2016/17 Renewal Meeting
April 15, 2016
Alliant
Christine Kerns, Senior Vice President
Reagan Peralta, Account Executive
Daniel Chow, Account Associate
Cruz Huerta, Benefits Analyst
Agenda
Section 1: Executive Summary
 2015/16 Financial Overview
 SISC Updates
Section 2: October 1, 2016 Medical Plan Renewal
 Current and Renewal Rates and Benefits
 SISC Medical Plan Options
 Companioncare (Individual Retirement Plan) Renewal Rates and Benefits
 Kaiser Permanente (Individual Retirement Plan) Renewal Rates and Benefits
 Contribution Analysis
Section 3: 2016/17 Dental Renewal Estimate
Section 4: Next Steps
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
2
SECTION 1: Executive Summary
Financial Overview
Line of Coverage
BLUE SHIELD ACTIVE & EARLY RETIREE
HMO $10-0
HMO $25-500
HMO $30-20%
PPO 80-E
PPO 80-J
PPO HDHP B
BLUE SHIELD RETIREE +65
HMO $10-0
HMO $25-500
HMO $30-20%
PPO 80-E
PPO 80-J
PPO HDHP B
COMPANIONCARE (Individual Ret Plan)
Blue Shield 65+ HMO Medicare CompanionCare
Anthem CompanionCare
KAISER PERMANENTE (Individual Ret Plan)
Kaiser Permanente
DELTA DENTAL (ACSIG)
Active
Retirees
Total Annual Premium
Enrollees
10/1/2015
10/1/2016
$
%
48
256
76
87
40
32
$1,024,188
$4,441,464
$1,182,096
$1,528,020
$749,028
$361,296
$1,025,184
$4,557,396
$1,213,584
$1,532,520
$751,308
$378,528
$996
$115,932
$31,488
$4,500
$2,280
$17,232
0.1%
2.6%
2.7%
0.3%
0.3%
4.8%
8
8
0
40
5
0
$64,704
$44,352
$0
$273,996
$29,100
$0
$69,408
$49,056
$0
$299,280
$32,040
$0
$4,704
$4,704
$0
$25,284
$2,940
$0
7.3%
10.6%
0.0%
9.2%
10.1%
0.0%
0
8
$0
$36,960
$0
$40,224
$0
$3,264
0.0%
8.8%
2
$11,880
$11,844
-$36
-0.3%
474
173
$721,664
$193,944
$721,664
$193,944
$0
$0
0.0%
0.0%
$10,662,692
$10,875,980
$213,288
2.0%
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
3
SECTION 1: Executive Summary
SISC – Renewal History
SISC HEALTH RENEWAL HISTORY:
(October 1st Renewal Cycle)
SISC RENEWAL HISTORY
YEAR
PPO
HMO
2010 - 2011
12.10%
12.40%
2011 - 2012
6.40%
6.40%
2012 - 2013
8.30%
8.30%
2013 - 2014
8.20%
8.20%
2014 - 2015
8.00%
8.00%
2015 - 2016
2.8%
2.8%
2016 - 2017
3.00%
3.00%
AVERAGE
7.67%
7.72%
Note: PPO/HMO renewal increases represent average Anthem Blue Cross and Blue Shield rate increases.
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
4
SECTION 1: Executive Summary
SISC – Plan Updates/Programs
SISC 2016-2017 Plan Year Medical Changes/Updates
NEW SISC Program Feature
GRAND ROUNDS – value added service effective 4/1/2016 that provides enrollees on any SISC medical
plan the option to obtain a second opinion on diagnosis and treatment from a world-class specialist in
their field
SISC Plan Changes
•
PPO Plan Changes:
•
•
HSA plan B
•
Pharmacy copays after deductible will change from $7-25 to $9-35
•
Annual family deductible increased from $5,000 to $5,200
HMO Plan Changes:
•
MDLive will be available to all Blue Shield HMO plans at a $5 copay
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
5
SECTION 1: Executive Summary
SISC – Plan Updates/Programs
GRAND ROUNDS is a powerful new addition to the SISC benefit platform offered free to all
members. This program began April 1, 2016 and is offered to members enrolled in any
SISC PPO and HMO medical plans.
