Fssc.k12.ar.us

Nicole A. Melendez, Supervisor of Payroll and Employee Benefits There will be significant changes in health insurance of school employees for 2007-2008. The accompanying rate sheet and schedule of benefits provides information on the plans that will be available for next year. For 2007-2008, our health insurance administrator, Employee Benefits Division, will no longer offer the PPO plans and HMO plans currently provided by Arkansas Blue Cross Blue Shield and NovaSys Health. The plans that will be provided are the ARHealth Plan, which is a Point of Service (POS) type plan, and the High Deductible PPO. ARHealth will be offered through Health Advantage and NovaSys Health. NovaSys Health will continue to offer the High Deductible PPO plan. The POS plan is structured like an HMO, but a paper referral and approval will not be necessary to access in-network specialty services. There is not a deductible. You are responsible for co-payments and co-insurance. The co-payment for an office visit to your primary care physician is $20.00, for an in network specialist it is $30.00. Pharmacy benefits will remain on a three -tier plan; the co-pay for generic drugs will be $10, preferred drugs will be $30, and non-preferred drugs will be $60. The high deductible plan offered by NovaSys Health has an individual deductible of $1,250. If you chose any coverage other than individual, your family deductible will be $2,500. Individuals within a family plan do not have a $1,250 individual deductible. One or a combination of family members must meet the entire $2,500 deductible before any benefits are paid. Once your deductible is met, you are responsible for 20% co-insurance while in-network. The pharmacy benefits are also applicable to the deductible and 20% co-insurance. Employee Benefits Division will be mailing out enrollment guides this summer with
more detailed information on the plans. A schedule of benefits with a summary of
common services is included in this booklet. Please review the guide carefully.

If you are currently enrolled in an HMO or POS with HealthAdvantage or NovaSys
Helath, you will be enrolled in the corresponding POS plan with your current provider. If
you are currently enrolled in the Blue Cross Blue Shield PPO, you will be enrolled in the
HealthAdvantage POS. If you are currently enrolled in the NovaSys Health PPO, you
will be enrolled in the NovaSys Health POS.
A form will be sent to all employees enrolled in the health insurance confirming what
health plan you are enrolled in for the 2007/2008 insurance year. The form needs to be
signed and returned to the insurance department at the service center no later than August
27, 2007. If you choose to move to a different plan, a new enrollment form will have to
be completed and returned to the insurance department at the service center. You can
obtain the form from the insurance department, the Fort Smith Public Schools website, or
from the Employee Benefits.
Our open enrollment period will officially begin August 1, 2007, but we will start
accepting change forms and enrollment forms July 1, 2007. If you wish to make changes
to your health insurance, you must complete the appropriate forms with Nicole Melendez
at the Service Center no later than August 27, 2007; this includes switching carriers,
canceling coverage, and adding or removing dependents.
Employee Benefits Division is again offering the Health Risk Assessment Survey (HRA)
to eligible health plan members. Completing the assessment is voluntary, but you will be
eligible for up to a $20 per month discount on your health insurance premiums. The
survey will be available on Monday, July 9, 2007. The survey can be found online at
the interactive voice response
system at 1-800-763-4674. A link to the survey is also on the Fort Smith Public Schools
website in the business section. The last day to complete the survey is August 31, 2007.
HEALTH INSURANCE RATES
2007/2008
Fort Smith Public Schools health insurance is administered by Employee Benefits Division (EBD). Employees must be covered to carry children or spouse on any health care plan. For more detail on the benefits of the plans please refer to EBD’s Health Insurance Enrollment Guide. Insurance Plan
Coverage
Monthly Cost to Employee
Before Survey Deduction
ARHealth-Health Advantage
ARHealth-NovaSys
ARHealth High Deductible PPO Employee 20.00

The ARHealth plan is a Point of Service (POS) type plan. The co-pay for primary care
visits is $20.00 and the co-pay for in-network specialists is $30.00. You do not have to
have a referral for specialty physician Medical Doctors (MD’s) or specialty physician
Doctors of Osteopathy (DO’s) in network. You will receive a pharmacy card with a
three-tier benefit ($10 co-pay generic, $30 preferred drugs, $60 non-preferred drugs.)
