Caring, Affordable - Family Health Centers of San Diego

2014 EMPLOYEE BENEFIT GUIDE
YOUR PATH TO
EXCEPTIONAL
HEALTH
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PHYSICAL
FINANCIAL
EMOTIONAL
SAFETY
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WELCOME TO YOUR 2014
EMPLOYEE BENEFITS
An important priority of FHCSD is to provide a competitive employee benefits program
for our valued employees. We know our employees view their benefits as an important
part of total compensation package.
Laura Rodriguez
Founder
Family Health Centers of
San Diego
For 2014, we are pleased the benefits offered to our employees and their families, are
even more comprehensive than in previous years. Employees who participated in our
wellness program were given a discount on their portion of their medical premiums.
This guide will assist FHCSD employees in making informed decisions regarding
their benefits. The benefits package offers a variety of coverage options to help our
employees choose a plan that best meets their needs. Please read the guide carefully
as it will help in making benefit choices.
Benefit packages are complex. To help better understanding the available benefits,
Family Health Centers of San Diego partnered with Intercare Insurance Solutions to
offer a hotline for our employees and their family members. This toll-free number gives
employees immediate and accurate answers to benefit questions.
Employee Benefits Service Center
Extension 4200 or 877-679-2011
service@intercaresolutions.com
7:00 a.m. to 5:30 p.m. Pacific Time l Monday through Friday
Closed on major U.S. holidays
Regards,
Fran Butler-Cohen
CEO, Family Health Centers of San Diego
Family Health Centers of San Diego (FHCSD) was established in
1970 as a result of a demonstration led by community activists
and a well-known grandmother and Barrio Logan resident,
Laura Rodriguez. Laura was involved in many worthy causes and
dedicated her life to improving the community of Barrio Logan.
Most special to her heart, was “La Clinica”.
After growing up without a neighborhood health facility, Laura
was inspired to lead a movement to establish a clinic in Barrio
Logan for children in her community. Once the clinic opened,
Laura worked tirelessly for 24 years to ensure its success. She
was known for her famous tamales and once said, “Making
tamales while talking about the health center’s needs has put me
in contact with hundreds of folks who helped build our center.
After all, Barrio Logan is my neighborhood. I will give it the best
I’ve got.”
Laura had a humble beginning but received many awards and
was recognized as a Presidential “Point-of-Light”. Today FHCSD is
the second largest federally qualified health center in the nation,
and we honor Laura by fulfilling our mission to provide caring,
affordable, high quality healthcare and supportive services to
anyone in need.
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Helping You Decide
Which Benefits Should I Look At
WRAPPING
UP
HAVE A PET
Don’t forget about
Pet Insurance!
WANT TO SAVE MONEY ON
CHILDCARE
Don’t forget about the
dependent care FSA!
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Table of Contents
GETTING
STARTED
05 Benefits-at-a-Glance
06 Employee Costs
07 Eligibility and Enrollment
WRAPPING
UP
37 Helpful Definitions
38 Employee Benefits Service Center
39 Important Notices
40 Contact Information
PHYSICAL
FINANCIAL
EMOTIONAL
SAFETY
10 Medical
Four plan choices that offer
a range of health benefits,
including free preventive care.
15 Prescription Drug Coverage
All of the medical plans
provide comprehensive
prescription drug coverage.
16 Dental
Four plan choices for your
dental care.
18 Vision
Vision coverage and additional
discounts for other vision
services.
20 Flexible Spending Accounts
Health Care and Dependent
Care accounts.
22 Life and AD&D Insurance
Basic Life and AD&D Insurance
for you; Additional Life
Insurance for you, your spouse
and dependents.
23 Disability Insurance
Long Term Disability insurance
for you.
24 Retirement Savings
403(b) and 457(b) plans to
help you save.
25 Additional Benefits
529 College Savings Fund, Pet
Insurance, Travel Assist, Legal
& Identity Theft Shield, Aflac
Benefits and Home, Renters &
Auto insurance.
29 Work Life Services
Confidential help when you
need it, 24/7.
30 FHCSD Wellness
Programs and resources to
help you on your wellness
journey.
31 Employee Perks
Awards and discounts for all
FHCSD employees.
34 Time Off
Paid time off, extended sick
insurance and holidays to help
you balance work and home.
36 Safety Starts With Me
Stay safe and earn rewards!
36 CPR Certification
Classes are offered every other
month.
36 Safety Training
Regular departmental safety
trainings offered throughout
the year.
36 Ergonomics
Free ergonomic assessments
available for all employees!
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Benefits-at-a-Glance
Medical
• UnitedHealthcare
SignatureValue
Advantage HMO
• UnitedHealthcare
SignatureValue HMO
(Full Network)
• Kaiser Permanente HMO
• SIMNSA HMO
(for Mexican nationals)
Dental
• United Concordia DHMO
• United Concordia DPPO
• SIMNSA DHMO
(for Mexican nationals)
Vision
• Vision Service Plan PPO
Flexible Spending Accounts
• Contribute up to $2,500 pretax
dollars per year for eligible
healthcare expenses.
• Contribute up to $5,000 pretax
dollars per year for eligible
dependent care expenses.
Life and AD&D Insurance
Basic Life and AD&D Insurance
• Benefit is equal to 2x annual
earnings to a maximum of
$500,000.
Additional Life Insurance
• Additional coverage is available for
you, your spouse and child(ren).
Disability Insurance
Basic Long-Term Disability
• 50% of monthly salary for up to 24
months.
Additional Long-Term Disability
• 60% of monthly salary up to the
current retirement age (age 65).
Retirement Savings
403(b) Retirement Plan
• You may contribute up to 50% of
your pre-tax earnings up to the
2014 federal maximum.
457(b) Retirement Plan
• You may contribute up to 100%
of your pre-tax earnings up to the
2014 federal maximum.
Additional Benefits
• 529 College Savings Fund
• VPI Pet Insurance
• Travel Assist
• LegalShield and Identity Theft
Shield
• Aflac Supplemental Benefits
• Home, Renters & Auto insurance
Work Life Services
• Horizon Health - Up to 3 faceto-face
counseling sessions per
incident for you or any member
of your household.
FHCSD Wellness
• Path to Exceptional Health -
FHCSD provides programs and
resources to help you on your
wellness journey.
Employee Perks
• Discounted Care at FHCSD Clinics
• Employee Referral Bonus
• Service Awards
• Union Bank Account Benefits
• Wireless Discounts
• Movie and Theme Park Discounts
Time Off
• Paid Time Off
• Extended Sick Insurance
• Holidays
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Employee Costs
FHCSD cares about your health and well-being and is pleased to offer an employee Wellness Program. We believe participation in the Wellness Program
will lead to better health. Employees who participated in the 2013 Wellness Program’s Health Screening earned a $50 credit each month towards the cost