The benefit consists of two major components:
1.
GRAND ROUNDS OPINIONS
2.
GRAND ROUNDS VISITS
1-844-252-3056
www.grandrounds.com/sisc
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
6
SECTION 1: Executive Summary
SISC – Plan Updates/Programs
GRAND ROUNDS OPINIONS offers a written second opinion from a world-leading expert
specializing in the area of need.
Members should use Grand Rounds when they:

Have a documented diagnosis from a doctor and would like an expert’s second opinion
regarding the diagnosis and treatment plan

Find themselves confronting a complex medical condition

Would like their medications or treatment plan reviewed

Are scheduled for surgery or major procedure
Key notes – Top 0.1% of physicians in the world review cases, 66% of cases result in a
change in diagnosis or treatment plan.
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
7
SECTION 1: Executive Summary
SISC – Plan Updates/Programs
GRAND ROUNDS VISITS is an in-person office visit with a highly-ranked physician in the
patient’s insurance network.
Members and their covered dependents should use Grand Rounds when they:
•
Want to see a physician in-person, within their insurance network
•
Recently moved and need to find new doctors
•
Are looking for new doctors for their children
•
Need to see a new type of specialist
Key Notes – Saves time, Grand Rounds can both find the physician and schedule the
appointment. Saves hassle, Grand Rounds will handle the transfer of the medical records,
normal co-pays apply for appointments
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
8
SECTION 1: Executive Summary
SISC – Plan Updates/Programs
Free onsite health screening events offered from January 2, 2016 through June 2016
Eligibility for program:
• All employees are eligible to participate
• Dependents are only eligible for the screening event if they are enrolled in a SISC
medical plan
• Only those enrolled on a SISC medical plan are eligible to earn the cash awards
Enrolled members earn cash awards
• SISC members who make an online appointment and get their numbers at the event
will receive a $30 cash award. Walk-ins earn $15
• A new incentive has been added - Twenty (20) $500 cash awards will be drawn from
all enrolled members who participate in the health screenings.
•
•
Drawings will be held at the end of each month from January through May.
New this year, members must present their SISC Blue Shield ID card to get their
cash award – nonmembers do NOT receive cash awards.
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
9
SECTION 1: Executive Summary
SISC – Plan Updates/Programs
Free onsite Flu Shot Clinics
•
In 2015
• 180 Districts participated
• Over 22,000 flu shots were provided at onsite clinics
• Offered every year to districts
• Held during the fall (September thru December)
• Watch for notification during the summer
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
10
SECTION 1: Executive Summary
SISC – Plan Updates/Programs
MDLive (24/7 Physician Access)
Over 3,000 MDLive “visits” since Jan 2013, MDLive provides SISC members with on-demand
access to board-certified physicians by online video, phone, or secure e-mail.
•
•
•
•
Doctor visits are available to HMO and PPO Members for a $5 co-pay regardless of the
plan’s regular office visit co-pay.
Great alternative to the ER or urgent care for a non-emergency medical issue or when a
Primary Care Physician is not available. Also great when traveling and in need of medical
care.
Available weekends and even holidays
The service is secure, confidential and compliant with all medical privacy regulations
Currently available to all SISC Blue Shield PPO enrollees
NEW – Blue Shield HMO effective 10-1-16
Note: The addition of MDLive to the Blue Shield HMO plans will result in the removal of the
24/7 Nurseline
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
11
SECTION 1: Executive Summary
SISC – Plan Updates/Programs
Costco $0 co-pay for generics
•
30 to 90-day supply of most generics for a $0 copay
•
Provided at Costco Retail Pharmacies and through Costco Mail Order on most SISC
pharmacy plans
•
You do not have to be a COSTCO member to use their pharmacy.
This feature is not available on the HSA, Kaiser, Minimum Value, Two-Tier Anchor Bronze or
Individual Retiree Plans (IRPs).
