A publication of the Fresno Unified School District and the Joint Health Management Board.(c) 2013. All Rights Reserved.

The Joint Health Management Board (JHMB) provides a variety of health benefits to Fresno Unified School District employees with three primary goals - low cost, high quality, and high member satisfaction. In this Winter 2013 HealthConnect edition, we explore benefits like vision services, the employee assistance program (EAP), and local gym discounts to help you kick off the New Year with a healthy start.

In all, the JHMB helps manage benefits services by 14 vendors to ensure that our active and retired employees receive the highest quality health benefits possible in the most cost-effective, innovative and efficient manner. But have you ever wondered about how the JHMB monitors the performance of its benefits programs?

Using Data to Make Adjustments Based on Cost, Quality, and Usage One key component that helps the JHMB monitor programs, analyze problems, and identify opportunities for improvement is the use of a performance dashboard. The performance dashboard starts with monitoring cost trends and a variety of other factors that affect the level of service provided by benefits vendors.

When the JHMB makes benefit design changes (such as changing the cost of a deductible), it monitors both cost changes for members as well as potential shifts in benefit usage. For example, if members begin to decrease use of a certain program, the JHMB may monitor data on whether members are avoiding emergency room admissions (favorable) or whether members are avoiding preventative care (unfavorable).

If the JHMB does identify a problem, such as increased use of emergency room services, the JHMB uses detailed data to analyze the cause of the problem. It could be, for example, that specific types of services received at the emergency room, such as treatment for migraines, are services that could also be provided after hours in urgent care by a primary care group with proven quality and member satisfaction. All information reviewed by the JHMB through its dashboard is anonymous, but contains enough detail for JHMB to promote health cost-effectively.

For more information on how the JHMB uses data to drive decision making and improve the quality of your benefits, visit www.JHMBHealthConnect.com and review the Behind-the-Scenes Video Series. There you will learn more about how the JHMB uses performance data to offer “the best possible healthcare at the best cost” for the District and its employees.

Dashboards Innovate Decision Making For Your Benefits

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Inside This Issue

Dashboards Drive Decision Making P.14 Key Online Resources P.2

MESVision & Gym Discounts P.3Employee Assistance Program P.4

Summary of Benefits and Coverage: Beginning in 2012, all benefit plan administrators were required by the federal government to provide you with an annual Summary of Benefits and Coverage (SBC). This new requirement is a direct result of the Patient Protection and Affordable Care Act (commonly referred to as Health Care Reform or simply the Affordable Care Act). This is being done to make it easier for you to compare different benefit plans.

The SBC provides you with a quick snapshot of what your plan covers and what it costs. This includes important answers regarding your deductibles, out-of-pocket limits, common medical events, and the types of services covered or excluded from the plan. The SBC also includes your rights to continue coverage, grievance and appeals rights, and coverage examples. SBC were mailed to all plan participant homes in November.

JHMB Quarterly Financial Report: Each quarter the JHMB provides a Quarterly Financial Report to each of the employee units represented on the JHMB. This report details the income, expenditures, and financial reserves for the District’s Employee Health Plan. Recently, the JHMB decided to provide a summary of this report to all employees. The latest report showed a net surplus of $9.6 Million with a net fund balance of $35.2 Million.

In the last few weeks, the Joint Health Management Board (JHMB) has added various resources and documents online to keep you informed about your healthcare choices. Here’s a brief preview of each of the recently added items. For more details or to download these items, visit www.JHMBHealthConnect.com.

JHMB Behind-the-Scenes Video Series: In the summer of 2012, the JHMB invited cameras into a series of meetings to capture a behind-the-scenes look at how the board makes decisions that affect your healthcare program. In the end, the group produced a 4-part video series that provides an in-depth look into how the group focuses on offering “the best possible healthcare at the best cost” for the District and its employees.

Plan Amendments: In the Fall of 2012, the JHMB approved two new plan amendments that affect Step Therapy Regimens for the Prescription Drug Plan and Vision Plan services. The Step Therapy Regimen changes were effective as of October 1, 2012, while the amendments to the Vision Plan became effective January 1, 2013. You can review and download the plan amendments from the Official Health Care Plan Booklet section of the JHMB website. The amendments were mailed to plan participant homes in December 2012.

HealthConnect

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4 Key Online Resources to Keep You Informed About Your Healthcare Benefits

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Employee Healthcare Plan A : Fresno Unified School District Coverage Period: 01/01/2013 – 12/31/2013 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: FAMILY | Plan Type: PPO

Questions: Call 1-800-807-0820 or visit us at www.deltahealthsystems.com. If you aren’t clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary at www.deltahealthsystems.com or www.healthcare.gov or call 1-800-807-0820 to request a copy.

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.deltahealthsystems.com or by calling 1-800-807-0820. If you aren’t clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary at www.deltahealthsystems.com or www.healthcare.gov

Important Questions Answers Why this Matters:

What is the overall deductible?

