Medical Insurance - Anthem Blue Access PPO HSA

Worthington Schools offer a High Deductible Health Care Plan with Anthem.  See the Anthem Implementation Guide for details of the plan. Anthem will send new identification cards to all employees via mail within 7-10 business days of January 1, 2023.  It should be noted that ID cards will come in plain white envelopes and will only contain up to 4 cards per envelope.  If you have a larger family, your ID cards will arrive in two separate envelopes.  If your ID cards are not received by January 1, 2023, and you need to see a doctor or pick up a prescription, you can email Beth Hohenstein to obtain a temporary ID card.  Please remember to begin providing your medical providers and pharmacy with your new ID card beginning January 1, 2023.

Once your ID card is received, employees should consider downloading the Anthem Sydney app or create an account on the Anthem website to be able to track deductible amounts met, find network physicians, compare costs of services, view Explanations of Benefits, utilize virtual care options, and find important information on other available programs, services and discounts.  

After your deductible is met, the only item that would apply to the Out of Pocket Maximum is the $250 emergency room copayment per ER visit, which is waived if you are admitted.  The out of pocket maximum is $2500 for single and $5000 for family for emergency room visit purposes.

The monthly premium for health care coverage is split into two equal deductions withheld on the first and second pay of each month.

2023 Medical Insurance Premiums:

• Certified Staff & Administrators
  
• Classified Staff

Annual Network Deductibles:                                   

• Single Deductible: $1,750
• Family Deductible: $3,500

Annual Out-of-Network Deductibles:

• Single Deductible: $3,500
• Family Deductible: $7,000

The Certificate of Coverage is a description of benefits and coverage under the plan and provides more in-depth detail about covered services and exclusions. 

High Deductible Health Plans provide the opportunity for you to open a Health Savings Account to help you to save to pay for eligible medical, dental, vision and prescription drug expenses if you meet eligibility requirements.  The Board of Education provides a flat dollar amount funding to an HSA opened by you through CME Federal Credit Union.  See additional information under Health Savings Accounts.    

Dependent Eligibility:  Dependent children can be covered under the plan up to age 26 regardless of financial dependence, student status, residence or marital status.  Dependents are automatically dropped from health insurance coverage at the end of the month in which the dependent turns 26.

New enrollees in the Medical Plan are required to send the following documentation to enroll a spouse and dependents: 

• Birth Certificates (Children) 
• Marriage Certificate (Spouse) 

Please send to WEC, Attn:  Beth Hohenstein before December 31, 2022 

Searching the Provider Network

To ensure your current providers are in Anthem's network, you can search as a guest on Anthem.com using the Blue Access PPO network until your coverage begins on January 1, 2023.  If you wish to search for network providers you and/or your dependents can use for out of state care, please be sure to search the National PPO (Blue Card PPO) network.  Once benefits become effective, you will be able to easily search for a provider in these networks by creating a user account on the Anthem website or downloading the Sydney Health App.

If you are traveling out of the country or have an insured dependent traveling abroad, please contact Beth Hohenstein for more details on international coverage.  

Prescription Drug Information

During this time of transition, Anthem will be obtaining files from MMO of any open prescriptions and transferring those refills to Anthem.  The formulary for prescription drugs can be viewed through your online Anthem account OR on the Anthem Sydney app starting Jan. 1, 2023.  In the meantime, click here for a searchable formulary to determine which tier of coverage your medication falls in and if a prior authorization is needed. If you currently have a prior authorization in place with MMO, the prior authorization will transfer to Anthem until the prior authorization expires (usually 1 year from the prior authorization issue date).  If your prior authorization has expired or if you have been newly prescribed a medication requiring prior authorization, your physician will need to provide the required information to Anthem before your prescription can be obtained.  