of their medical plan! This discount is shown in the “Wellness Participant” column below. Employees who did not to participate in the Health Screening will
pay medical contribution amounts shown in the “Non-Participant” column. Dental and vision contributions are not impacted by your participation in the
health screening or in any wellness programs. Medical, dental and vision contributions are taken out of all paychecks except for 05/30/2014 and 10/31/2014
paychecks.
TIER
Save $25
per pay period!
WELLNESS
PARTICIPANT
WELLNESS
NON-PARTICIPANT
UNITEDHEALTHCARE SIGNATUREVALUE ® ADVANTAGE NETWORK HMO
WELLNESS
PARTICIPANT
KAISER PERMANENTE HMO
WELLNESS
NON-PARTICIPANT
Employee Only $15.00 $40.00 $15.00 $40.00
Employee + 1 Dependent $72.50 $97.50 $72.50 $97.50
Employee + Family $112.50 $137.50 $112.50 $137.50
UNITEDHEALTHCARE SIGNATUREVALUE ® FULL NETWORK HMO
Save $25
per pay period!
SIMNSA HMO
Employee Only $30.00 $55.00 $0.00 $25.00
Employee + 1 Dependent $127.50 $152.50 $0.00 $25.00
Employee + Family $195.00 $220.00 $0.00 $25.00
TIER UNITED CONCORDIA DHMO UNITED CONCORDIA DPPO SIMNSA DHMO
Employee Only $7.15 $17.74 $6.95
Employee + 1 Dependent $12.50 $33.27 $12.50
Employee + Family $21.70 $54.11 $21.70
TIER
VSP VISION PLAN
Employee Only $4.01
Employee + Spouse $6.87
Employee + Child(ren) $7.02
Employee + Family $11.31
When any insurance policy or other benefit program provides
that benefits continue through the end of the month in which
you terminate or are no longer benefit-eligible, your share of
the cost for the remainder of the month will be deducted from
your paycheck and coverage will continue through the end of
the month in which you terminate or lose coverage.
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Eligibility & Enrollment
Who Can Enroll
Regular Employees
• Working full-time (30 hours or more each week on a regular basis).
Spouse/Domestic Partner
Our benefits
last from
January 1 to
December 31.
• Your legally married spouse (same or opposite sex).
• Your California registered domestic partner (as defined by California Family Code Section 297).
Children
• Your children, stepchildren or children of your domestic partner to age 26, regardless of marital or
student status.
• Any children for whom you are required to provide coverage under a Qualified Medical Child
Support Order.
• Disabled Child: your unmarried children, step-children or children of your domestic partner of any
age, if they are incapable of self-care due to a physical or mental disability.
Who Pays
FHCSD and You
FHCSD pays most of the cost of medical
coverage for you and your eligible spouse,
domestic partner and children. The amount you
pay for medical, dental and vision is taken from
your paycheck before federal and state taxes are
taken out. This can help reduce the amount of
taxes you pay.
Refer to the carrier documents for enrollment requirements.
Your spouse, domestic partner and children can be enrolled in our medical, dental, vision, supplemental
life insurance plans and LegalShield and Identify Theft Shield.
When Can I Enroll
Open Enrollment
• During open enrollment you can enroll or make changes to your benefits.
• Open enrollment happens every year.
New Hire
• You are eligible to enroll on the first of the month following 30 days of employment, not to exceed
60 days.
Example: if you start working at FHCSD on March 15, your benefits start on May 1.
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Eligibility & Enrollment
When Can I Change My Benefits
Open Enrollment
• During open enrollment you can make changes to your benefits – like choosing a different medical plan or enrolling or re-enrolling in the Flexible
Spending Account plans.
Qualifying Event
• You can make changes during the plan year if something in your life changes (and is an event recognized by the IRS), such as:
Marriage,
divorce, legal
separation
Birth,
adoption,
death
Change in
residence
causing loss
of coverage
Change in employment,
eligibility, or cost of
benefit coverage for you,
your spouse or dependent
Loss of other
coverage for
your dependent
Medicare or Medicaid
entitlement for you, your
spouse or dependent
Reduced hours
at work for you
or your spouse
Qualified
Medical Child
Support Order
(QMCSO)
• You’ll make qualifying event changes online in BeneTrac. You must notify Human Resources, and provide documentation, within 30 days of the qualifying
event. The election change must be consistent with the event. Benefit election decisions will then remain in force for the remainder of the plan year.
How Can I Enroll
Enroll Online at https://www.eenroller.net/login.aspST=FHSD7891
• Your BeneTrac User Name is your Employee ID.
• First time users: your temporary BeneTrac Password is the last four digits of your Social Security number. You will be asked to change your password once
you login for the first time.
• Please use the link “Click here if you have forgotten your User Name or Password” if you need help with your BeneTrac User Name or Password.
• Once you’ve reviewed your personal information and enrolled/changed your benefits, you will finalize your changes by clicking on the “Review and
Finalize” button to approve your changes.
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PHYSICAL
10 Medical
15 Prescription Drug Coverage
16 Dental
18 Vision
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Medical Plan Choices
HMO Plans
A Health Maintenance Organization (HMO) offers you a range of health benefits, including free
preventive care. You have the choice to enroll in one of three HMO plans. With any of the HMO
plans, you must see doctors and visit hospitals in the network. Except for emergency and urgent
care, if you obtain care outside the HMO’s network without a referral, you will have to pay the full
cost of services.
UnitedHealthcare HMO
You have the option to select the UnitedHealthcare SignatureValue Advantage HMO or the
UnitedHealthcare SignatureValue HMO (Full Network).
• You and your covered dependents must select the same HMO plan.
• Whichever HMO you choose, you must select a primary care physician (PCP) from a list of
doctors provided by the HMO.
• Your PCP coordinates all your care, including referrals to specialists and approving further
medical treatment.
• Each family member may choose his/her own PCP.
• UnitedHealthcare covers treatment for infertility services for the diagnosis of an underlying
condition only.
SignatureValue Advantage HMO
• Same high quality care as the SignatureValue HMO (Full Network).
• A slightly more limited network of providers means you will pay less for your medical care.
• No access to providers at Scripps Coastal Medical Group, Scripps Clinic and UCSD.
SignatureValue HMO (Full Network)
• UnitedHealthcare’s complete network of HMO physicians.
• Higher copayments and higher monthly contributions.
• Access to many providers including Scripps Coastal Medical Group, Scripps Clinic and UCSD.
COVERAGE INFORMATION & DOCTOR
SEARCHES AT YOUR FINGERTIPS!
Just log on to www.uhcwest.
com from your smartphone
browser and begin using it
to search for doctors, access
health and wellness resources,
and order a health plan ID card.
10 / 40