$250 Individual/$500 Family Network. $750 Individual/$1,500 Family Non-Network. Doesn’t apply to preventive care, hospice, prescription drugs or inpatient mental health or substance abuse care.

You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible.

Are there other deductibles for specific services?

No You don’t have to meet deductibles for specific services, but see the chart starting on page 2 for other costs for services this plan covers.

Is there an out–of–pocket limit on my expenses?

Yes. $5,000 Individual/$10,000 Family Network. $10,000 Individual/$20,000 Family Non-Network.

The out-of-pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses.

What is not included in the out–of–pocket limit?

Premiums, balance-billed charges, health care this plan doesn’t cover, copayments, deductibles, penalties for failure to obtain pre-authorization for services, and prescription drug charges.

Even though you pay these expenses, they don’t count toward the out-of-pocket limit.

Is there an overall annual limit on what the plan pays?

Yes. $1.5 million 01/01/2013-06/30/2013, then $2 million 07/01/2013 – 12/31/2013.

This plan will pay for covered services only up to this limit during each coverage period, even if your own need is greater. You’re responsible for all expenses above this limit. The chart starting on page 2 describes specific coverage limits, such as limits on the number of office visits.

Winter 2013Fresno Unified Welcomes New Vision Carrier Effective January 1, 2013 MESVision is the new vision carrier for the District. MESVision provides access to the largest vision care network of participating providers in California with access to over 20,300 provider locations nationwide! Since 1976, MESVision has been providing quality vision care services to thousands of employer groups and millions of insured members through a variety of vision care plans.

The MESVision Participating Provider Network is comprised of the Four “Os”: independent Ophthalmologists, Opticians, and Optometrists and many popular Optical retail chain locations that include Costco Optical, Target Optical, Sears Optical, LensCrafters, and Wal-Mart and Sam’s Club Vision Centers as In-Network vision care Providers. You will find that the MESVision Network includes almost all of the providers that you have accessed in the past, and MESVision is currently recruiting those providers that are not in their network.

All MESVision Providers have accepted a schedule of reimbursements as payment in full for covered services and eye wear material for the insured MESVision Member. The addition of these provider types provides Fresno Unified members hundreds of new choices in Network Providers that can help save out of pocket costs and help benefit dollars go farther.

Discount Gym Memberships

the latest deals available through the Fresno Unified Employee Discount Program.

American Kickboxing: Learn self-defense and fitness. Receive 15% discount for any FUSD employee or family member.

Blast Fitness: Receive a month-to-month (no contract) membership for $10.00. Enrollment fee $70.00.

Centerpoint Athletic Club: All memberships are month-to-month with no long-term contracts. $35 Single membership, $55 Couple membership, $65 family. No enrollment fee.

Ft. Washington Fitness: Single memberships at $32.00 and Couples $54.00. Enrollment fee $99 (single), $149 (couple). GB3: One week free trial for Fresno Unified employees and a family member or friend. 50% off registration, plus first month free! Also, includes three free personal training sessions and group fitness classes. Daycare available for a nominal fee.

Shapemakers: All Women’s Health Club. Daycare available onsite. $29 per month, $39 per month mother/daughter (daughters 14-21 years of age). Sierra Sport and Racquet Club: $10 start-up and $39 monthly. Includes unlimited access to Blackstone location and unlimited access to women’s only facility on First and Herndon.

Visit www.JHMBHealthConnect.com for more details on the Fresno Unified Employee Discount Program.

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Did you know that as a Fresno Unified employee or retiree you can receive discounts at local health clubs? The start of a new year is always the best time to set healthy goals and begin new habits. Check out

Fresno Unified School District

Joint Health Management Board

Benefits and Risk ManagementFresno Unified School DistrictEducation Center2309 Tulare StreetFresno, CA 93721-2287

This is HealthConnect, a publication from your FUSD Joint Health Management Board (JHMB).For more information, visit the HealthConnect website at www.JHMBHealthConnect.com.

Send your feedback about HealthConnect to JHMBHealthConnect@yahoo.com.

HealthConnectClaremont EAP Helps You Reduce Stress in the New YearThe New Year is a great time to set goals and identify opportunities to create balance between personal and professional responsibilities. The District’s Employee Assistance Program (EAP) provides you and your family members professional, confidential counseling at no cost (for the first 5 visits) through Claremont EAP.

Available to help you address virtually any personal concern or question, Claremont EAP’s licensed professional staff can help you with life’s challenges hopefully before they become more serious and difficult to manage. Upon initial contact, you will be referred to a conveniently located counselor or resource with expertise

in your area of concern. Day and evening appointments are available for a variety of services, including:

• Marital/Relationship issues• Parenting/Family concerns• Substance abuse• Depression• Anxiety• Stress• Work concerns• Legal issues• Financial matters• Work/Life referralsFor more information or confidential help, contact Claremont EAP at (800) 834-3773 or online at www.ClaremontEAP.com.