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2022 Open EnrollmentSweetwater Union High School District:NAGEWelcome VEBA Members!Welcome to your 2022 Open Enrollment Guide.This guide was designed to give you quick access toall of the resources you may need to make yournew plan selection for next year.Your Available Plans:1. UHC Harmony HMO2. UHC Performance HMO Network 1 Network 2Not sure where to start? Here are some helpfullinks:3. UHC Alliance HMOPage 14. UHC Alliance HMO with 1200 HRAAvailable plans are listed to the right.5. SIMNSA HMOPage 26. Kaiser HMORead more about these plans and learn what is newfor next year.7. UMR NexusACO PPOPage 3Is making all of these decisions stressing you out?Take a moment for yourself at our Virtual VRC.Page 4-5Get a breakdown on the medical groups available,finding a doctor and carrier contacts.Page 6-8See a side-by-side comparison of all plans offeredto you for 2022.Questions?» Go to myveba.org» Call VEBA Advocacy at 888-276-0250 or email Advocacy@mcgregorinc.com» Contact your HR department1
2022 Open EnrollmentSweetwater Union High School District:NAGE2022 HighlightsFree UHC Virtual CareEffective January 1, 2022, virtual appointments areavailable to UHC Harmony members for 0 copay/no cost share. Various cost share applies for allother VEBA plans.You will also have an additional vendor to choose.Optum will be added as a 4th vendor alongsideDoctor on Demand, AmWell and Teladoc for allphone and video virtual appointments.To learn more or get started, visit UHC’s site.New Carrum HealthCovered BenefitCarrum Health is a premium surgery benefitfor PPO members that makes it easier and lessexpensive to get world class care.Your surgery costs are covered when using asurgeon within Carrum Health’s program, as wellas travel expenses. Covered surgeries includemusculoskeletal procedures and cardiac surgeries.Beginning January 1, 2022, bariatric surgery willalso be covered.Learn more at Carrum.me/CSVEBA or call888-855-7806.UHC Alliance HMO PlanThe UHC SignatureValue Alliance HMO Plan is aninnovative health plan offering a distinct networkof physicians from the UnitedHealthcare full HMOnetwork. San Diego medical groups include RadyChildren’s, Scripps and UCSD Medical Group.Optum Emotional Well-being Resourcesand Expedited AppointmentsOptum provides a free emotional support line for all VEBA members. Anyone(including your family and friends) can call 866-342-6892 to speak to a mentalhealth expert 24/7.In addition, VEBA members have free, confidential access to all of Optum’sservices, including professional care, self-help programs and personalizedassistance. Visit liveandworkwell.com (access code: VEBA) or call888-625-4809.Need an appointment through EAP immediately? You can take advantage ofPsych Centers at San Diego (PCSD) telehealth group therapy and personalizedtherapy sessions through your Optum EAP benefit.For expedited appointments, you will first have to get an authorization codefrom EAP. Then, call PCSD to schedule an appointment within one week.Here’s how:1.Contact Optum at 888-625-4809 or VEBA Advocacy at 888-276-0250 oremail advocacy@mcgregorinc.com for an authorization code2.Call PCSD at 619-528-4600 ext. 7878 with your authorization code toschedule your appointmentTo find a provider near you, visit UHC’s site.2
2022 Open EnrollmentSweetwater Union High School District:NAGEIntroducing theVirtual VEBAResource CenterThe VEBA Resource Center is here to supportyou as you define your path to well-being. Weunderstand everyone has unique needs and weare here to help you every step of your journey.As a VEBA member, you have free access topersonalized resources designed to help youachieve your well-being goals.Accessing the VRC has never been easier! All of ourprograms and classes are offered online from thecomfort of your own home so all you need to do islog in!Group ClassesThe VRC offers more than 60 live group classes each week. Whether you arewanting to relax with yoga or mindfulness, reduce stress by learning aboutyour finances, or step up your cardio through one of our movement class, wehave you covered!Our entire calendar of online offerings can be found here.Personalized CareIf you are looking for a place to start or if you have a specific health conditionor concern, we offer personalized one-on-one visits with a Care Navigator.The Care Navigator will help you explore your challenges and develop apersonalized plan for your mind, body, and spirit.Individual health coaching is also available for VEBA members and covereddependents. To register, members can email VRC@mcgregorinc.com or call619-398-4220.Don’t have time to take an online class? Noproblem! Check out our social media channels forvideos and the latest well-being content.3