Medical Plan Choices
Kaiser Permanente HMO
As a member of Kaiser Permanente, you are encouraged to select a primary care physician, but it is
not a requirement.
• Choose your personal doctor. You’re free to change at anytime, for any reason.
• With Kaiser doctor profiles you have access to all the information you need to make the right
doctor match.
• Each family member may choose his/her own doctor.
• Access to the full Kaiser health system
• Most locations include pharmacy, lab, X-ray services, and more
Most services are covered at 100% after you pay a copayment. There is no deductible with the
HMO and no claim forms for you to submit. Additionally, Kaiser is the only medical plan option that
provides coverage for the treatment of infertility.
GOOD HEALTH IS IN YOUR HANDS
My Health Manager is your
one-stop online resource
for time-saving features.
Use it to email your doctor,
refill prescriptions, view
appointments, and more!
Just download the Kaiser Permanente app
for the iPhone, iPad, or iPod touch from the
App Store or for Android from Google Play.
Bookmark www.kp.org on your Webenabled
phone or mobile device.
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UnitedHealthcare & Kaiser Medical Plan Highlights
FEATURES
CALENDAR YEAR DEDUCTIBLE
UNITEDHEALTHCARE
SIGNATUREVALUE®
ADVANTAGE NETWORK HMO
UNITEDHEALTHCARE
SIGNATUREVALUE®
FULL NETWORK HMO
KAISER
PERMANENTE
HMO
Individual / Family None / None None / None None / None
OUT-OF-POCKET MAXIMUM
Individual / Family $2,000 / $6,000 $3,000 / $9,000 $1,500 / $3,000
PREVENTIVE
Preventive Care Services
Adult Routine Physicals
Well-Woman Care
Well-Baby Preventive Care
No Charge No Charge No Charge
Routine Check-ups (Ages 2-18)
Immunizations @ PCP
PHYSICIAN SERVICES
PCP/Specialist Office Visits $20 Copay (PCP); $40 Copay (Specialist) $20 Copay (PCP); $40 Copay (Specialist) $20 Copay (PCP); $40 Copay (Specialist)
Therapy* $20 Copay $20 Copay $20 Copay
Laboratory and X-Rays - Standard No Charge No Charge No Charge
Complex X-Rays - CT, MRI, PET $50 Copay $200 Copay No Charge
Maternity Care No Charge $20 Copay No Charge
Infertility Services Not Covered Not Covered 50% Per Visit
HOSPITAL SERVICES
Inpatient Hospital $250 Copay Per Admission $400 Copay Per Admission $250 Copay Per Admission
Outpatient Surgery $125 Copay $400 Copay $100 Per Procedure
Emergency Room $100 Copay $150 Copay (Waived if Admitted) $100 Copay (Waived if Admitted)
Urgent Care Services $40 Copay; $100 Copay (Out of Area) $40 Copay; $75 Copay (Out of Area) $20 Copay
Ambulance $50 Copay $50 Copay $50 Copay
MENTAL HEALTH
Mental Health Inpatient $250 Copay Per Admission $250 Copay Per Admission $250 Copay Per Admission
Mental Health Outpatient $40 Copay $40 Copay $20 Per Visit
Chiropractic 1 $15 Copay $15 Copay $15 Copay
*
Outpatient Medical Rehabilitation Therapy (Physical, Occupational and Speech)
1
Limited to 20 visits/year.
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SIMNSA Medical Plan
SIMNSA Baja HMO
The SIMNSA Baja HMO is an HMO available only to Mexican Nationals.
A Mexican National is defined as:
a. a person born in Mexico;
b. a person born in another country with a Mexican father or a
Mexican mother, or both;
c. a foreign woman or man who marries a Mexican man or woman
and lives in Mexico; or
d. a foreigner who becomes naturalized in Mexico.
Features of this plan include:
• Comprehensive medical coverage that includes preventive care
and fixed copays for most services.
• No annual deductible or lifetime dollar maximum.
• The ability to choose your own SIMNSA personal physician who
will be responsible for providing or coordinating all of your
medical care, including specialty care referrals.
• Ability to access Urgent Care Centers in the U.S. at all non-Mexico
urgent care centers, including FHCSD clinics, for an Out of Area
copay.
FEATURES
CALENDAR YEAR DEDUCTIBLE
Individual/Family
OUT-OF-POCKET MAXIMUM
Individual/Family
PREVENTIVE
Preventive Care Services
Adult Routine Physicals,
Well-Woman Care
Well-Baby Preventive Care
Routine Check-ups (Ages 2-18)
Immunizations @ PCP
PHYSICIAN SERVICES
PCP/Specialist Office Visits
Therapy 1
Laboratory and X-Rays - Standard
Complex X-Rays - CT, MRI, PET
Maternity Care
Infertility Services
HOSPITAL SERVICES
Inpatient Hospital
Outpatient Surgery
Emergency Room
Urgent Care Services
Ambulance
MENTAL HEALTH
Mental Health Inpatient
Mental Health Outpatient
Chiropractic 2
PRESCRIPTION
Retail
Mail Order
SIMNSA HMO
None
N/A
No Charge
$7 Copay
$10 Copay
No Charge
No Charge
$7 Copay
Not Covered
No Charge
No Charge
$25 Copay (Waived if Admitted); $100 Copay (Out of Area)
$25 Copay; $50 Copay (Out of Area)
No Charge
No Charge
$7 Copay
Not Covered
$10 Copay
Not Covered
1
Outpatient Medical Rehabilitation Therapy (Physical, Occupational and Speech)
2
Limited to 20 visits/year.
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Free Medical Care
All medical plans cover preventive care services, for enrolled members, that meet the requirements of federal and state law, including certain screenings,
immunizations and physician visits. If you visit in-network providers, you don’t have to pay for preventive care services. If you use an out-of-network provider,
a charge may apply.
Child Preventive Care (Birth to 18 years)
Preventive Physical Exam
Age-appropriate screening tests may include:
• Newborn screenings
• Vision screening
• Hearing screening
• Developmental and behavioral assessments
• Oral health assessment
• Screening for lead exposure
• Height, weight and body mass index (BMI)
• Screening for sexually transmitted infections
Immunizations:
• Hepatitis A
• Hepatitis B
• Diphtheria, Tetanus, Pertussis
• Varicella (chicken pox)
• Influenza (flu)
• Pneumococcal (pneumonia)
• Human Papillomavirus (HPV)
• Haemophilus Influenza type B (Hib)
• Measles, Mumps, Rubella (MMR)
• Meningococcal (meningitis)
This is not a contract or policy. This list is not a contract with Anthem. If there is any
difference between this sheet and the group policy, the provisions of the group policy will
govern. Please talk with your doctor about specific health guidelines. This summary of
preventive care and physical exam benefits is a brief overview. Preventive Health Guidelines
reflected in this document are recommendations for individuals of average risk. Individuals
who are higher-risk, including but not limited to those in certain racial/ethnic groups or with
personal/family medical history, should check with his/her health care provider for preventive
health guidance. Please see your Summary Plan Description as amended, for coverage
exclusions and limitations.
Adult Preventive Care (Age 19 and older)
Preventive Physical Exams
Age-appropriate screening tests may include:
• Cholesterol screening for high risk adults
• Blood pressure
• Screening for depression
• Type 2 Diabetes screening for adults with high blood pressure
• Breast cancer screening, including exam and mammography
• Screening for sexually transmitted infections
• HIV screening
• Osteoporosis screening
• Colorectal cancer screening
• Intervention services (includes counseling and education):
• Screening and counseling for obesity
• Genetic counseling for women with a family history of breast or
ovarian cancer
• Behavioral counseling to promote a healthy diet
• Primary care intervention to promote breastfeeding
• Screening and behavioral counseling related to tobacco use
• Screening and behavioral counseling related to alcohol misuse
Immunizations:
• Hepatitis A
• Hepatitis B
• Varicella (chicken pox)
• Influenza (flu)
• Pneumococcal (pneumonia)
• Human Papillomavirus (HPV)
• Measles, Mumps, Rubella (MMR)
• Meningococcal (meningitis)
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Prescription Drug Coverage
UnitedHealthcare
UnitedHealthcare members can utilize both retail pharmacy and mail order
pharmacy services.
Mail Order
If you take maintenance medications for chronic conditions, such as high
blood pressure, asthma or diabetes, using the mail order service can save
time and money. When using the mail order service, you will receive a
3-month supply for the cost of 2 months!
You can order refills:
Online - www.prescriptionsolutions.com By Phone - 800-562-6223
By Mail - Complete the Order or Reorder Form and mail with payment in
full to the address listed on the form.
Retail Pharmacy
• Show your medical plan ID card at a participating pharmacy.
• You will pay a copayment based on the type of prescription you receive.
• You will receive a 30-day supply for your prescription.
FEATURES
UNITEDHEALTHCARE
SIGNATUREVALUE®
ADVANTAGE NETWORK
HMO
UNITEDHEALTHCARE
SIGNATUREVALUE®
FULL NETWORK
HMO
RETAIL PHARMACY COPAYMENT (UP TO A 30-DAY SUPPLY)
Generic $10 $10
Brand Name $25 $25
Non-Formulary $35 $35
MAIL ORDER COPAYMENT (UP TO A 90-DAY SUPPLY)
Generic $20 $20
Brand Name $50 $50
Non-Formulary $70 $70
Save Money On Your
Medications
Ask For Generic Drugs
You can save money by asking for
generic drugs. The FDA requires
that generic drugs have the same
high quality, strength, purity, and
stability as brand-name drugs.
The next time you need a
prescription, ask your doctor to
prescribe a generic drug when it
is available and appropriate.
Kaiser Permanente
Kaiser members can utilize both
retail pharmacy and mail order
pharmacy services.
Kaiser members will coordinate
prescriptions through Kaiser
Permanente. Prescriptions can be
filled at a retail pharmacy or online
at www.kp.org.
Mail Order
Using the mail order service can save
you time and money.
You can receive up to a 100-day
mail order supply for maintenance
medications.
KAISER
FEATURES PERMANENTE
HMO
RETAIL PHARMACY COPAYMENT
(UP TO A 30-DAY SUPPLY)
Generic $10
Brand Name $25
Non-Formulary Not Covered
MAIL ORDER COPAYMENT
(UP TO A 100-DAY SUPPLY)
Generic $20
Brand Name $50
Non-Formulary Not Covered
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Dental Plan Choices
Strong teeth and gums are an important part of good health, which is why FHCSD
offers you a choice of dental plans to help pay for many of the dental expenses you
and your family may have.
All the plans help you pay for most necessary dental services and supplies, including:
• Diagnostic and preventive care (such as exams, cleanings, and x-rays),
• Basic and major services (such as fillings, crowns, and dentures).
The DPPO features UCWellness, a dental wellness program that provides enhanced
coverage and targeted education for members with diabetes, heart disease and stroke.
Review the comparison chart below for a summary of plan features.
The United Concordia Dental PPO plan is accepted with certain
dentists at FHCSD Dental Clinic locations.
FEATURES
UNITED CONCORDIA DHMO
UNITED CONCORDIA DPPO
IN-NETWORK ONLY IN-NETWORK OUT-OF-NETWORK*
CALENDAR YEAR DEDUCTIBLE
Individual / Family None $50 / $150
CALENDAR YEAR MAXIMUM
Per Person None $1,500***
PREVENTIVE & DIAGNOSTIC CARE (DEDUCTIBLE WAIVED)
Routine Exams, Teeth Cleaning, Bitewing X-rays No Charge You pay 0% You pay 0%
BASIC CARE
Oral Surgery, Endodontics, Fillings
Refer to Schedule
of Benefits**
You pay 10% You pay 20%
MAJOR CARE
Inlays, Onlays, Crowns
Refer to Schedule
of Benefits**
You pay 40% You pay 50%
Orthodontia
24-Month Treatment Fee
$1,500/Child $2,000/Adult
Not Covered
*When using a non-PPO (out-of-network) provider, you pay your coinsurance plus any amount over the prevailing charge, which is the price most providers in the geographic area charge for a specific service.
**You can find the full schedule of benefits on BeneTrac.
***Preventive Incentive: Preventive care services do not count toward the calendar year maximum
16 / 40

