Wellness Programs

Anthem Blue Cross Diabetes Prevention Program

Anthem Blue Cross, in conjunction with Solera Health, are offering Anthem HMO and PPO members a free voluntary program to help you lose weight and significantly reduce your risk of developing diabetes. If eligible, the 16-week program gives members access to: small group support, a personal health coach, tools like a wireless scale or activity tracker, and weekly lessons from an array of national and local programs, like Weight Watchers, Retrofit and Jenny Craig.

To find out if you or your dependents qualify for the program, take a 1-minute quiz at CSEBO's dedicated link, found here.
For a flyer with a description of the program and an FAQ, please click here.


Oxnard Union High School District Retiree Association

The OUHSD Retiree Association, formed in November 2013, works collaboratively with OUHSD, CSEBO and vendor partners for the benefit of vested retired employees and their covered spouses. Members from the Retiree Association regularly meet with CSEBO and attend Board Meetings to inform their membership of any changes to their plans.

For more information on the Retiree Association, please visit their website.


Medicare and Your OUHSD Retiree Plan

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A few months before you or your spouse turn 65, Oxnard Union High School District will send you a letter for your options for coverage past 65. Once you obtain Medicare A and B, you will be converted from the District's commercial policy to one of the following Medicare Advantage plans administered through CSEBO:

Anthem Blue Cross
       - Medicare Preferred PPO
       - Senior Secure HMO

Kaiser Permanente
       - Kaiser Permanente Senior Advantage (KPSA)

Below is an overview of the transition from the commercial plan to the respective Medicare Advantage Plan:

Once your enrollment has been accepted by Anthem and CMS, you will now be enrolled in a Medicare Advantage Plan, which is a Medicare Part C (supplemental plan) combined with Part D prescription drug coverage. You will receive a new Anthem Medicare Advantage ID card in the mail. Please discard your old Anthem ID card. Please remember to update your providers and pharmacies with your new Anthem ID card. You do not need to show your Medicare red, white and blue card to providers (with the exception of routine clinical research studies and hospice services). Anthem will coordinate with Medicare and the provider on your behalf.

In addition to your standard benefits, the Medicare Advantage Plans also includes access to SilverSneakers, a copay-free fitness program designed for Medicare-eligible individuals, which offers physical activity, health education and social events. You will have access to SilverSneakers premier fitness center network, you’ll receive a complimentary basic membership with access to a variety of participating fitness centers throughout the country, with amenities such as:

  • Fitness equipment, free weights and pools
  • The signature SilverSneakers Fitness program classes, designed specifically for older adults and taught by certified instructors

To receive more information and find a participating location near you, please visit the SilverSneakers website.


Receiving Medical Care

The Medicare Advantage Plan works the same as the commercial PPO, except there are no deductibles or copays, and the same in and out-of-network benefits. You may continue to see the same in-network providers you were seeing before, with the addition of out-of-network providers for medically necessary services. Please note, for the medical services to be covered out-of-network, the out-of-network provider must be eligible to participate in Medicare. If the provider does not participate in Medicare, you may be responsible for a higher cost share of the services rendered. You may request a pre-visit coverage determination ahead of your visit by calling Customer Service.

 On the Medicare Advantage Plan, there are certain procedures that will require pre-authorization prior to you receiving the services that may not have been required on the commercial plan. This pre-authorization determines medical necessity in advance of you receiving the services. This pre-authorization is a CMS requirement and ensures you will not be responsible for services that are considered medically necessary. Pre-authorizations are initiated by your treating physician. Please refer to the Evidence of Coverage (EOC) to see which services require pre-authorization.


Filling Prescriptions

Like the commercial plan, the Medicare Advantage Plan also utilizes Anthem Blue Cross and Express Scripts for its members. The Medicare Advantage Plan covers all Medicare Part D prescription drugs, in addition to additional drugs not covered by Part D, referred to as “Extra Covered Drugs.” This list of covered drugs is also known as a formulary. Generally, the lower the tier on the formulary, the less the drug will cost you.

The Medicare Advantage Plan will generally cover your drug so long as the prescription is written by a provider, the prescriber of the drug accepts Medicare, the drug is filled at an in-network pharmacy and is on the plan’s formulary. To find an in-network pharmacy, please call Customer Service.

The mail-order service allows members to receive up to a 90-day supply for most drugs. However, specialty drugs are limited to a 30-day only supply. Typically, a mail-order pharmacy fill will be delivered to you in no more than 14 days. If this is your first mail-order delivery, it is advisable to have at least a 30-day supply of medication on hand when a mail-order request is placed. To obtain a refill, please contact your pharmacy 21 days before the drugs you have on hand will run out to ensure the order is shipped to you in time.

To receive forms and information about filling your prescription by mail, please contact Customer Service.


Once your enrollment has been accepted by Anthem and CMS, you will now be enrolled in a Medicare Advantage Plan, which is a Medicare Part C (supplemental plan) combined with Part D prescription drug coverage. You will receive a new Anthem Medicare Advantage ID card in the mail. Please discard your old Anthem ID card. Please remember to update your providers and pharmacies with your new Anthem ID card. You do not need to show your Medicare red, white and blue card to providers (with the exception of routine clinical research studies and hospice services). Anthem will coordinate with Medicare and the provider on your behalf.