In the past few years, mandatory mail order was required for any maintenance medication.  While members are welcome to continue to use Anthem's mail order pharmacy, Carelon, for these services, it is no longer required.  Maintenance medications can be obtained at a network retail pharmacy as long as the prescription is written for a 90-day supply.  In addition, we are pleased to announce that many preventive medications for conditions such as asthma, diabetes, heart issues, cholesterol, and osteoporosis may be obtained at no cost.  Click here for a complete listing of those preventive medications. Please note that formularies do change throughout the year to comply with the Food & Drug Administration recommendations.  

Medical Carrier Transition Informational Meetings and FAQ's

The district held informational meetings focusing on the transition to Anthem effective January 1, 2023. Watch a recorded session of this meeting.

District staff, our insurance broker and Anthem have worked together to create a list of Frequently Asked Questions related to this time of transition from MMO to Anthem.  However, if you have a question that is more personal in nature or that isn't addressed in this FAQ document, please contact Gallagher Benefit Services at 614.761.2901 or Anthem at 844.995.1752.  

Health Savings Accounts - CME Federal Credit Union

High Deductible Health Plans are coupled with the opportunity to open a Health Savings Account (HSA) to help you to save to pay for eligible medical, dental, vision and prescription drug expenses.  For more information on HSA rules and eligibility requirements, please see the 2023 Benefit Summary booklet.  The Board of Education provides a flat dollar amount funding to an HSA opened by you through CME Federal Credit Union.  You can apply for your HSA online by following these step-by-step instructions. 

Eligible CLASSIFIED employees enrolled in a single medical plan will receive $250 in January 2023 in their HSA, while those enrolled in the family medical plan will receive $500. Those employees have the opportunity to earn an additional $250 and $500, respectively, by completing specific wellness activities. Any Board HSA funds earned through completing wellness activities in 2022 will be deposited in February 2023. Employees can use this Preventative Care Form to send information to MMO for any HSA activities completed during 2022 under a prior carrier or for which a claim was not submitted through MMO.  

Eligible CERTIFIED employees and ADMINISTRATORS enrolled in a single medical plan will receive $200 in January 2023 in their HSA, while those enrolled in the family medical plan will receive $400. Those employees have the opportunity to earn an additional $200 and $400, respectively, by completing specific wellness activities. Any Board HSA funds earned through completing wellness activities in 2022 will be deposited in February 2023. Employees can use this Preventative Care Form to send information to MMO for any HSA activities completed during 2022 under a prior carrier or for which a claim was not submitted through MMO.

Employees have the option to deposit pre-tax dollars into a Health Savings Account so long as the total amount contributed by the employee and the Board of Education does not exceed the contribution limit set forth by the IRS (see below).  Employees can choose to have their personal HSA contributions deducted over 2, 12 or 24 pay periods.  This option is available to you when completing your online enrollment during open enrollment. 

2023 HSA Contribution Limits:

Single Plan = $3,850

Family Plan = $7,750

Additional catch-up contribution (age 55 or older) = $1,000

*Please note, these are annual limits.  If you are joining or leaving the plan mid-year, these limits should be prorated by the number of months you were enrolled in the medical plan. The negotiated agreement also requires employees leaving the plan prior to the end of the calendar year to pay back a prorated portion of the Board HSA contribution granted in January. It is also the employee's responsibility to ensure he or she does not overcontribute to their HSA.

Dental Insurance - Delta Dental (PPO)

Worthington City Schools offers a comprehensive dental plan administered by Delta Dental of Ohio.  See Benefit Summary for details of plan. If enrolling for the first time, Delta Dental will mail your ID card prior to January 1, 2023.  Your ID card can also be obtained online by creating an account on Delta Dental's website. 

2023 Dental Insurance Premiums: 

• Certified Staff
  
• Classified Staff
  

The monthly premium for dental is withheld on the second pay of each month. 

Dependent eligibility: Dependent children may remain on a parent's plan until the end of the month in which the child turns 24 if the child is a full-time student at an accredited school, college or university, is unmarried and not employed on a full time basis.  If a dependent child does not meet those eligibility requirements, then coverage ends at the end of the month in which the child turns 19.