2022 Open EnrollmentSweetwater Union High School District:NAGEChoosing a Provider Group that Meets Your NeedsSharp HealthCare is San Diego’s health care leader,with more than 2,700 doctors. Sharp is available inthe following plans: UHC Harmony HMO UHC Performance HMO Network 1 UMR PPOClick here to find a doctor near you or learn moreabout Sharp.The Scripps network consists of thousands ofphysicians and nationally recognized specialty careat Scripps Clinic.Choose one of these plans if you are looking for aScripps provider: UHC Performance HMO Network 2 UHC Alliance HMO UHC Alliance HMO with HRAOr email choosesharp@sharp.com or call the SharpOpen Enrollment concierge for VEBA members at858-499-2666, Monday to Friday, 7 a.m. to 7 p.m.Click here to find a doctor near you or learn moreabout Scripps. You can also call 800-SCRIPPS,Monday through Friday, 7 a.m. to 7 p.m.UC San Diego Health offers an expanded networkof primary care, the area’s leading hospitals andnationally ranked specialty care.Rady Children’s Hospital provides state-of-the-artcare to children in San Diego. Rady Children’s is theonly hospital in San Diego dedicated to pediatrichealth care and is the largest children’s hospital inCalifornia.UC San Diego Health is available to you in thefollowing plans: UHC Harmony HMO UHC Alliance HMO UHC Alliance HMO with HRAClick here to find a doctor near you or learn moreabout UC San Diego Health. Or you can call858-657-7000.Looking for a plan with Rady Children’s? Exploreone of the these available plans: UHC Performance HMO Network 1 UHC Performance HMO Network 2 UHC Alliance HMO UHC Alliance HMO with HRAClick here to search for a provider or read moreabout Rady Children’s. You can also call CustomerService at 800-788-9029.4
2022 Open EnrollmentSweetwater Union High School District:NAGENeed Help Looking for a Provider?How to Choose Your UHCHMO PCPFor a full listing of Participating Medical Groups, orto find a PCP, follow the directions below:1. Go to csveba.welcometouhc.com.2. Under “Wondering if your doctor is in ournetwork?” Select “Find a Network Doctor orHospital”3. Scroll down and choose from the plan options.Benefit Contacts4. Select Continue.5. Select Change Location and enter your ZIPcode, then select Update Location.6. Now you can search by People, Places,Service and Treatments, or Care by ConditionHow to Choose Your UMRPPO PCPFor the NexusACO PPO plan, you will need toselect a PCP. Follow the directions below to find aprovider or facility:1. Go to umr.com.2. Click on “Find a Provider.”3. In the search box, type “NexusACO” tobring up the UnitedHealthcare NexusACONetwork. Or scroll down to the “U” menu andchoose the UnitedHealthcare NexusACONetwork.4. Click “View Providers” to be taken to thesearch menu.5. Search by Name, Specialty, Facility or Zipcode.6. Choose a Tier 1 PCP for the highest level ofcoverage.BenefitWebsitePhoneCarrum Healthcarrum.me/csveba888-855-7806Delta Dental PPOdeltadentalins.com866-499-3001Express Scripts(UHC members)express-scripts.com800-918-8011Inside Rx ba800-464-4000Optum EmployeeAssistance Programliveandworkwell.com888-625-4809Optum Health (Chiro/Acufor UHC and 6337OptumHealth Financial(HRA for Alliance 424-4652Teladoc Medical Experts(formerly Best Rumr.com800-826-9781United Concordia ealthcare (UHC)csveba.welcometouhc.com888-586-6365VEBA Advocacyemail: Advocacy@mcgregorinc.com888-276-0250access code: VEBAQuestions?» Go to myveba.org» Call VEBA Advocacy at 888-276-0250 or email Advocacy@mcgregorinc.com» Contact your HR department5
Sweetwater Union High School District: NAGEEffective Period: January 1, 2022 ‐ December 31, 2022No plan design changes for 2022Benefit SummaryMedical Deductible(individual/family)Medical Out‐of‐PocketMaximum (individual/family)UHC SignatureValueHarmony HMO 10UHC Performance HMOPlan D, Network 1UHC Performance HMOPlan D, Network 2What You PayWhat You PayWhat You PayNoneNoneNone 1,500 / 3,000 1,500 / 3,000 5,000 / 10,000Health AccountNoneNoneNonePCP Office Visit 10 copay 20 copay 30 copaySpecialist Office Visit 10 copay 20 copay 40 copayPreventive CareNo chargeNo chargeNo chargeInpatient Hospital CareNo charge 250 admit copay 500 admit copayMental Health Services(outpatient/inpatient) 10 copay /No charge 20 copay / 250 copay 30 copay / 500 copayNo chargeNo chargeNo chargeNo chargeNo chargeNo chargeNo charge 100 copay 200 copayNo chargeNo charge 250 copay 10 copay 20 copay 30 copay 10 copay 20 copay 30 copay 10 copay / 50 copay 20 copay / 75 copay 30 copay / 100 copay 100 copay 150 copay 200 copayNoneNoneNone 3,000 / 6,000 3,000 / 6,000 1,600 / 3,200PerformanceExpress Advantage Network** 5 Generic 25 PB50% 40 min 175 max NPB 10 Generic 50 PB50% 80 min 350 max NPBPerformanceExpress Advantage Network** 10 Generic 25 PB50% 40 min 175 max NPB 20 Generic 50 PB50% 80 min 350 max NPBPerformanceExpress Advantage