SIMNSA Dental Plan
SIMNSA DHMO
The SIMNSA DHMO is a Dental HMO available only to Mexican Nationals.
A Mexican National is defined as:
a. a person born in Mexico;
b. a person born in another country with a Mexican father or a Mexican
mother, or both;
c. a foreign woman or man who marries a Mexican man or woman and
lives in Mexico; or
d. a foreigner who becomes naturalized in Mexico.
There is no deductible or calendar year maximum. Most diagnostic and
preventive procedures are covered at no cost to you, however other services
may have a copay associated with them.
FEATURES
CALENDAR YEAR DEDUCTIBLE/MAXIMUM
Calendar Year Deductible (Individual/Family)
Calendar Year Maximum Benefit per Person
SIMNSA DHMO
IN-NETWORK ONLY
None
None
PREVENTIVE & DIAGNOSTIC CARE (DEDUCTIBLE WAIVED)
Routine Exams, Teeth Cleaning, Bitewing X-rays 100%
BASIC CARE
Oral Surgery, Endodontics, Fillings
Refer to Schedule of Benefits**
MAJOR CARE
Inlays, Onlays, Crowns
Orthodontia
Refer to Schedule of Benefits**
24-Month Treatment
$50/Visit
**You can find the full schedule of benefits on BeneTrac.
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Vision Plan
FHCSD provides vision coverage through Vision
Service Plan (VSP). VSP has one of the largest
networks of private practicing optometrists,
ophthalmologists and opticians.
• You can see a VSP in-network provider or an outof-network
provider.
• Your costs will be lower if you visit an in-network
provider.
• You will not receive a VSP I.D. card as it is not
required to receive service.
• Just call a VSP network doctor to schedule an
appointment and be sure to tell them you are a
VSP member. The doctor and VSP will handle the
rest!
VISION SERVICE PLAN
FEATURES
OUT-OF-NETWORK
IN-NETWORK
REIMBURSEMENT
Materials Copay
$20 Copay
Exam
$20 Copay, Then
$20 Copay
Once Every 12 Months
Plan Pays Up To $45
Lenses
Once Every 12 Months
After Materials Copay, You Pay: After Materials Copay, Plan Pays:
Single Vision
Up to $30
Bifocal No Charge
Up to $50
Trifocal Up to $65
Frames
Once Every 24 Months
Plan Pays Up To $130 (Retail) +
20% Off the Amount Over Your
Allowance
Plan Pays Up To $70 (Retail)
Contact Lenses (Instead of Glasses)
Once Every 24 Months
Contact lens exam (fitting & evaluation) Plan Pays Up To $60 Plan Pays Up To $45
Materials (contacts) Plan Pays Up To $150 Plan Pays Up To $105
To locate and select a VSP provider, visit www.vsp.com
or call Customer Service at 800-877-7195.
Special Discounts!
In addition to the vision benefits provided
through your FHCSD benefits program,
VSP offers special discounts on a number
of non-covered services, such as:
• Additional pairs of glasses
• Special lens options
• LASIK surgery
18 / 40