Non-covered drugs are 100% member responsibility.
The ARHealth HD PPO has an individual deductible of $1,250. If you chose any
coverage other than individual you have a family deductible of $2,500. The entire $2,500
deductible must be met by one or a combination of family members before any benefits
are paid. Individuals within a family plan do not have a $1,250 individual deductible.
Once your deductible is met you are responsible for 20% coinsurance. The co-pay
structure does not apply to pharmacy benefits.
Employees who participate in any of the health plans will be eligible for $5,000 of Basic
Group Term Life and Accidental Death and Dismemberment coverage with USAble Life.
The insurance premiums listed above are before any deductions given for completing the
Health Risk Assessment Survey (HRA).
2008 Plan Year Summary of Common Services Individual (after deductible)Annual Coinsurance Limit - Care ServicesOther Physician Services (including ObservationPreventive Care / Wellness Services six (6) monthsVision Screening - one (1) every * Above is a summary of common services - Please refer to the Schedule of Benefits for full details, limitations and exclusions Additional services may require pre-approval by the Benefit Coordinator * Limited Benefit: $1,000 per member per plan year but does not include charges for emergency medications administered during transport Behavioral / Mental Health & Substance Abuse Treatment Services * See Behavioral / Mental Health and Substance Abuse Treatment Care Services for detailed information six (6) monthsRepair to non-diseased teeth due Coverage is provided for the following dental services in an outpatient setting: * Treatment and x-rays necessary to correct damage to non-diseased teeth or surrounding tissue caused by an accident or Sjogren's syndrome occurring on or after effective date * Treatment or correction of a non-dental physiological condition caused by Sjogren's syndrome * Injury that has resulted in severe functional impairment * Treatment for tumors or cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth * Removal of impacted or partially impacted wisdom teeth * Pre-treatment dental services in connection with treatment of cancer of the head or neck * Diabetic Supplies, Insulin, Insulin Syringes and Lancets (if purchased together) available through prescription drug card at your Pharmacy. Applicable charges may apply such as Copayments, deductible charges, or coinsurance charges * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator * The Plan does not provide benefits for DME that is for patient convenience * Limited to $10,000 annual maximum benefit from the Plan * Medical emergency means the sudden onset of a medical condition with symptoms enough to cause a prudent person to believe that lack of immediate medical attention could result in serious jeopardy to his / her health, the health of an unborn child, impairment of a bodily function or dysfunction of any bodily organ or part * Copayment waived if admitted directly to the hospital or transferred directly to another facility from that emergency admission* You may contact the contact the toll free number listed on your health identification card for participating facility or physician in the ever of an emergency outside of the service area Additional services may require pre-approval by the Benefit Coordinator Employee Assistance Program (EAP) Services * Employee Assistance Program (Star EAP) Telephonic Consultation and Face-to-Face Short Term / Brief Resolution Counseling is provided for all active insured employees and covered dependents * Limited to eight (8) EAP sessions per episode with no Copayment * Must contact Arkansas Help Line at 1-866-378-1645 * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator * Limited to 30 visits per member per Plan Year. Pre-certification required for additional visits * Coverage is provided for home intravenous (IV) drugs and solutions when ordered by an in-network physician * Some medications may require prior authorization for coverage by the Benefit Coordinator * You may contact your Benefit Coordinator's customer service department to verify if a medication requires prior authorization for coverage. You are responsible for the appropriate coinsurance * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator * Copayment charged per admission for the POS Plan except in cases of direct transfer to another facility * Maximum of 3 Copayments per Member per Plan Year * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator * If you select a private room, member is responsible for the difference in charges for private room and semi-private room * Diagnostic Services and procedures are performed outside the PCP office * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator * Subject to Plan Exclusions and Limitations as defined in the Summary Plan Description (SPD) * Coverage is provided for home intravenous (IV) drugs and solutions when ordered by an in-network physician * Some medications may require prior authorization for coverage by the Benefit Coordinator * You may contact your Benefit Coordinator's customer service department to verify if a medication requires prior authorization for coverage. You are responsible for the appropriate coinsurance * Prenatal and Postnatal outpatient care Copayment required on first visit only Additional services may require pre-approval by the Benefit Coordinator Maternity and Family Planning Services - Cont.