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
12
SECTION 2: Medical Plan Renewal
SISC – Blue Shield HMO
Benefits
HMO $10-0 w/Chiro
Calendar Year Deductible (Individual / Family)
None
Out-of-Pocket Maximum
Individual / Family
HMO $30-20%
Zero Facility w/Chiro
HMO $25-500 w/Chiro
None
None
$1,000 / $2,000
Calendar Year Copayment Maximum
$2,000 / $4,000
Calendar Year Copayment Maximum
$1,500 / $3,000
Calendar Year Copayment Maximum
$10
$10 referral / $30 Access+ self-referral
No charge
$10
No charge
No charge
$10 / 30 visits (combined)
$25
$25 referral / $30 Access+ self-referral
$0
$25
$500 / Admit
No charge
$10 / 30 visits (combined)
$150 at an Ambulatory Surgery Center;
$300 at a Hospital
$100
$500 / Admit
$500 / Admit
$25 per visit
$30
$30 referral / $45 Access+ self-referral
$0
$30
20% up to $1,500 p/member
No charge
$10 / 30 visits (combined)
MAJOR MEDICAL
Physician Office Visit
Specialist Visit
Preventive Care
Urgent Care
Inpatient Hospital
Lab & X-Ray
Chiropractic / Acupuncture
Outpatient Surgery
No charge
Emergency Room
Mental Health Care/Substance Abuse
Inpatient Hospital Facility
Outpatient Physician Visit
Outpatient Prescription Drugs
Showing In-Network Benefits Only
$100
No charge
No charge
$10
Navitus (Retail)
Rx Out of Pocket Maximum (Ind / Fam)
Costco
Navitus (Retail)
$1,500 / $2,500
(At participating Pharmacies only)
$0/$10
$9/$35
2016-2017
$0/$35
$0/$90 (Costco Mail Order)
N/A
2015-2016
Costco
Generic/Brand
$0/$35
$0/$90 (Costco Mail Order)
N/A
Actives
Navitus (Retail)
$2,500 / $3,500
$9/$35
$0/$20 (Costco Mail Order)
Annual Deductible
Costco
Generic/Brand
$5/$10
Mail order - 90 day supply
$150
20% up to $1,500 p/member
20% up to $1,500 p/member
$30 per visit
$2,500 / $3,500
Generic/Brand
Retail - 30 day supply
No charge
N/A
2015-2016
2016-2017
2015-2016
2016-2017
Employee Only
13
$980
$982
101
$792
$813
40
$742
$762
Employee + 1
13
$1,900
$1,902
51
$1,554
$1,594
7
$1,453
$1,492
Family
11
$2,653
$2,654
90
$2,186
$2,243
28
$2,043
$2,097
Total Monthly Premium
37
$66,623
$66,686
242
$355,986
$365,277
75
$97,055
$99,640
$799,476
$800,232
$4,271,832
$4,383,324
$1,164,660
$1,195,680
Total Annual Premium
$ ? to Current
$756
$111,492
% ? to Current
0.1%
2.6%
Early Retiree
Employee Only
Employee + 1
4
5
2015-2016
2016-2017
$980
$1,900
$982
$1,902
10
4
2015-2016
2016-2017
$792
$1,554
$813
$1,594
$31,020
2.7%
0
1
2015-2016
2016-2017
$742
$1,453
$762
$1,492
Family
2
$2,653
$2,654
0
$2,186
$2,243
0
$2,043
$2,097
Total Monthly Premium
11
$18,726
$18,746
14
$14,136
$14,506
1
$1,453
$1,492
$224,712
$224,952
$169,632
$174,072
$17,436
$17,904
Total Annual Premium
$ ? to Current
$240
$4,440
% ? to Current
0.1%
2.6%
Retirees Over Age 65
2015-2016
2016-2017
2015-2016
$468
2.7%
2016-2017
2015-2016
2016-2017
Retiree
8
$674
$723
8
$462
$511
0
$460
$509
Retiree plus 1 dependent
0
$1,348
$1,446
0
$924
$1,022
0
$920
$1,018
Total Monthly Premium
8
$5,392
$5,784
8
$3,696
$4,088
0
$64,704
$69,408
$44,352
$49,056
Total Annual Premium
$0
$0
$0
$0
$  to Current
$4,704
$4,704
$0
%  to Current
7.3%
10.6%
0.0%
Note: This summary is for informational purpose only. It does not amend, extend, or alter the current policy in any way. In the event information in this summary differs from the Plan Document, the Plan Document will prevail.