FINANCIAL
20 Flexible Spending Accounts
22 Life and AD&D Insurance
23 Disability Insurance
24 Retirement Savings
25 Additional Benefits
19 / 40

Flexible Spending Accounts
What is a Flexible Spending Account (FSA)
• An account that allows you to save money to use for certain health care
and dependent care costs.
• You can enroll in the health care account, the dependent care
account, or both.
• The money in the account is only available one year at a time
(January 1 - December 31).
How does an FSA work
• You put money into the account through your paycheck, before any
Federal, State, and Social Security taxes are taken out.
• These deductions are taken throughout the year in equal amounts.
• For example, if you decide to put $500 into an FSA, you’ll have
$20.83 taken out of 24 paychecks and put into your account.
• The best part FHCSD does it for you, so you don’t have to worry
about transferring money!
• You must use all of the money you put in the account during the year -
the money does not roll over to the next year.
Health Care FSA
How much can I contribute
• You can put up to $2,500 per year into the Health Care FSA.
Who can I use the money for
• You
• Your legal spouse
• Your dependent children
What can I use the money for
• Deductibles and copayments
• Medically necessary maintenance and support devices
• Treatment of alcoholism or drug dependency
• Dental, vision and hearing: dental checkups, orthodontics, glasses, LASIK
and hearing aids (including batteries)
CLICK HERE for a full list of eligible services, products and treatments.
20 / 40

Dependent Care FSA
Can I save money on child care
• Yes. Consider enrolling in the Dependent Care FSA.
How much can I contribute
• You can put up to $5,000 per year into the Dependent Care FSA.
• If you are married and filing your tax return separately, you can put up to
$2,500 per year into the Dependent Care FSA.
Who can I use the money for
• Children under the age of 13 who are listed as dependents on your
income tax return.
• Dependents of any age who are incapable of caring for themselves and
who regularly spend at least 8 hours a day in your home.
• Daycare expenses are defined as those that are necessary in order for
you (and your spouse, if you’re married) to continue working.
What can I use the money for
Eligible Dependent Care expenses, covered while you are at work, include:
• Babysitters
• Day Care Centers
CLICK HERE for a full list of eligible services.
• Nursery School/Preschool
• After School Care Programs
Account Details
How do I use the money
When you have an eligible expense, you can:
• Submit a claim for reimbursement and;
• choose to receive a check by mail or,
• have a direct deposit to your checking or savings account.
• Have funds automatically deducted from your account by using your FSA
Benefits Card.
• The Benefits Card can only be used with your Health Care FSA
dollars.
• You must submit receipts for reimbursement for your Dependent
Care expenses.
• The FSA Benefits Card deducts each payment directly from your FSA
account.
Your Health Care and Dependent Care accounts function separately. You
cannot use funds from one account to pay for eligible expenses from the
other account (for example, using Dependent Care account funds for health
care expenses).
Should I keep my receipts
CLICK HERE
to see how you
can reduce your
taxable income
and save money by
enrolling in an FSA.
Yes. You may be occasionally asked to submit your receipt as proof of an
eligible expense. Remember to keep original receipts for your records as you
may be required to provide documentation directly to the IRS in the event of
a personal tax audit.
How long can I access the money in the account
You will lose any money that you set aside for your Health Care or
Dependent Care accounts that is not used or reimbursed for claims incurred
through December 31, 2014. Do not contribute more than the amount you
are sure you will use during the plan year for eligible expenses.
21 / 40

Life and AD&D Insurance
Basic Life Insurance (paid by FHCSD)
Life insurance protects your family or other beneficiary(s) in the event of your
death while you are still actively employed at FHCSD. Your coverage amount will
be paid to the beneficiary(s) of your choice.
What is the Basic Life Benefit
FHCSD pays for coverage in the amount of:
• Two times your annual earnings
• The benefit amount is a minimum of $40,000 to a maximum of $500,000
Accidental Death & Dismemberment (paid by FHCSD)
If your death is due to an accident, your beneficiary will receive an additional
amount through Accidental Death and Dismemberment (AD&D) coverage.
What is the AD&D Benefit
• AD&D coverage is equal to your life insurance coverage amount.
• AD&D benefits are payable if you pass away, lose a limb, or have a loss of
speech, hearing, or eyesight because of a covered accident (either on or off the
job) and the loss occurs within one year of the covered accident.
The payable amount of your AD&D benefit depends on the type of loss. In the
event of death due to an accident, your beneficiary(s) may receive both your life
and AD&D benefits.
Note: You will automatically be covered under the Basic Life Insurance plan.
Designate a Beneficiary!
Don’t forget to designate a beneficiary(s) for your life and AD&D Benefits.
CLICK HERE to designate beneficiary in BeneTrac.
Additional Life Insurance (paid by you)
BENEFICIARY:
a person or group
that receives
benefits, funds or
other property under
a will, trust, insurance
policy, etc.
It is important to have enough life insurance protection for your family.
If you determine you need more than the Basic Life coverage, you may
want to add coverage for yourself and your eligible dependents.
To determine how much it will cost for the Additional Life, log-on to
BeneTrac or the FHCSD HR Intranet.
For You
For Your Spouse
For Your
Children
ADDITIONAL LIFE INSURANCE
Coverage is available in $10,000 increments. Benefit
amount is a minimum of $10,000 up to $500,000.
Guaranteed Issue: $150,000
Coverage is available in $5,000 increments. Benefit
amount is a minimum of $5,000 up to $500,000 (not to
exceed 100 percent of your additional life coverage).
Guaranteed Issue: $25,000
6 Months to age 21 or 24 (if full-time student) - $10,000
Guaranteed Issue: $10,000
Guaranteed Issue amounts only apply for newly eligible employees.
If you are electing Additional Life Insurance outside of when it was
first offered to you, or in amounts over the guaranteed issue, you will
be required to submit a Medical History Statement for approval by
the insurance company before coverage can become effective.
22 / 40

Long Term Disability
Long Term Disability
Long Term Disability (LTD) insurance pays you a portion of your income if
you become unable to perform your regular job duties for 90 days due to
illness or injury. FHCSD offers you two levels of coverage:
• Basic LTD plan (paid by FHCSD)
• You will automatically be covered under the Basic LTD plan if you
do not enroll for coverage under the Additional LTD plan.
• Additional LTD plan (paid by you)
What is the Long Term Disability Benefit
LTD works with Social Security and any other group disability coverage to
provide you with a combined monthly benefit.
Basic LTD Plan (paid by FHCSD)
• You’ll get 50% of your monthly pre-disability earnings, up to $10,000
per month for up to 24 months.
Additional LTD Plan (paid by you)
• You’ll get 60% of your monthly pre-disability earnings, up to $12,000
per month up to your Social Security Normal Retirement Age.
How much does Additional Long Term Disability cost
To determine how much it will cost for the Additional LTD plan, log-on to
BeneTrac or the FHCSD HR Intranet.
KNOW WHERE TO START
Even with a healthy lifestyle and preventive care, sometimes
an illness or accident can still happen. If you become disabled,
contact The Standard at 800-368-1135 so they can certify your
claim and assist you with the disability claim process.
23 / 40

