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2024 Plan Information

2024 Plan Information

Active Employees

Use the links below to view the 2024 plan information:

RATES:
2024 Open Enrollment Informational Meeting Presentations:
 
MEDICAL PLAN INFORMATION AND CHANGES FOR ACTIVE EMPLOYEES:
DENTAL:
VISION:
PLAN # / CONTACT INFO

COBRA Participants

  • 2024 Open Enrollment Informational Meeting Presentations:
MEDICAL PLAN INFORMATION AND CHANGES FOR COBRA:
DENTAL:
VISION:
RATES:

Retirees

  • 2024 Open Enrollment Informational Meeting Presentations:
MEDICAL PLAN INFORMATION AND CHANGES FOR RETIREES:
DENTAL PLAN INFORMATION:
RATES: 

United Health Care
Kaiser
Cigna Select HMO
AB528 - Certificated Only
Dental
Important Information

Important Information

VEBA Health Fair - Thursday, September 19, 2024 @ 2pm - 6pm

 
Join us for free health screenings and services, food, giveaways, and raffle prizes!
 
Free to California Schools VEBA members and their dependents (ages 18 and up). 
 
Flu Shots, Blood Pressure Readings, Carotid Artery Scans, Thyroid Ultrasounds, and DermaScans!
 
Thursday, September 19, 2024 | 2pm - 6pm
 
@ CUSD Board Room
 
Please be aware that these services will be available on a first come, first serve basis. 
 

VEBA Advocacy

Who is VEBA and how can their Advocacy team support me?

  • VEBA is the trust that administers our insurance and their advocacy team facilitates communication between you and the insurance carrier.
  • For quicker member validation and Advocacy team response, please complete the VEBA online contact form. It will allow you to securely provide protected health information.

VEBA Advocacy Contact Information 

 

California Schools Benefit Trust: VEBA

  • Guest ID: CAPUSD
 
 
Updates and Information
 
Mental Health & Well-Being Information 
 
TalkSpace offers therapy for Emotional Wellbeing Solutions (EWS) for beneficiaries when you need it - NO APPOINTMENT IS NECESSARY. Connect virtually with a licensed, in-network provider including unlimited text messaging and real-time audio/ video appointments. To get started, call (888) 625-4809 to obtain an authorization code before registering (first visit only), then choose a provider and message anywhere, anytime. 
 
Need help finding a doctor? Have an issue you can't resolve with the health insurance carrier? Reach out to VEBA Advocacy by calling (888) 276-0250 or complete their online contact form. 
 

MyVEBA and the VEBA Resource Center

Qualifying Life Events

What is a qualifying life event?
  • An event that takes place outside of Open Enrollment or an employee's new hire period that allows an opportnity to enroll or disenroll from coverage.
  • Examples of qualifying life events:
    • Marriage or Divorce
    • Birth or Adoption
    • Gain or Loss of Coverage

What do I need to prove I had a qualifying life event?
  • Qualifying life events are only valid for thirty days from the event. 
    • Example: If you are not enrolled in any CUSD health benefits because you held external coverage. The external coverage termination became effective February 1, 2024. You have thirty days from the loss of coverage date to provide proof of the loss of coverage (a letter from the insurance carrier, or insurance department that details who was on the coverage, what type of coverage was held, and when the loss of coverage took place), dependent documentation (if applicable), and an enrollment and changes form. You would have until February 30, 2024 to submit documents. Since you lost coverage on February 1, 2024, the coverage would be retroactive to February 1, 2024.
  • We can accept copies of documents. Per board policy (1340a), if you bring in an original document without a copy, we can make a copy for $0.25 per page (cash only). 
  • If you are outside of the thirty day timeline, you will have to wait for open enrollment or another qualifying life event to take place. 


Where do I send all of my completed documents to make the qualifying life event change?
  • Our internal email system is not secure, which means it is not safe to send sensitive documents via email. 
  • Documents that contain sensitive information (such as SS #'s) can be sent via fax, district mail, US mail, or in person. 
  • However, if your documents do not contain sensitive information, please send an email to one of our department contacts. 
  • Our department is open Monday - Friday, 8:00am - 4:30pm. 
  • No appointments are necessary. 
 