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
13
SECTION 2: Medical Plan Renewal
SISC – Blue Shield PPO
Benefits
PPO 80-E
MAJOR MEDICAL
Physician Office Visit
Specialist Visit
Preventive Care
Urgent Care
Inpatient Hospital
Lab & X-Ray
Chiropractic / Acupuncture
Outpatient Surgery
Emergency Room
Mental Health Care/Substance Abuse
Inpatient Hospital Facility
Outpatient Physician Visit
Outpatient Prescription Drugs
Showing In-Network Benefits Only
Rx Out of Pocket Maximum (Ind / Fam)
$300 / $600
$750 / $1,500
$3,000 p/ind; $6,000 per fam
Calendar Year Out-of-Pocket Max
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
Ded waived; $30
Ded waived; $30
Ded waived; 100%
Ded waived; $30
80%
80%
80%
50%
50%
Not Covered
50%
$600 p/day
Not Covered
Not Covered
90%
90%
Ded waived; 100%
90%
90%
90%
80%
50%
50%
Not Covered
50%
$600 p/day
Not Covered
Not Covered
90%
50%
50%
Not Covered
50%
$600 p/day
Not Covered
Not Covered
80%
$350 p/day
80%
$350 p/day
90%
$350 p/day
$100 per visit + 20% (waived if admitted)
Ded waived; $20
50%
80%
$600 p/day
Ded waived; $20
50%
$100 per visit + 20% (waived if admitted)
Ded waived; $30
50%
80%
$600 p/day
Ded waived; $30
50%
Navitus (Retail)
Navitus (Retail)
Costco
$2,500 / $3,500 (In-network Only)
Generic/Brand
Generic/Brand
Mail order - 90 day supply
$0/$25
Actives
Rx w/ Blue Shield Contracted Provider
Combined with Medical OOP Maximum
Generic/Brand
$9/$35
$0/$60 (Costco Mail Order)
$300 p/ind; $600 p/fam
$100 per visit + 10% (waived if admitted)
90%
50%
90%
$600 p/day
90%
50%
Costco
$1,500 / $2,500 (In-network Only)
$7/$25
Annual Deductible
$3,000 / $5,200
$5,000 p/ind or $10,000 per fam
Calendar Year Out-of-Pocket Max
Ded waived; $20
Ded waived; $20
Ded waived; 100%
Ded waived; $20
80%
80%
(At participating Pharmacies only)
Retail - 30 day supply
PPO HDHP -B w/HSA Compatibility
$1,000 / $3,000
Calendar Year Out-of-Pocket Max
Calendar Year Deductible (Individual / Family)
Out-of-Pocket Maximum
Individual / Family
PPO 80-J
$9/$35 after the deductible
$0/$35
$0/$90 (Costco Mail Order)
$750 p/ind; $1,500 p/fam
2015-2016
2016-2017
$18/$90 (Blue Shield Mail Order)after the deductible
$3,000 medical deductible must be met
2015-2016
2016-2017
2015-2016
2016-2017
Employee Only
27
$968
$971
14
$861
$864
23
$701
$734
Employee + 1
15
$1,807
$1,814
10
$1,607
$1,614
4
$1,323
$1,389
Family
10
$2,679
$2,681
13
$2,382
$2,387
4
$1,998
$2,093
Total Monthly Premium
52
$80,031
$80,237
37
$59,090
$59,267
31
$29,407
$30,810
$960,372
$962,844
$709,080
$711,204
$352,884
$369,720
Total Annual Premium
$ ? to Current
$2,472
$2,124
% ? to Current
0.3%
0.3%
Early Retiree
Employee Only
Employee + 1
19
16
2015-2016
2016-2017
$968
$1,807
$971
$1,814
2
1
2015-2016
2016-2017
$861
$1,607
$864
$1,614
$16,836
4.8%
2015-2016
2016-2017
1
0
$701
$1,323
$734
$1,389
$2,093
Family
0
$2,679
$2,681
0
$2,382
$2,387
0
$1,998
Total Monthly Premium
35
$47,304
$47,473
3
$3,329
$3,342
1
$701
$734
$567,648
$569,676
$39,948
$40,104
$8,412
$8,808
Total Annual Premium
$ ? to Current
$2,028
$156
% ? to Current
0.4%
0.4%
Retirees Over Age 65
2015-2016
2016-2017
2015-2016
$396
4.7%
2016-2017
2015-2016
2016-2017
Retiree
37
$531
$580
5
$485
$534
0
$485
$496
Retiree plus 1 dependent
3
$1,062
$1,160
0
$970
$1,068
0
$970
$992
Total Monthly Premium
40
$22,833
$24,940
5
$2,425
$2,670
0
$0
$0
$273,996
$299,280
$29,100
$32,040
$0
$0
Total Annual Premium
$  to Current
$25,284
$2,940
$0
%  to Current
9.2%
10.1%
0.0%
Note: This summary is for informational purpose only. It does not amend, extend, or alter the current policy in any way. In the event information in this summary differs from the Plan Document, the Plan Document will prevail.
