provide the full benefit available under each plan, resulting in a double benefit.
Medical: Standard coordination of benefits for double coverage under medical provides the richest benefit of each plan, but does not result in double benefit.
Double-BSSP Medical: Where both spouses are full-time employees required to enroll in a BSSP medical plan, BSSP provides a 25% premium discount when both spouses are covered as employees and each other's dependent under a BSSP composite-rate medical plan. BSSP recommends one spouse enroll in the Waiver Fee, which is equal in cost to minimum plan available. Enrollment in the Waiver Fee will allow the employee to be primarily covered under the spouse’s coverage and avoid confusion regarding primary and secondary coverage as well as delays in processing claims through double coverage.
WHEN DOUBLE COVERED, which plan is my primary and which is my secondary?
The plan in which you are the main subscriber will always be your primary coverage. The plan in which you are covered as a dependent will be your secondary, regardless of which is the “better” benefit. Note that BSSP's Waiver Fee does not constitute coverage for coordination of benefits.
For children, in most cases, coverage under the parent with the earliest birth date in the calendar year will be primary and coverage under the parent with the later birth date in the calendar year will be secondary.
For children, in most cases, coverage under the parent with the earliest birth date in the calendar year will be primary and coverage under the parent with the later birth date in the calendar year will be secondary.
Does Ameriben know I have secondary coverage through my spouse?
AmeriBen may not automatically apply your secondary coverage to your account. When you receive the Coordination of Benefits (COB) request asking to verify if there is other group coverage, it is essential for you to respond. Otherwise, AmeriBen will put any claims into a pending status until the COB is received.
The easiest way to update your COB is online via your AmeriBen portal at sisc.myameriben.com. Or, you may call Member Services at (877) 379-4844. You will need to have the group number and Member ID number of the other plan in which you are enrolled.
The easiest way to update your COB is online via your AmeriBen portal at sisc.myameriben.com. Or, you may call Member Services at (877) 379-4844. You will need to have the group number and Member ID number of the other plan in which you are enrolled.
What ID card do I provide to my doctor’s office?
At the time of any MEDICAL services (doctor’s appointment, lab services, hospitalization, etc.), you must inform the provider that you are double covered. First, present the ID card that corresponds with the plan in which you are covered as the main subscriber, and then provide the card that corresponds with the plan in which you are covered as a dependent. You will need to instruct the provider to submit your claim to both of your policies, first to primary and then to secondary.
You will receive an Explanation of Benefits (EOB) from each plan showing what was processed under each plan and what your member responsibility is after each plan has paid its portion.
You will receive an Explanation of Benefits (EOB) from each plan showing what was processed under each plan and what your member responsibility is after each plan has paid its portion.
What happens if my provider does not submit my claims in the correct order (primary first, then secondary)?
You will need to contact your provider and ask them to re-bill your services first to your primary and then to your secondary. You may need to contact Member Services at (877) 379-4844 to ensure your claim has been applied to your secondary coverage after receiving the EOB from your primary plan.
WHAT ID CARD DO I PROVIDE THE PHARMACY?
At the time of any PHARMACY services (including mail order service), you will only present one ID card. It is recommended to provide the card that corresponds to the better of the two plans in which you are enrolled, regardless if it is your primary or secondary coverage.
Unlike medical services, pharmacy benefits will only process claims under one insurance plan; they do not coordinate between multiple plans. To help identify which card to use for pharmacy benefits, we recommend writing “Rx Only” on the ID card that corresponds with the better prescription benefits.
Unlike medical services, pharmacy benefits will only process claims under one insurance plan; they do not coordinate between multiple plans. To help identify which card to use for pharmacy benefits, we recommend writing “Rx Only” on the ID card that corresponds with the better prescription benefits.
What happens if I give the pharmacy the ID card that does not correspond to the better benefit?
You may be able to go back to the pharmacy where your prescription was filled and ask them to reprocess your claim under the better prescription benefit of your two plans. Otherwise, you may file a claim with Navitus to seek reimbursement.
What plan combinations are recommended for double-covered families?
BSSP recommends one spouse enroll in the Waiver Fee plan. The Waiver Fee plan qualifies for the 25% double-covered discount while avoiding the hassle of coordination of benefits.
Can I waive or Opt out of coverage?
Part-time employees may decline coverage when they become eligible to participate or during any open enrollment period.
Full-time employees may opt out of coverage, at no cost, ONLY with proof of enrollment in Medicare, Medi-Cal, Tri-Care of subsidized Covered California benefits.
Full-time employees may enroll in the Waiver Fee plan at the same cost as the minimum medical plan. Under the Waiver Fee plan, the employee and dependents are not eligible for services at the Health and Wellness Centers nor to submit claims for medical and/or prescription services to Anthem and/or Navitus.
The Waiver Fee plan does not reduce benefits available under another BSSP medical/prescription plan.
Full-time employees may opt out of coverage, at no cost, ONLY with proof of enrollment in Medicare, Medi-Cal, Tri-Care of subsidized Covered California benefits.
Full-time employees may enroll in the Waiver Fee plan at the same cost as the minimum medical plan. Under the Waiver Fee plan, the employee and dependents are not eligible for services at the Health and Wellness Centers nor to submit claims for medical and/or prescription services to Anthem and/or Navitus.
The Waiver Fee plan does not reduce benefits available under another BSSP medical/prescription plan.