In addition to your standard benefits, the Medicare Advantage Plans also includes access to SilverSneakers, a copay-free fitness program designed for Medicare-eligible individuals, which offers physical activity, health education and social events. You will have access to SilverSneakers premier fitness center network, you’ll receive a complimentary basic membership with access to a variety of participating fitness centers throughout the country, with amenities such as:

  • Fitness equipment, free weights and pools
  • The signature SilverSneakers Fitness program classes, designed specifically for older adults and taught by certified instructors

To receive more information and find a participating location near you, please visit the SilverSneakers website.


Receiving Medical Care

The Medicare Advantage Plan works the same as the commercial HMO. You may continue to see the same in-network providers you were seeing before. Please be sure to state your preferred Primary Care Physician (PCP) on your enrollment form.


Filling Prescriptions

Like the commercial plan, the Medicare Advantage Plan also utilizes Anthem Blue Cross and Express Scripts for its members. The Medicare Advantage Plan covers all Medicare Part D prescription drugs, in addition to additional drugs not covered by Part D, referred to as “Extra Covered Drugs.” This list of covered drugs is also known as a formulary. Generally, the lower the tier on the formulary, the less the drug will cost you.

The Medicare Advantage Plan will generally cover your drug so long as the prescription is written by a provider, the prescriber of the drug accepts Medicare, the drug is filled at an in-network pharmacy and is on the plan’s formulary. To find an in-network pharmacy, please call Customer Service.

The mail-order service allows members to receive up to a 90-day supply for most drugs. However, specialty drugs are limited to a 30-day only supply. Typically, a mail-order pharmacy fill will be delivered to you in no more than 14 days. If this is your first mail-order delivery, it is advisable to have at least a 30-day supply of medication on hand when a mail-order request is placed. To obtain a refill, please contact your pharmacy 21 days before the drugs you have on hand will run out to ensure the order is shipped to you in time.

To receive forms and information about filling your prescription by mail, please contact Customer Service.


 

The Anthem Medicare Advantage Plans and the Kaiser Senior Advantage are Medicare-supplemental Part C plans, which requires enrollment in Medicare Part A and Part B. If you stop premium payments or cancel your Part A or B, you will automatically be dis-enrolled from the Plan. If you sign up for Part D prescription drug coverage outside of the Anthem Medicare Preferred PPO, Senior Secure HMO or Kaiser Senior Advantage Plan you will also be automatically dis-enrolled from the respective plan.

If your modified adjusted gross income (MAGI) as reported on your IRS tax return from 2017 is above a certain amount, you may pay an extra premium for Part D coverage. The chart below shows the extra premium based on your income:

If you filed an individual tax return and your income in 2017 was:

If you were married but filed for a separate tax return and your income in 2017 was:

If you filed a joint tax return and your income in 2017 was:

This is the 2019 monthly cost of your extra Part D amount (to be paid in addition to your premium to the District):

Less than or equal to $85K

Less than or equal to $85K

Less than or equal to $170K

Your plan premium

Greater than $85K and less than or equal to $107K

N/A

Greater than $170K and less than or equal to $214K

$12.40 + Your plan premium

Greater than $107K and less than or equal to $133.5K

N/A

Greater than $214K and less than or equal to $267K

$31.90 + Your plan premium

Greater than $133.5K and less than or equal to $160K

N/A

Greater than $267K and less than or equal to $320K

$51.40 + Your plan premium

Greater than $160K and less than or equal to $500K

Greater than $85K and less than $415K

Greater than $320K and less than or equal to $750K

$70.90 + Your plan premium
Above $500K Above $415K Above $750K $77.40 + Your plan premium

If you do not pay your extra Part D amount, you will automatically be dis-enrolled from the plan and lose prescription drug coverage. Currently, Oxnard Union High reimburses retirees for Part D. For more information, please see the attached form.

OUHSD Retiree Plan Documents

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       - 90% PPO Plan
       - HMO Comparison


      Anthem Blue Cross
       - PPO 90
       - Medicare Advantage PPO 5/5/5
       - Medicare Advantage PPO 5/10/10
       - HMO 10
       - Medicare Advantage HMO


      Kaiser Permanente
       - HMO 10
       - Kaiser Permanente Senior Advantage (KPSA)

Commercial Plan Retirees

Carrier

Website

Member Services Number

Additional Resources

Anthem Blue Cross PPO

https://www.anthem.com/

1-800-759-3030

LiveHealth Online

Anthem Blue Cross HMO

https://www.anthem.com/

1-800-227-3771

24/7 NurseLine: 1-800-977-0027

Anthem Blue Cross Pharmacy

https://www.anthem.com/

1-833-261-2460

 


Medicare Advantage Retirees

Carrier

Website

Member Services Number

Additional Resources

Anthem Blue Cross Medicare Advantage PPO

https://www.anthem.com/

1-877-411-1640

LiveHealth Online

24/7 NurseLine:
1-800-700-9184

 

Anthem Blue Cross Medicare Advantage HMO

https://www.anthem.com/

1-800-225-2273

Kaiser Permanente Senior Advantage

https://www.kp.org

1-800-443-0815