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
14
SECTION 2: Medical Plan Renewal Options
SISC – Blue Shield HMO
See Handout
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
15
SECTION 2: Medical Plan Renewal Options
SISC – Blue Shield PPO
See Handout
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
16
SECTION 2: Medical Plan Renewal
SISC – Blue Shield 65+ Medicare Advantage Plan
BLUE SHIELD 65+ HMO MEDICARE ADVANTAGE PLAN
Effective October 1, 2016
SERVICES
Current
Ambulance
$0 co-pay per trip
Annual Physical Examination
• Office visit co-pay may apply
$0 co-pay*
Durable Medical Equipment (DME)
Medicare covered services
$0 co-pay
Hospitalization
• Inpatient
• Outpatient hospital services
• Emergency Room
$0 co-pay per admission
$20 co-pay
$50 co-pay/waived if admitted within 24 hrs for the same condition
Immunizations
• Includes flu injections and all Medicare approved immunizations
$0 co-pay*
Laboratory Services
No charge
Manual Manipulation of the Spine
$20 co-pay per visit (subject to medical necessity)
No charge for day 1-150
Member pays 100% from day 151 and over
Mental Health - Inpatient
Mental Health - Outpatient unlimited visits
$20 co-pay
Physician Services/Basic Health Services
• Office visits
• Consultation, diagnosis & treatment by a specialist
Prescription Drugs
30 day supply at Retail and 90 day supply through Mail Order
Generic
Preferred Brand
Non-Preferred Brand
Injectables
Specialty
Skilled Nursing Facility
X-Ray Services
$20 co-pay
$20 co-pay
10/30/50 Three Tiered Plan
$10 Retail, $20 Mail order
$30 Retail, $60 Mail order
$50 Retail, $100 Mail order
20% up to $100 per prescription Retail, $300 Mail order
20% up to $100 per prescription Retail, $300 Mail order
Covered in full for 100 days per benefit period
• Includes routine annual mammography
$0 co-pay*
Rates
Retiree
Total Monthly Premium
Total Annual Premium
$  to Current
%  to Current
0
2015-2016
$428
2016-2017
$422
$0
$0
$0
$0
$0
0.00%
Note: This summary is for informational purpose only. It does not amend, extend, or alter the current policy in any way. In the event information in this summary differs from the Plan Document, the Plan Document will
prevail.
