4J Licensed Newsletter #213

INSURANCE CARD CLARIFICATION
4J FLU SHOT CLINICS
DEDUCTIBLES
AN OFFER YOU CAN’T REFUSE
MR. BENEFITS ANSWER MAN

INSURANCE CARD CLARIFICATION (back to top)
As new enrollees to our OSBA/Regence In-surance plans begin to receive their insurance cards (only certified & Admin so far), I have begun to receive several calls from alarmed non-PPO members who have noticed that their insurance card has a “PPO” designation in the upper right corner. Those who have not enrolled in the PPO plan are understandably concerned that an error has occurred and that they are incorrectly enrolled. Not to worry – every member’s card has that “PPO” printed in the upper right corner. It does not signify enrollment in a particular plan. In fact, no one's card indicates which of the three available plans he/she is enrolled in. It signifies only that your plan is subject to a “PPO Overlay” provision. Should you go to a medical provider who is a participant in the PPO panel, then your coinsurance percentage is calculated on the lower PPO reimbursement rate – you save a little money – always a good thing!

If you have questions, call (x3244) or email me (caley@4j.lane.edu)

4J FLU SHOT CLINICS (back to top)
We have set the dates for our annual fall flu shot clinics. All active employees and their dependents are eligible to be vaccinated – even those not participating in the district insurance plans. Retirees who are covered under the district insurance plans and their insurance-eligible dependents will also be vaccinated.

This year, in accordance with the guidelines set by the CDC, children, age 9-17 may be vaccinated with parent permission. For those under age 9, flu vaccinations should be obtained through family doctor/pediatrician.

Please note: You will need to bring your insurance card to the clinics. Your group and member number will be required so that the cost of the immunization can be charged to Regence BCBSO.

DEDUCTIBLES (back to top)
Some common questions regarding deductibles arise every fall at open enrollment time. I’ll try to answer them before confusion sets in.

The deductible year is January 1 – December 31. Whatever plan you have elected will have an annual deductible that is your responsibility to pay before Regence BCBSO begins to pay benefits.

The deductible begins new each January 1. But, there is a deductible “carryover” provision. If you do not meet the entire amount of your annual deductible by the end of the calendar year, the amount that was applied during the final three months (October-December) will be carried over to the next year’s deductible. Although the deductible and plan maximums apply to the calendar year, our plan year and renewal date is October 1. If you have made a plan change for the new plan year, the amount of deductible you have paid earlier in the year will apply to your new plan -- i.e., if you change from the A200 plan to the C500 plan, the $200 (or any part) you have already met will apply to your new plan. You will have to pay the next $300 for services received on or after October 1 but at the same time your monthly premium cost will drop – to $0 if a full time member.

The family deductible on all plans is equal to three times the individual deductible – a fact that means this provision does not apply to a family of fewer than 4. The family deductible in each of our plans are: A200 -- $600, PPO -- $300 (in-panel) $600 (out-of-panel), C500 -- $1500.

AN OFFER YOU CAN’T REFUSE (back to top)
I might modify those immortal words of Vito Corleone, the patriarch in Mario Puzo’s classic novel, The Godfather, to “An offer you shouldn’t refuse.” The offer is to significantly reduce your risk of coronary heart disease (CHD). A study reported in the American Heart Association journal Circulation was conducted at the Harvard School of Public Health. In a 16-year examination of 42,827 male subjects of how their lifestyle choices correlated with their risk of CHD, the researchers defined the following lifestyle factors:

1. Not Smoking
2. Daily Exercise (at least 30 min. daily)
3. Moderate alcohol consumption
4. A healthy Body Weight (BMI under 25)
5. A healthy diet

Over 2100 coronary events were documented. They concluded that 62% of those events might have been prevented if all the men in the study had adhered to all five healthy life-style factors. Even among those subjects on drug regimens for hypertension and high cholesterol, the conclusion was that 52% of those events could have been prevented. A lesser but significant reduction in risk was associated with adoption of one or more, but less than all five factors.

The question is, if medical science/research can offer you the chance (not the guarantee) to increase the quantity and/or quality of your life, is that an offer you can refuse?

MR. BENEFITS ANSWER MAN (back to top)
When Mr. BAM offered up a set of counter-affirmations from Despair, Inc. last year, the response was so positive that he thought he would “go to the well” again. Consider:

Beauty: If you're attractive enough on the outside, people will forgive you for being irritating to the core.

Change: When the winds of change blow hard enough, the most trivial of things can become deadly projectiles.

Cluelessness: There are no stupid questions, but there are a LOT of inquisitive idiots.

Dare to Slack: When birds fly in the right formation, they need only exert half the effort. Even in nature, teamwork results in collective laziness.

Fear: Until you have the courage to lose sight of the shore, you will not know the terror of being forever lost at sea.

Michael Caley
Licensed-Staff Benefits Coordinator
Eugene School District 4J
200 North Monroe
Eugene, OR 97402-4295
Phone: W: 541-687-3244 H: 541-485-1493
fax: 541-687-3687 e-mail: caley@4j.lane.edu

4J Benefits and Wellness Newsletter