Retirement Saving Plans
403(b) Plan
The 403(b) plan gives you the opportunity to save money for your retirement before taxes
are taken out. Eligible employees* may begin making contributions on the first monthly
entry date.
How much can I save
• You can save from 1% to 50% of your total pay up to the 2014 IRS annual maximum.
• If you are 50 years or older you may contribute an additional amount up to the
2014 IRS catch-up contribution maximum.
• The money you contribute is always 100% vested.
When does the money come out of my paycheck
• Retirement plan contributions are taken out of all 26 paychecks.
Is there a match
Yes. FHCSD will match 6% of your contribution based on the schedule below:
YEARS OF SERVICE
FHCSD MATCH
Less than 1 year 0%
1 year but less than 4 25%
4 or more years 50%
Note: Employee contributions that are over 6% of your pay will not be matched.
How is my money invested
• You have a menu of funds to choose from if you wish to direct your investments.
• If you do not choose your investment option(s), contributions will be automatically
deposited in the plan’s investment default.
• For detailed information about your investment options, please contact Principal at
www.principal.com or call 800-547-7754.
*You are an eligible employee if you are expected to work at least 1,000 hours per year.
ACCESS YOUR RETIREMENT PLAN
ANYWHERE!
View your retirement account
from the Principal Financial
Group® anytime and anywhere –
with this free and secure mobile
app for Apple, Android and
Blackberry.
Search “Principal Financial” in your app store to
download.
457(b) Plan
The 457(b) plan is a retirement plan that is available for
governmental and certain non-governmental employers.
The plan operates similarly to our 403(b) plan and allows
you to save beyond the limits of the 403(b) plan alone.
Who can enroll
• You can enroll in the plan if you hold the title of:
• Director or Licensed Independent Practitioner
• Have completed 90 days of service
• And work a minimum of 20 hours per week
How much can I save
• You can save from 1% to 100% of your total pay up to
the 2014 IRS annual maximum.
• The money you contribute is always 100% vested.
How is my money invested
• You have a menu of funds to choose from if you wish
to direct your investments.
24 / 40

Additional Benefits
529 CollegeBoundfund
Savings Plan
The Section 529 plan through
AllianceBernstein allows you to
save money for college.
You contribute to an account on an
after-tax basis and use the money
to pay for qualified expenses (e.g.,
tuition, books, room and board) for
you or your child(ren). Your earnings
in the account will be free from any
federal income taxes.
Pet Insurance
VPI Pet Insurance offers affordable plans for dogs, cats, birds,
reptiles and other exotic pets. Policies cover a wide range of
care from minor ailments to serious conditions such as cancer
and heart disease.
VPI Pet Insurance reimburses for:
• Office visits
• Prescriptions
• Treatments
• Lab fees
• X-rays
• Surgeries
• Hospitalization
• And more!
Pet owners are free to visit any veterinarian. VPI has coverage
in all 50 states including Washington D.C.
For more details or if you are interested in enrolling, please
contact VPI at 1-877-738-7874 or on line at
www.petinsurance.com/affiliates/fhcsd.
MEDEX® Travel Assist
This benefit protects you when you travel for business or pleasure at least
100 miles from your home. Pre-trip and medical assistance, transportation
and evacuation services are available 24 hours a day. Coverage is
automatic, and FHCSD pays the full cost for you and your eligible
dependents.
25 / 40

Additional Benefits
LegalShield TM
You can enroll in the legal assistance plan, which is designed to
help you with many everyday issues, including traffic violations,
credit problems, child custody matters, and landlord issues.
As a participant in the LegalShield plan, you will have access to
a wide variety of attorneys from top law firms in your area.
Identity Theft Shield TM
You have the option to enroll for Identity Theft Shield identity
theft protection. This benefit may save you time and money
- and restore your name and credit for you if your identity is
stolen.
Trained experts provide you with fraud alert notifications,
perform proactive database searches, and continuously monitor
your credit.
BENEFIT PLAN
LegalShield
Employee, Spouse/DP & Child(ren)
Identity Theft Shield
Employee and Spouse/DP
LegalShield + Identity Theft Shield
Employee and Spouse/DP
LegalShield + Identity Theft Shield
Employee, Spouse/DP & Child(ren) to age 18
DP: Domestic Partner
EMPLOYEE COST
PER PAY PERIOD
(EXCEPT FOR 05/30/2014 AND
10/31/2014 PAYCHECKS)
$7.98
$6.48
$12.95
$13.45
Supplemental Insurance
The following Aflac supplemental plans are available to you.
Contact Aflac directly to enroll for coverage. CLICK HERE for their
contact information.
• Term Life insurance
• Disability Income Protector
• Sickness Indemnity
• Hospital Protection
• Accident Indemnity
• Cancer Indemnity
• Hospital Intensive Care
• Specified Health Event
26 / 40

Additional Benefits
Benefits Plus
Home and Auto Insurance Discount Program
With Benefits Plus you may be able to save on quality
home, renters and auto insurance. As an employee of
FHCSD you may qualify for special discounts that can save
you money. You’ll also have the option to have policy
premiums deducted from your bank account.
To obtain a quote or receive more information on this
program, all you need to do is call the Employee Benefits
Service Center at extension 4200 or 877-679-2011.
When you call, you will:
• Receive a professional help with choosing the right
insurance
• Get a free, no-obligation quote for coverage
To make sure you get an accurate comparison with your
current coverage, be sure to have a copy of your policy
handy.
27 / 40

EMOTIONAL
29 Work Life Services
30 FHCSD Wellness
31 Employee Perks
34 Time Off
28 / 40

Work Life Services
Work Life Services
Because unresolved personal issues can affect every aspect of one’s life,
FHCSD offers you and your family the Horizon Health Work Life Services
Program at no cost to you.
What is Work Life Services
Work Life Services is a confidential program for you, your family and all
household members; it provides:
• Unlimited telephonic access.
• 24-hour crisis response by licensed counselors, seven days a week.
• Each member of your household receives 3 in-person visits per issue
per year.
What can I call about
Call for confidential assistance with nearly any personal matter you may
be experiencing, including:
• Financial concerns
• Legal concerns
• Substance abuse
• Stress
• Anxiety
• Grief and loss
• Marital/relationship issues
Counselors can also provide free access to in-person counseling,
dependent care referrals, other community referrals, and written
information.
HELP WHEN YOU NEED IT!
A single call will connect
you to a specialist who
will provide you with
immediate assistance.
888-293-6948
You can also login to the
website at:
www.horizoneap.com
Login ID: standard
Password: eap4u
29 / 40

Your Path to Exceptional Health
At FHCSD, we strive for a company culture that supports a healthy, active
lifestyle. As a valuable member of our team, your health and quality of life are
important to us. That’s why we’ve implemented Your Path to Exceptional Health.
We encourage you to become an actively involved in Your Path to Exceptional
Health and to take advantage of this fantastic benefit.
OUR MISSION
To create a culture that
encourages employees and their
families to adopt and sustain
behaviors that enhance health
and well-being and maximize
quality of life.
How can I get involved
The Path to Exceptional Health includes many ways to learn and to participate
including:
• Monthly Newsletters
• Team-based health challenges with prizes
• Free employee health screenings
All employees are encouraged to participate and join us on The Path to
Exceptional Health!
To Help You On Your Path
FHCSD provides discounts on memberships to 24-Hour Fitness to join:
• Bring a current pay stub, photo ID and discount code (81516) to any
24 Hour Fitness location
• Call 800.224.0240 or visit www.24hourfitness.com to find club near you
• Or activate online at www.24hourfitness.com/corporate
24 HOUR FITNESS MEMBERSHIP RATES
MEMBERSHIP TYPE ONE MEMBER COST EACH FAMILY ADD-ON
One Club Active/Sport $26.99 $26.99
All Club Sport $29.99 $26.99
All Club Super Sport $44.99 $39.99
All Club Ultra Sport $59.99 $59.99
30 / 40