* Hospital Length of Stay for Childbirth: This Plan complies with federal law that prohibits restricting benefits for any hospital length of stay in connection with childbirth for the mother and newborn child to less than 48 hours following a normal vaginal delivery or less than 96 hours following a caesarean section delivery * Treatment for infertility is not a covered benefit under the ARHealth or ARHealth HD PPO plan. Services related to infertility are covered up to diagnosis.
Organ Transplant Services (Pre-Authorization Required) * Benefit Limited to Two (2) organ transplants per Member per Lifetime * Benefit Limited to $10,000 lifetime limit for travel and lodging in conjunction with transplant services * Coverage is provided for transplant services subject to the benefit maximums and requirements. Transplant services MUST be provided by in-network providers and facilities * In order to be eligible for coverage, you MUST notify your Benefit Coordinator prior to receiving any transplant services, including transplant evaluation. The Benefit Coordinator MUST coordinate all transplant services, including transplant evaluation. Questions about your transplant benefits, contact your Benefit Coordinator * Benefit Limited to a Three (3) month supply * For Maximum benefits, ostomy supplies should be obtained through a DME provider that is contracted with your Benefit Coordinator * Contact your Benefit Coordinator for a list of participating DME providers * Drugs not covered by the Plan are paid at 100% member responsibility * ARHealth HD PPO members may receive a negotiated discount for their prescription. Cost of prescription will count toward applicable deductible and Coinsurance Annual Limit * See Preventive Care Services for detailed information * ARHealth members must select a PCP that is contracted with the Benefit Coordinator to receive in-network benefits * No Referral Necessary from PCP for Specialist Office Visit / Specialty Care Services provided by a specialist physician M.D. (medical doctor) or D.O. (doctor of osteopathy) * Certain specialist physicians may require your PCP to call and schedule your appointment. Additional services may require pre-approval by the Benefit Coordinator * Benefit Limited to One (1) prosthetic device that aid in bodily functioning or replace a limb after an accident or surgical loss and Two (2) orthotic devices used for correction or prevention of skeletal deformities * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator * Appliance provider of the appliance must be contracted with your Benefit Coordinator * In order for the device to be covered, it must be an appliance that is defined by the Medicare DME Manual * Repair or replacement of devices due to normal growth or wear is a covered benefit * Maintenance and repairs resulting from misuse or abuse is not covered and is the responsibility of the member * Benefit limited to $15,000 in Prosthetic / Orthotic Plan benefits per Plan Year * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator * Charges apply when services are not provided in conjunction with PCP or Specialist visit * Out-Patient or In-Patient Copayment will apply as applicable * Children 18 years and under for specific conditions for congenital deformity or accident / injury repair.
* Coverage is provided when medically necessary and pre-approved by your Benefit Coordinator. Contact your Benefit Coordinator confirmation of covered services. The circumstances for coverage are very limited * Benefit limited to Sixty (60) days per member per Plan Year * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator * Benefit limited to Fifteen (15) visits per therapy per member per Plan Year * Cardiac Rehabilitation benefits will be applied based on medical necessity and utilization management criteria * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator * The Plan does not provide benefits for maintenance therapy. Maintenance Therapy refers to therapy in which you actively participate that is provided to you after no continued significant and measurable improvement is reasonably or medically anticipated * Benefit limited to Sixty (60) days per member per Plan Year * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator Temporomandibular Joint (TMJ) Dysfunction Services (Pre-Authorization Required) * PCP or Specialist Copayment will apply as applicable * Coverage is provided only when medically necessary and pre-approved by your Benefit Coordinator Additional services may require pre-approval by the Benefit Coordinator

Source: http://www.fssc.k12.ar.us/business_office/0708HealthInsChanges.pdf