Dear Friends and Colleagues,
Many of you have already learned that the District is considering a decision to move from CalPERS to SISC as our health benefits provider. The District’s decision is motivated by the substantial increase in CalPERS premiums for the coming year. While everyone can pretty much agree that the cost of health care and benefits is expensive, the cost increases with CalPERS are exactly what the Retiree’s Association had warned District officials about when the move to CalPERS was being considered. It is what we learned from other colleges that already opted for CalPERS. Since saving money is the motivation, it is highly likely that benefit coverage will be reduced or more difficult to access with the new provider. We have and continue to express our concerns to the District and request clarification. As with most things, the Devil will be in the details.
Here are a few thoughts we have based upon the single information session that was conducted for retirees; please keep in mind that we have very little factual information at this time but we do have some common-sense suggestions that you may want to consider:
- We know that three types of plans were presented to retirees and will likely be offered to us during open enrollment for SISC (Self-Insured Schools of California). They are:
A) Companion Care – a straight-up Medicare supplemental plan that will only pay for Medicare approved services,B) Anthem PPO – a coordinated benefits plan that may offer coverages beyond Medicare approved services but we are lacking details,
C) Kaiser Permanente Senior Advantage – as far as we understand, this is the basic Kaiser plan and does have copays. It is not as good as Kaiser Summit Senior Advantage plan which some of you on Kaiser have now.
The coverage booklets for these plans can be found on the District website under Benefits: https://www.vcccd.edu/departments/human-resources/benefits
2) If you have Medicare, your Medicare coverage will not change. However, your District-paid additional coverage with SISC could introduce changes in the following areas, among others:
A) Benefits such as hearing, chiropractic, physical therapy, acupuncture, and days covered for stays in the hospital, rehab facilities, and nursing homes
B) Required pre-authorizations
C) Freedom to choose doctors or treatment facilities
3). Kaiser coverage will not be available to retirees living out-of-state, nor will any other type of managed care coverage.
4) Prescription coverages may be changed, and the provider will definitely be changed to Navitas instead of OptumRX. For example, we have been told that compound drug prescriptions will not be covered, but there seems to be some contradiction to that, and we are requesting clarification. There may be restrictions on brand name access, more prescriptions that require pre-authorization, or requirements to try less expensive drugs before authorization of doctors drug of choice, higher costs due to tier placement, more limited in-network pharmacy choices.
5) We do not know how Retirees over 65 who don’t have Medicare A & B will be served. They will be provided coverage until they are able to fully enroll for Medicare parts A & B. We do not have details on the type of coverage or process for enrollment in Medicare yet. Those under age 65 will be provided access to the same plans as active employees get.
6) Spouses of deceased Retirees who were eligible for District paid benefits also received District paid benefits because CalPERS required it. District contract language does not require such coverage and those spouses may again have to find and pay for their own coverage.
New plan coverage will begin January 1, 2024 with new enrollment likely beginning October 1, 2023. You know what an ordeal the last transition was, and we have no reason to believe we will receive even as much help this time as was available last time.
WHAT TO DO NOW IN THE NEXT THREE MONTHS?
1) Maximize all of your prescription refill opportunities starting now through the end of the year. (Fill as many as you can, as many times as you can.) This is especially important with any compound medications or ones that you know will require approvals.
2) If you are considering treatments, elective procedures, new medical equipment, visits to specialists, or other medical services, it may be wise to consider them now, before January 1, if it is appropriate for you, especially in treatment areas that may disappear or be greatly reduced under the new plan. An example of this is hearing aid coverage for those with Anthem plans.
3) If you are a spouse of a deceased Retiree who was eligible for District paid benefits and have been receiving spousal benefits while the District contracted with CalPERS, you may need to find and pay for your own benefits because the District is not contractually required to provide them under the new plan, and will probably no longer do so. Please explore your options for insurance now.
4) If you live outside California and are on Kaiser, you will need to find medical providers that are either covered by Blue Cross or, if you are over 65, by Medicare or by both. You should also get whatever care you need no later than Dec. 31, 2023, so that the transition will be easier for you.
Susan Bricker, President
Ventura Community College District Retirees Asso.