Employee Perks
Discounted Care at FHCSD Clinics
As an employee of FHCSD you, and your
immediate family members, are eligible to
receive discounted services at our clinic
locations (only if you are not otherwise
insured). See the table to the right for a list
of discounted services.
DEPARTMENT
EMPLOYEE
DISCOUNT**
EXCEPTIONS
SELF PAY
DEPOSIT
MAXIMUM
SELF-PAY
DISCOUNT***
EXCEPTIONS
Adults 50% Yes* $35 80% Yes*
Pediatrics 50% Yes* $35 80% Yes*
Women’s 50% Yes* $35 80% Yes*
Dental 25% Yes* Variable** 25% Yes*
Vision Care 40% Yes* $65 40% Yes*
Speech, Hearing, Early Int. 50% No $40 50% No
ENT 50% No $40 50% No
Other Specialties 50% Yes* $40 50% Yes*
* Purchased materials/supplies – costs plus handling fee.
X-Ray and Pharmacy are not subject to discount.
Some procedures discounted down to cost, plus handling fee (i.e. lab,
glasses frames).
** Depends upon treatment rendered. Typical range is $35.00 to $50.00.
*** Subject to minimum fee of $35.00 as well as income and number of
family members.
31 / 40

Employee Perks
Employee Referral Bonus
A cash bonus is paid to employees who refer an applicant who are hired
to work at FHCSD.
For more information, see HR policy and www.fhcsd.jobs.
Service Awards
All regular full-time and part-time employees are eligible to receive a
service award upon completion of five years of service and at the end
of every additional five years of service. Service does not have to be
continuous to count toward service credit for the award.
Union Bank
Benefits include:
• A $50 welcome bonus when you open a new checking account
• No monthly service charge
• Free welcome package of checks
• Free debit card
• Free online banking and bill pay
• Mobile Banking
• Discounted safe deposit box
For more informationm stop by a Union Bank branch, visit
www.unionbank.com or contact Jojo Bondoc at 619-336-2008.
FHCSD’s company ID code is 27777.
32 / 40

Employee Perks
Wireless Discounts
AT&T
• Qualified employees can receive 25% off wireless voice communication
products and data service plans.
• To sign up, visit www.att.com/wireless/premiergpo and enter your 8-digit
Foundation Account Number: 04553393.
• You can also visit any AT&T corporate-owned/stand-alone store (but not an
authorized retail store).
• The employee must be the primary account holder for his/her family to be
eligible for the discount.
• You will be required to provide proof of employment.
Verizon
• Get a 22% discount on Verizon Wireless calling plans of $34.99 monthly access
or higher, 25% discount on accessories, plus 250 free texts!
• To register, visit www.verizonwireless.com/discount and enter your work e-mail
address. If you do not have a work e-mail address, select the appropriate action
under “Don’t Have a Work E-mail Address”
• You can also visit any Verizon corporate-owned/stand-alone store (but not an
authorized retail store) or call 800-899-4249.
• You will be required to provide proof of employment.
Tickets2Fun Discounts
FHCSD employees can save up to 40% off nationwide family
attractions including:
• Disneyland and California Adventure
• SeaWorld
• Catalina Island Cruises
• Movie Theaters
• Knott’s Berry Farm
• Legoland
• and more!
Here’s how to login & order:
1. Go to www.tix2fun.com and click Login
2. First time New Customers click Register Now…
3. Enter the Partner Code, FHC513
4. Complete your registration. You’re ready to shop.
5. Your personal password will be emailed to you later.
6. You’re done! Start Shopping and Saving with Tickets 2 Fun
For more information contact: Tickets2Fun 949-683-6851
33 / 40

Time Off
At FHCSD, we encourage you to have a healthy work/life balance. Our
time off programs are a way for you to relax and recharge so you can
be your best you.
Paid Time Off and Extended Sick Insurance
PTO (Paid Time Off) and ESI (Extended Sick Insurance) are benefits
provided by FHCSD to ensure you have periodic time off for personal
recreation and relaxation or while you or a family member is
recovering from an illness or injury.
Who is eligible
All regular employees who work 24 or more hours weekly accrue PTO
and ESI credit each pay period based on the percentage of time or
number of hours worked for that particular pay period.
Part-time employees working less than 24 hours per week, or on-call,
per diem or temporary employees are not eligible for PTO/ESI.
How do I earn PTO
YEARS OF SERVICE
PTO ACCRUAL RATE
DAYS PER YEAR
HOURS PER PAY
PERIOD
0 to 4 years 16 days (128 hours) 4.93 hours
5 to 9 years 19 days (152 hours) 5.85 hours
10+ years 22 days (176 hours) 6.78 hours
The maximum PTO accrual is 320 hours.
ESI 1
In most cases, ESI is used for
illnesses or injuries that last three
or more days. The first two days of
illness is usually paid from your PTO
bank (if available). Three days of ESI
may be used for bereavement of the
death of a family member. Family
members include child, spouse and
parent.
How do I earn ESI
• Full-time regular employees earn
3 days (24 hours) per year of ESI.
• ESI accrues at a rate of 0.92
hours per pay period.
• ESI hours are available for use as
they are earned each pay period.
• You can earn up to a maximum
of 720 hours.
1
Employees who have not completed their
orientation period accrue PTO/ESI during
orientation time, but are not allowed to use
PTO/ESI until successful completion of that
period.
Holidays*
Each year FHCSD observes a number of
paid holidays, giving you the opportunity to
spend quality time with family and friends.
The following holidays will be observed in
2014:
• New Year’s Day
• Memorial Day
• Independence Day
• Labor Day
• Thanksgiving Day
• Day after Thanksgiving
• Christmas Day
• Birthday Holiday**
*Regular employees who work at least 24 hours per
week are eligible for holiday pay from commencement
of employment. Holiday hours will be paid to an
eligible part-time employee only when a holiday falls
on a day that he/she works on a regular basis and at
the same number of hours regularly scheduled that
day.
**All regular employees who work 40 hours per week
are eligible to take their birthday as a paid holiday.
Birthday holidays will not be granted until successful
completion of the orientation period.
34 / 40

SAFETY
36 Safety Starts With Me
36 CPR Certification
35 / 40

Safety
Safety Starts With Me
Create and maintain a culture of safety that values and demonstrates
behavior to promote a safe environment for all.
• Our Be Alert! Don’t Get Hurt! Safety and Recognition Program encourages
employee participation in improving safety in the workplace, and rewards and
acknowledges employees who take action and provide solutions for workrelated
safety issues.
• Safety Kudos - You can give a co-worker a Safety Kudos ticket whenever you
observe them taking safety measures in their daily work activities.
• Safety Quest - On a quarterly basis, you will have access to an on-line safety
quest for safety information. All entries submitted with a score of 100% will be
entered into a drawing for prizes.
• Safety Suggestions - The employee who submits the best safety suggestion
each quarter will receive an award.
CPR Certification
CPR Certification class offered every other month at Gateway.
Safety Training
Regular departmental safety trainings offered throughout the year.
Ergonomics
Free ergonomic assessments available for all employees!
36 / 40