Vision Insurance - EyeMed

Worthington City Schools offers vision benefits administered by EyeMed.  See Benefits Summary for details of plan. If enrolling for the first time, EyeMed will mail your ID card prior to January 1, 2023.  Your ID card can also be obtained online by creating an account on EyeMed's website. To search for a network provider, search the Insight network at eyemed.com.  EyeMed also offers a hearing aid discount benefit.  Click here for FAQ's related to our vision coverage.  

 2023 Vision Insurance Premiums: 

• Certified Staff Members - Board pays 100% of premium
• Classified Staff
  

The monthly premium for vision is withheld on the second pay of each month. 

Dependent eligibility: Dependent children may remain on a parent's plan until the end of the month in which the child turns 24 if the child is a full-time student at an accredited school, college or university, is unmarried and not employed on a full time basis.  If a dependent child does not meet those eligibility requirements, then coverage ends at the end of the month in which the child turns 19.   

Note: Also, if you are enrolled in the health insurance plan, Anthem covers one eye exam if using an Anthem network provider. 

Life Insurance - MetLife

Worthington City Schools provides employees with a district paid basic term Life and Accidental Death & Dismemberment Insurance policy.  The amount provided depends upon employee job class as outlined below.  

• Certified: $70,000   Life Insurance Details
• Classified: $50,000   Life Insurance Details
• Classified PT: $20,000    Life Insurance Details
• Administrators: $100,000  Life Insurance Details

Supplemental Life Insurance - MetLife (Optional)

As an employee you may elect Supplemental Term Life Insurance up to $100,000.  The cost of the coverage is based on your current age and rates as listed as  in the above Life Insurance Detail provided above. 

Note:  Any coverage greater than $50,000 requires a Statement of Health Form to be completed when applying for supplemental coverage.  (Return the form to Financial Services:  Attn:  Beth Hohentein by December 31, 2022.)

Employee Assistance Program (EAP) - MetLife

Worthington City Schools provides employees with an Employee Assistance Program administered by MetLife.  This program provides you with services to help with everyday life challenges that may affect your health and family life.  The EAP may be used to address a broad range of issues including marriage, relationship and family problems, problems at work, legal and financial issues, stress and anxiety, alcohol and drug dependency, and much more.  See the Lifeworks Benefit Summary for details.  Log on to Lifeworks with the user name and password outlined below or call toll-free at 888-319-7819 for help or more information.

User Name: Metlifeeap
Password: eap 

Voluntary Benefits - American Fidelity

Voluntary benefits such as Accident, Disability, Cancer, Critical Illness, Hospital Indemnity and Life insurance are offered through American Fidelity.  These options allow you to strengthen your overall benefits package and are designed to provide additional cash flow to assist with your out of pocket medical costs and bills.  Employees can enroll in these plans during open enrollment.  Any questions should be directed to Mike Moore at American Fidelity at 877-518-2337 x2731 or their member service center at 800-325-0654.  Employees may also email Mike directly at Mike.Moore@AmericanFidelity.com.

Resigning or retiring employees should contact the American Fidelity Policy Continuation Team at 800-943-2231 to continue those policies once employment is severed.  If you currently hold a Texas Life insurance policy and wish to continue that policy after resignation or retirement, please contact them directly at 800-283-9233.  

Creditable Prescription Coverage

HHS Notice of Privacy Practice - Health

Marketplace Coverage Notice

Newborns Health Protection Act Disclosure

No Surprise Medical Billing Rights

The link below leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

https://www.anthem.com/machine-readable-file/search

Special Enrollment Notice

State Premium Assistance Notice

Summary of Benefits and Coverage

Wellness Program Notice

Women's Rights under HealthCare Reform

Contact Beth Hohenstein
(614) 450-6163
bhohenstein@wscloud.org