Personal Information Changes

It's important that all of your contact information is up to date with CUSD departments. If you have a personal information change (such as address, phone number, or email), please complete this form and return a copy to both Human Resource Services and our Insurance Department (via fax, district mail, US mail, or in person). 
 
You can also email Human Resource Services (hrservices@capousd.org) and cc one of our Insurance Department contacts. 
 
If you have a name change, please contact Human Resource Services Department to find out what documentation is required. Once the change is made in their database, we will be able to update your information in our databases and with the insurance carriers. 
 

OPTUM Emotional Wellbeing Solutions (EWS)

 
For Help With:
  • Depression or Stress
  • Substance Abuse
  • Childcare and Elder Care
  • Grief and Loss
  • Money Management
  • Legal Consultation
  • Mental Health Emergencies (Call 988)
 
  • OPTUM Emotional Wellbeing Solutions (formerly known as Employee Assistance Program)
    • Accessible to employees enrolled in current Medical coverage
    • What is Emotional Wellbeing Solutions resource?
    • Call: 1 (888) 625-4809
      • Access Code: VEBA
    • "Browse as a guest" and enter code VEBA
    • Register for an Employee Portal through Optum to schedule a virtual or in person appointment (Kearny Mesa - San Diego).

  • UNUM EAP
    • For all Employees who are not enrolled in Medical coverage
    • Call: 1 (800) 854-1446
    • Work/ Life Balance
 
  • TalkSpace offers therapy for Emotional Wellbeing Solutions (EWS) for beneficiaries when you need it - NO APPOINTMENT IS NECESSARY. Connect virtually with a licensed, in-network provider including unlimited text messaging and real-time audio/ video appointments. To get started, call (888) 625-4809 to obtain an authorization code before registering (first visit only), then choose a provider and message anywhere, anytime. 
 
DOMESTIC VIOLENCE RESOURCES

CUSD Cares

CUSD Cares is a District-wide effort to support the well-being of students and staff members.
 
Click here to access helpful employee resources for mental health, fitness and more!
 

Fitness Memberships

 

KindBody

American Fidelity: Flexible Spending Account (FSA)

 
 
The Flexible Spending Account (FSA) and Dependent Care Account (DCA) are Section 125 plans managed by our third-party administrator, American Fidelity.  The funds for these accounts are pre-tax and can be used for medically related expenses or childcare expenses.  For complete information on these programs view this flyer: American Fidelity FSA Information Packet.
 
To speak with an American Fidelity representative about the FSA or DCA programs call:
 
Customer Service:  (800) 365-9180
 
Flexible Spending Account (FSA) - Designate up to $3,050 annually per household for medically-related expenses, such as prescriptions, co-pays, co-insurance and selected other expenditures. For more information view the flyers below:
 
 
Dependent Care Account (DCA) - Designate up to $5,000 annually per household for childcare expenses for your children ages 12 and under.  Daycare must be with a licensed daycare provider. 
 

Workers' Compensation

INTRODUCTION

The Workers' Compensation Program at Capistrano Unified School District is permissibly self-insured. This means that CUSD pays all of the expenses associated with workers' compensation claims.
 
The District makes every attempt to provide a safe and healthful work environment for all employees. Job specific safety training is also provided to help employees reduce the possibility of being injured on the job. Unfortunately, accidents do happen that may require an employee to obtain medical care.
 
The District Insurance Office has staff dedicated to workers' compensation administration to assist you and may be reached at (949) 234-9401 or workcomp@capousd.org. 
 
If you are an active employee and would like more information about the workers' compensation process, please access your information via Tilt and MyCUSD. You will have to login to your MyCUSD account to access the information. If you are having trouble logging in, you will need to contact TIS Radar at (949) 234-5500.
 
California State Law governs the procedures all employers must follow in the administration of workers' compensation claims. Workers' compensation laws are complicated, which can make navigating the workers' compensation system confusing and frustrating for both injured employees and employers. If you have questions, or if you are unsure as to whether or not you may have a claim, please feel free to call the District Insurance Office.
 