Helpful Definitions
What Does It Mean
Employee Contribution: The amount an employee pays for their benefits
through payroll deductions.
Copayment: The amount which a covered individual is required to pay for
certain services after meeting any applicable deductible.
Deductible: The amount of out-of-pocket expenses that must be paid for
services by the insured before becoming payable by the carrier.
Eligibility: Conditions that an employee must meet to participate in a plan or
obtain a benefit.
Enrollment Period: The period of time you have to sign up for insurance.
EPO: An Exclusive Provider Organization (EPO) is a network of providers that
provide discounted services to their members. Members are reimbursed only
when in-network providers are used.
Formulary: A list containing the names of certain prescription drugs that a
medical plan covers when dispensed to its members who have drug coverage.
Guaranteed Issue: The amount of life insurance coverage you are guaranteed to
receive without the requirement of medical history or examination.
HMO: Health Maintenance Organizations (HMO) offer a range of health care
services at a fixed price and require that covered individuals see doctors that
are in their network of providers. HMOs require a referral to network providers
after the member has selected a Primary Care Physician.
In-Network: Medical, dental and vision providers or facilities who have agreed
to discounted fees with insurance carriers to participate within their provider
networks.
Inpatient: A person who occupies a hospital bed, crib or bassinet while under
observation, care, diagnosis or treatment for at least 24 hours.
Mail Order Prescriptions: A method of dispensing medication directly to the
patient through the mail by means of a mail-order drug distribution company.
Offers greatly reduced costs for prescriptions, especially for long term drug
therapy.
Medical Group (network): An organization of physicians who are generally
located in the same facility or participate in a group network and provide
services to covered individuals.
Member: A person eligible to receive, or receiving, benefits from an insurance
policy. Includes both those who have enrolled or subscribed and their eligible
dependents.
Non-Formulary: A drug or medication not listed and approved on a health
insurance plan coverage schedule.
Out-of-Network: A healthcare provider with whom an insurance carrier does not
have a contract to provide services. A member may pay higher copays, and/or
deductibles to see an out-of-network provider or have no coverage at all.
Out-of-Pocket Maximum: The maximum amount of money a person will pay in
addition to copays and deductibles, in a calendar year.
Outpatient: A person who visits a clinic, emergency room or health facility and
receives health care without being admitted as an overnight patient.
PCP: Primary Care Physician (PCP) provides treatments for routine illness and
injuries. For members enrolled in an HMO Plan, a PCP will need to refer the
member to a specialist.
PPO: Preferred Provider Organizations (PPO) have a network of providers whose
services are available to members at lower cost that services of out-of-network
providers. PPOs allow members to self-refer to any network provider at any time.
Premium: The amount of money an insurance company charges for insurance
coverage.
Reasonable & Customary: The prevailing charge made by physicians of similar
expertise for a similar procedure in a particular geographic area.
Wellness: A healthy balance of the mind, body and spirit that results in an
overall feeling of well-being and leads to a high quality of life.
37 / 40

Employee Benefits Service Center
My plan didn’t
pay my bill.
What do I do
When is Open
Enrollment
Is my provider
in-network
I lost my
ID card!
Who is eligible
for benefits on
my plan
How does my
plan work
Can I have
double
coverage
I can’t enroll...
help!
YOUR EMPLOYEE BENEFITS SERVICE CENTER IS HERE TO HELP
YOUR EMPLOYEE BENEFITS SERVICE CENTER is the only call you need to make with employee benefit and wellness questions.
The Family Health Centers of San Diego Employee Benefits Service Center is here to answer your questions and help make your employee benefits easier to
use. The Benefits Service Center is the only call you need to make for employee benefit and wellness questions...and best of all, it’s free!
Within 24 hours of your initial call, the Service Center will either have the issue resolved or will update you on any further actions including the time frame
for resolution. Below are some of the questions the Service Center can answer.
Benefit Questions
I need to have surgery; does my insurance cover it How much will my portion of the cost be
EXTENSION 4200
or 877.679.2011
Claims Assistance
I received a bill from my doctor. I thought these services were covered. What do I do now
Referrals
I need to see a specialist, but I’m having trouble getting a referral. What do I do
Eligibility Issues
I tried to pick up a prescription today, but the pharmacy is saying that I’m not covered. Why
champion@intercaresolutions.com
Fax: 866.214.2211
Monday - Friday
7:00 a.m. to 5:30 p.m. PT
All inquiries will be responded to within
24 hours of your call or e-mail.
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Important Notices
The following important notices can be found on the FHCSD Intranet.
• CA Maternity Coverage
• Continuation of Benefits under COBRA
• Family Health Centers Summary Plan Wrap Document
• Medicaid and the Children’s Health Insurance Program (CHIP)
• Medicare Part D Creditable Coverage
• Newborn And Mothers Health Protection (Out of CA) Act Of 1996
• Patient Protection (Primary Care Physician (PCP) and OB/Gyn selection)
• Privacy Rights
• Qualified Medical Child Support Orders (QMCSO)
• Special Open Enrollment Rights for Certain Individuals under Health
Insurance Portability and Accountability Act of 1996 (HIPAA)
• Summary of Benefits Coverage (SBC)
• Wellness Plan Notice
• Women’s Health & Cancer Rights Act
Additional important carrier information will be provided to you after you
enroll.
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IMPORTANT CONTACT INFORMATION
BENEFIT CARRIER GROUP NUMBER PHONE NUMBER WEB ADDRESS
Online Enrollment System BeneTrac N/A N/A
Medical
Dental
UnitedHealthcare SignatureValue
Advantage HMO
UnitedHealthcare
SignatureValue HMO (Full Network)
525640
525638
https://www.eenroller.net/login.aspST=FHSD7891
User Name: Employee ID
800-624-8822 www.uhcwest.com
Mail Order Prescriptions N/A 800-562-6223 www.prescriptionsolutions.com
Kaiser Permanente HMO 116102 800-464-4000 www.kp.org
SIMNSA HMO 820 800-424-4652 www.simnsa.com
United Concordia DHMO 903055001 866-357-3304 www.ucci.com
United Concordia DPPO 903055000 800-332-0366 www.ucci.com
SIMNSA DHMO 820 800-424-4652 www.simnsa.com
Vision Vision Service Plan PPO 30028835 800-877-7195 www.vsp.com
Flexible Spending Accounts (FSA) Ceridian L06825 877-799-8820 www.ceridian-benefits.com
Life/AD&D The Standard 643599 800-628-8600 www.standard.com
Long Term Disability (LTD) The Standard 643599 800-368-1135 www.standard.com
403(b) Plan Principal Financial Group 446501 800-547-7754 www.principal.com
457(b) Plan Principal Financial Group 610033 800-547-7754 www.principal.com
529 Savings Plan AllianceBernstein CollegeBoundfund 703584 800-227-2900
www.collegeboundfund.com
(general info)
www.corporatecollegeboundfund.com
User ID: FHCSD Password: COLLEGEFUND
Pet Insurance VPI N/A
877-PETS-VPI
(877-738-7874)
www.petinsurance.com/affiliates/fhcsd
Travel Assistance Medex N/A 800-527-0218 operations@medexassist.com
Legal Services LegalShield 14257 800-654-7757 www.legalshield.com
Identity Theft Identity Theft Shield 14257 888-494-8519 www.legalshield.com
Aflac Supplemental Benefits Aflac RH826 800-992-3522 www.aflac.com
Home, Renters & Auto Insurance Benefits Plus N/A 877-679-2011 champion@intercaresolutions.com
Work Life Services Horizon Health EAP N/A 888-293-6948
www.horizoneap.com
Login ID: standard Password: eap4u
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