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
17
SECTION 2: Medical Plan Renewal
SISC – Companioncare Retiree Plan
Anthem CompanionCare - RETIREE PLAN
Effective October 1, 2016
CompanionCare
Current / Renewal
SERVICES
Pays $1260 (1-60 days)
Pays $315 a day (61-90 days)
Pays $630 a day (91-150 days)
Inpatient Hospital (Part A)
Pays 100% after Medicare and Lifetime reserve are exhausted up to 365 days per lifetime
Pays nothing
Pays $157.50 a day for 21st to 100th day
Pays nothing after 100th day
Pays $147
Pays 20% MA charges including 100% of Medicare Part B deductible
Pays 20% MA charges
Skilled Nursing Facilites
(Must be approved by Medicare)
Deductible (Part B)
Basis of Payment (Part B)
Medical Services (Part B)
Doctor, x-ray, appliances, &
ambulance Lab
Pays nothing
Pays 20% MA charges up to the Medicare annual benefit amount. (Physical & Speech Therapy Combined)
Physical/Speech Therapy (Part B)
Pays 1st 3 pints unreplaced blood and 20% MA charges
Blood (Part B)
Travel Coverage
(when outside the US for less than
6 consecutive months)
Pays 80% inpatient hospital, surgery, anesthetist and in hospital visits for medically necessary services for 90 days of
treatment per lifetime
Outpatient Prescription Drugs
(Navitus)
CompanionCare EMPLOYEES
Retiree
Total Monthly Premium
Total Annual Premium
$  to Current
%  to Current
EE
8
8
* Generic: $9 co-pay for a 30-day supply at a retail pharmacy or $18 co-pay for a 90-day supply through home delivery
service
* Brand: $35 co-pay for a 30-day supply at a retail pharmacy or $90 co-pay for a 90-day supply through home delivery
service
2015-2016
2016-2017
$385
$3,080
$36,960
$419
$3,352
$40,224
$3,264
8.8%
* CompanionCare is a Medicare Supplement plan that pays for medically necessary services and procedures that are considered as a Medicare Approved Expense
Note: This summary is for informational purpose only. It does not amend, extend, or alter the current policy in any way. In the event information in this summary differs from the Plan Document,
the Plan Document will prevail.
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
18
SECTION 2: Medical Plan Renewal
SISC – Kaiser Permanente Individual Retiree Plan
KAISER PERMANENTE INDIVIDUAL RETIREE PLAN
Effective October 1, 2016
Current / Renewal
SERVICES
Hospitalization
* Inpatient
* Emergency Room
Skilled Nursing Facility
Physician Services/Basic Health Services
* Office visits
* Consultation, diagnosis, and treatment by a specialist
X-Ray Services
* Includes routine annual mammography
Laboratory Services
Annual Physical Examination
* Includes pap smears
$0/Admit
$50 co-pay/waived if admitted
Covered in full for 100 days per benefit period
$10 co-pay per visit
No charge
No charge
$10 co-pay per visit
Chiropractic/Acupuncture
* ASH Network
$10 co-pay per visit/ 30 visits combined
$10 co-pay per visit; $5 co-pay per group visit
Outpatient Mental Health / Unlimited Visits
Vision Care
* Examination for eyeglasses
* Glaucoma testing
* Standard frame/lenses every 24 months
Dental Care (DeltaCare)
Hearing Examination
Immunizations
* Includes flu injections and all Medicare approved immunizations
Ambulance
$10 per visit
$10 co-pay per visit
$150 frame and lens allowance every 24 months
Not covered
$10 co-pay per visit
No charge 1
$50/Trip
$10 co-pay per visit
(subject to medical necessity)
Manual Manipulation of the Spine
$10 co-pay per generic/$20 co-pay per brand name up to $100 day supply at Kaiser pharmacies
Prescription Drugs
Retiree Over Age 65
Subscriber w/Medicare
Subscriber w/Medicare + Spouse w/Medicare
1
1
Total Monthly Premium
Total Annual Premium
2
$  to Current
%  to Current
1
2015-2016
$330
$660
$990
$11,880
2016-2017
329
658
$987
$11,844
-$36
-0.30%
Office visit co-pay may apply if administered as part of a physician office visit
Note: This summary is for informational purpose only. It does not amend, extend, or alter the current policy in any way. In the event information in this summary differs from the Plan Document, the
Plan Document will prevail.