District Workers' Compensation Claims Administrator:
Athens Administrators
P.O. Box 696
Concord, CA
94522
 
If you have additional questions regarding the state of California worker's compensation program, please contact:
Workers' Compensation Appeals Board
Information and Assistance Officer
28 Civic Center Plaza, Room 451
Santa Ana, CA 92701
(714) 558-4597
 
FRAUD NOTICE:
Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of a felony. Such persons may be punished by imprisonment and/or a fine (Labor Code Section 3820; Penal Code Section 549; Insurance Code Section 1871).
 

PROGRAM PROCEDURES

Following is a brief explanation of the procedures that need to be followed by the employee for a worker's compensation illness/injury, in accordance with State law. 
 
In the event of an "industrial injury," an injury or illness which occurs while you are performing your work, you must:

1. Immediately report your injury to your supervisor, no matter how small the injury may seem to be. The California Labor Code requires that we provide you a Claim for Workers' Compensation Benefits (California State Form DWC-1) within 24 hours of the injury. So it is important that we know an injury has occurred in order to be in compliance with the Labor Code. They will complete the Supervisor's Report of Accident form and forward the information to the District Insurance Office. 

2. Complete the DWC 1 form, Employee's Claim for Workers' Compensation Benefits form. You may obtain this form from your site administrative office or the District Insurance Office. Your supervisor will forward the claim to the District Insurance Office, or you may do so directly. Claims are administrated by CorVel Corporation (see more information under Claims Administration below).
 
FAILURE TO COMPLETE NO. 1 AND 2 MAY DELAY OR JEOPARDIZE YOUR RIGHT TO BENEFITS

3. If your injury requires medical treatment, check with your site office manager or contact the District Insurance Office at (949) 234-9401 to obtain authorization for treatment at one of the following medical facilities or your pre-designated physician. The District Insurance Office must pre-authorize your medical treatment.
 
If you wish to seek medical care from your own physician, you must notify the District Insurance Office in writing prior to incurring a work-related injury. Your physician must also sign an agreement to provide treatment in accordance with the workers' compensation provisions of the California Labor Code.
CUSD currently refers injured employees for initial treatment to one of the following medical providers:
 
 
4. If you are dissatisfied with the doctor treating you, you may request a change of physician by contacting the CorVel Corporation.
 
Claims Administration:
Capistrano Unified School District employs an independent claims administrator (CorVel) to manage all workers' compensation claims. Once a claim has been filed with the District Insurance Office, the claim is turned over to the administrator, who then handles all aspects of the claim. This includes arranging doctors' appointments, approving treatment and medications, and making sure you receive all of the benefits you are guaranteed by law.
 
The District's claims administrator is:
Athens Administrators
P.O. Box 696
Concord, CA
94522
 

PROGRAM BENEFITS

The following is a brief explanation of your workers' compensation benefits:
MEDICAL CARE: You receive medical treatment, surgery, hospitalization, prescriptions, and mileage at no cost to you.
 
COMPENSATION:
If you are unable to perform your regular assignment while convalescing, you may be eligible for 90 days of industrial disability leave, during which you will continue to receive full salary from CUSD. Per Education Code Section 44984, "full salary" is computed as the portion of salary due for any month in which the absence occurs as, when added to temporary indemnity under Division 4 or Division 4.5 of the Labor Code, will result in a payment of not more than full salary. After the 90 days are exhausted, you may still be eligible for temporary disability and extended sick leave benefits. If you are not eligible for the 90-day salary continuance, you may be entitled to temporary disability benefits.
 
PERMANENT DISABILITY:
If your industrial injury results in permanent disability, you will be entitled to compensation based on the extent of your disability. The amount you receive is based on a rating from the Workers' Compensation Appeals Board Rating Bureau. If you have a permanent disability as a result of your injury, CorVel Corporation will assist you in obtaining such a rating.
 
REHABILITATION SERVICES:
If your injury results in permanent disability which restricts your ability to work and prevents you from returning to your usual and customary position, the law entitles you to vocational rehabilitation benefits. These benefits may involve a training program and/or direct job placement and/or, if possible, adjustments to your regular duties.
 
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