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
19
SECTION 2: Medical Plan Renewal
Contribution Analysis – 12thly
MEDICAL
HMO $10-0 w/Chiro
HMO $25-500 w/Chiro
HMO $30-20%
PPO 80-E
PPO 80-J
PPO HDHP -B w/HSA
Compatibility
Renewal Rate
Renewal Rate
Renewal Rate
Renewal Rate
Renewal Rate
Renewal Rate
Actives
Employee Only
$982.00
$813.00
$762.00
$971.00
$864.00
$734.00
Employee +1
$1,902.00
$1,594.00
$1,492.00
$1,814.00
$1,614.00
$1,389.00
Family
$2,654.00
$2,243.00
$2,097.00
$2,681.00
$2,387.00
$2,093.00
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
Current Rate
Current Rate
Current Rate
Current Rate
Current Rate
Current Rate
DENTAL
Actives
Employee Only
$67.29
$67.29
$67.29
$67.29
$67.29
$67.29
Employee +1
$132.73
$132.73
$132.73
$132.73
$132.73
$132.73
Family
LIFE & DISABILITY
$196.73
$196.73
$196.73
$196.73
$196.73
$196.73
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
Current Rate
Current Rate
Current Rate
Current Rate
Current Rate
Current Rate
$43.53
$43.53
$43.53
$43.53
$43.53
$43.53
Total Premium
Total Premium
Total Premium
Total Premium
Total Premium
Total Premium
Actives
Employee Only
TOTAL Monthly Premium
Actives
Employee Only
$1,092.82
$923.82
$872.82
$1,081.82
$974.82
$844.82
Employee +1
$2,078.26
$1,770.26
$1,668.26
$1,990.26
$1,790.26
$1,565.26
Family
$2,894.26
$2,483.26
$2,337.26
$2,921.26
$2,627.26
$2,333.26
Estimated Employer
Contribution
$896.45
Estimated Employer
Contribution
$896.45
Estimated Employer
Contribution
$896.45
Estimated Employer
Contribution
$896.45
Estimated Employer
Contribution
$896.45
Estimated Employer
Contribution
$896.45
Total Monthly Employer Cost
Actives
Employee Only
Employee +1
$1,717.58
$1,717.58
$1,717.58
$1,717.58
$1,717.58
$1,717.58
Family
$2,408.96
$2,408.96
$2,408.96
$2,408.96
$2,408.96
$2,408.96
Estimated Employee
Contribution
Estimated Employee
Contribution
Estimated Employee
Contribution
Estimated Employee
Contribution
Estimated Employee
Contribution
Estimated Employee
Contribution
Employee Only
$196.38
$27.37
$0.00
$185.38
$78.37
$0.00
Employee +1
$360.68
$52.68
$0.00
$272.68
$72.68
$0.00
Family
$485.30
$74.30
$0.00
$512.30
$218.30
$0.00
Total Monthly Employee Cost
Actives
NOTE: HMO $25‐$500 as base plan
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
20
SECTION 2: Medical Plan Renewal
Contribution Analysis – 10thly
MEDICAL
HMO $10-0 w/Chiro
HMO $25-500 w/Chiro
HMO $30-20%
PPO 80-E
PPO 80-J
PPO HDHP -B w/HSA
Compatibility
Renewal Rate
Renewal Rate
Renewal Rate
Renewal Rate
Renewal Rate
Renewal Rate
Actives
Employee Only
$1,178.40
$975.60
$914.40
$1,165.20
$1,036.80
$880.80
Employee +1
$2,282.40
$1,912.80
$1,790.40
$2,176.80
$1,936.80
$1,666.80
Family
DENTAL
$3,184.80
$2,691.60
$2,516.40
$3,217.20
$2,864.40
$2,511.60
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
Current Rate
Current Rate
Current Rate
Current Rate
Current Rate
Current Rate
Actives
Employee Only
$80.75
$80.75
$80.75
$80.75
$80.75
$80.75
Employee +1
$159.28
$159.28
$159.28
$159.28
$159.28
$159.28
Family
LIFE & DISABILITY
$236.08
$236.08
$236.08
$236.08
$236.08
$236.08
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
ACTIVE EMPLOYEE
Current Rate
Current Rate
Current Rate
Current Rate
Current Rate
Current Rate
$52.23
$52.23
$52.23
$52.23
$52.23
$52.23
Total Premium
Total Premium
Total Premium
Total Premium
Total Premium
Total Premium
$1,013.78
Actives
Employee Only
TOTAL Monthly Premium
Actives
Employee Only
$1,311.38
$1,108.58
$1,047.38
$1,298.18
$1,169.78
Employee +1
$2,493.91
$2,124.31
$2,001.91
$2,388.31
$2,148.31
$1,878.31
Family
$3,473.11
$2,979.91
$2,804.71
$3,505.51
$3,152.71
$2,799.91
Estimated Employer
Contribution
$1,075.73
Estimated Employer
Contribution
$1,075.73
Estimated Employer
Contribution
$1,075.73
Estimated Employer
Contribution
$1,075.73
Estimated Employer
Contribution
$1,075.73
Estimated Employer
Contribution
$1,075.73
Total Monthly Employer Cost
Actives
Employee Only
Employee +1
$2,061.10
$2,061.10
$2,061.10
$2,061.10
$2,061.10
$2,061.10
Family
$2,890.75
$2,890.75
$2,890.75
$2,890.75
$2,890.75
$2,890.75
Estimated Employee
Contribution
$235.64
Estimated Employee
Contribution
$32.84
Estimated Employee
Contribution
$0.00
Estimated Employee
Contribution
$222.44
Estimated Employee
Contribution
$94.04
Estimated Employee
Contribution
$0.00
Employee +1
$432.81
$63.21
$0.00
$327.21
$87.21
$0.00
Family
$582.35
$89.15
$0.00
$614.75
$261.95
$0.00
Total Monthly Employee Cost
Actives
Employee Only
NOTE: HMO $25‐$500 as base plan
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
21
SECTION 3: 2016/17 Dental Estimated Renewal
Delta Dental PPO (ACSIG)
ACTIVES
Delta Dental PPO
Dental Benefits
Calendar Year Maximum
Calendar Year Deductible
Individual / Family
Diagnostic and Preventive
Oral Exam & X-Rays
Teeth Cleaning
Fluoride Treatment
Space Maintainers
Bitewings
Basic Services & Crowns
Amalgam/Composite Fillings
Periodontics (Gum disease)
Endodontics (Root Canal)
Extractions & Oral Surgrey
Sealants
Crown Repair
Restorative - Inlays and Crowns
Prosthodontics
Orthodontics
Eligible for Benefit
Lifetime Maximum
Dental Accident
Lifetime Maximum
PPO Premier
PPO Premier
Out-of-Network
PPO Premier
PPO Premier
Out-of-Network
$2,000/Member
$2,000/Member
$2,000/Member
$2,000/Member
None
None
None
None
70-100%
70-100%
70-100%
70-100%
70-100%
70-100%
70-100%
70-100%
60%
50%
60%
50%
50%
Child(ren) Only
$1,000
100%
$1,000/Member
Rate Guarantee
Active
Employee Only
Employee + 1 Dependent
Employee + 2 or More Dependents
RETIREES
50%
Child(ren) Only
$1,000
100%
$1,000/Member
1 Year
EE
194
125
155
474
Total Monthly Premium
Total Annual Premium
$  to Current
%  to Current
1 Year
2015-2016
$67.29
$132.73
$196.73
2016-2017
$67.29
$132.73
$196.73
$60,139
$721,663.92
$60,139
$721,664
$0
0.0%
EE
87
79
7
173
2015-2016
$65.09
$117.88
$169.52
2016-2017
$65.09
$117.88
$169.52
$16,162
$193,943.88
$16,162
$193,944
$0
0.0%
* If PPO Dentist is used
1
The Unlimited dental benefit has a $2,000 benefit maximum for dental implants
Renewal rates are expected to be released by May 28, 2016
2
Members will receive 50% coverage for Prosthodontics when using a Premier Network Dentist
Note: This summary is for informational purpose only. It does not amend, extend, or alter the current policy in any way. In the event information in this summary differs from the Plan Document, the Plan Document will
prevail.
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
22
SECTION 4: Next Steps
 SISC
 District must submit any desired benefit modifications to SISC by August 1, 2016
 ACSIG – Delta Dental Renewal
 ACSIG Board meeting on May 22
 Expect to have Cabrillo College’s specific Dental renewal no later than May 28
 Tentative Open Enrollment Dates:
 Monday, August 15, 2016 through Wednesday, August 31, 2016
 Open enrollment activity is due to SISC by September 1, 2016
© 2016 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
23
Public Entity Benefits Group
100 Pine Street, 11th Floor
San Francisco, CA 94111