Network** 15 Generic 35 PB50% 40 min 175 max NPB 30 Generic 70 PB50% 80 min 350 max NPBSharp Rees‐Stealy,Sharp Community,UCSD MedicalSharp Rees‐Stealy, Sharp Community,Primary Care Associates,Arch Health Partners,Rady Children'sMercy Physicians,Greater Tri‐Cities,Scripps Physicians Medical,Rady Children'sSubstance Abuse Services(outpatient/inpatient)Outpatient DiagnosticLaboratory and Radiology(standard procedures)Complex Radiology(PET & MRI)Outpatient SurgeryOutpatientPhysical/Rehabilitation Therapy(Office Visit)Chiropractic and AcupunctureServices*Urgent Care(office visit only)Emergency Room(Copay waived if admitted)Rx Deductible(individual/family)Rx Out‐of‐Pocket Maximum(individual/family)Rx Formulary ListRx Pharmacy NetworkShort‐Term PrescriptionDrugs***(up to 30‐day supply)Long‐Term PrescriptionDrugs***(up to 90‐day supply)Available Medical GroupsInfertility services are excluded/not covered under non‐Kaiser HMO plans and are included/covered under Kaiser HMO (excluding Kaiser Bronze) plans, please see your policies for details.*Chiropractic services have no annual visit maximums, must be medically necessary and may be subject to prior authorization from OptumHealth. This also applies to Acupuncture services if elected by your employer, as itis optional.**Pay standard copays if you fill your prescription at an EAN Pharmacy (EAN Pharmacies include Rite Aid, Costco, Ralphs, Kmart, Vons, Haggen, Safeway, SuperValue, WinnDixie, Walmart, and many independentpharmacies) visit www.Express‐scripts.com for a complete list of EAN pharmacies.**Pay standard copays plus 5/prescription if you fill your prescription at a non‐EAN Pharmacy (Non‐EAN Pharmacies include CVS, Walgreens, and certain independent pharmacies).**You will pay the Retail Refill Allowance (RRA) penalty (equal to 2 times short‐term medication copay for 30‐day supply) if you fill long‐term prescriptions at a network pharmacy other than Smart90.**Copays waived for preferred generic hypertension and hypoglycemic purchased at mail or Smart 90. This does not include normal retail use or brand drugs.***G Generic, P Preferred, B Brand, PB Preferred Brand, NPB Non‐preferred Brand, S SpecialtyDisclaimer: Prepared by Gallagher Benefit Services, Inc. on behalf of VEBA.This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all the terms, coverages, exclusions, limitations, and conditions of the actual contract language. The policiesthemselves must be read for those details. The intent of this document is to provide you with general information about your employee benefit plans. It does not necessarily address all the specific issues which may be applicable to you. It should not beconstrued as, nor is it intended to provide, legal advice. Questions regarding specific issues should be directed to your Human Resources/Benefits Department.6
Sweetwater Union High School District: NAGEEffective Period: January 1, 2022 ‐ December 31, 2022No plan design changes for 2022UHC SignatureValueAlliance HMO 1,200 HRASIMNSA HMO 5;Rx: 5 30‐dayKaiser HMO 10,Rx: 10 / 10 100‐dayWhat You PayWhat You PayWhat You PayWhat You PayNone 2,000 / 2,000NoneNone 1,500 / 3,000 3,000 / 6,000 6,350 / 12,700 1,500 / 3,000Health AccountNoneOptumBank HRA 1,200NoneNonePCP Office Visit 10 copay 35 copay 5 copay 10 copaySpecialist Office Visit 10 copay 50 copay 5 copay 10 copayPreventive CareNo chargeNo chargeNo chargeNo chargeBenefit SummaryMedical Deductible(individual/family)Medical Out‐of‐PocketMaximum (individual/family)UHC SignatureValueAlliance HMO 10Inpatient Hospital CareNo chargeMental Health Services(outpatient/inpatient)Substance Abuse Services(outpatient/inpatient)Outpatient DiagnosticLaboratory and Radiology(standard procedures)Complex Radiology(PET & MRI) 10 copay /No chargeOutpatient SurgeryNo chargeOutpatientPhysical/Rehabilitation Therapy(Office Visit)Chiropractic and AcupunctureServices*Urgent Care(office visit only)Emergency Room(Copay waived if admitted)Rx Deductible(individual/family)Rx Out‐of‐Pocket Maximum(individual/family)Rx Formulary ListRx Pharmacy NetworkShort‐Term PrescriptionDrugs***(up to 30‐day supply)Long‐Term PrescriptionDrugs***(up to 90‐day supply)Available Medical GroupsNo chargeNo charge 40 copay /20% coinsurance(after deductible) 5 copay /No charge 10 copay /No chargeNo chargeNo charge 5 copay /No charge 10 copay /No chargeNo chargeNo chargeNo chargeNo chargeNo chargeNo chargeNo charge 10 copay 35 copay 10 copay 10 copay 10 copay 30 copayNot covered 10 copay 10 copay / 50 copay 35 copay /20% coinsurance(after deductible) 25 copay / 50 copay 10 copay 100 copay 300 copay (after deductible) 250 copay(U.S. or out of plan area) 50 copayNoneNoneNoneNone 1,600 / 3,200 1,600 / ss Advantage Network**Express Advantage Network**SIMNSAKaiser 10 Generic 30 PB50% 40 min 175 max NPB 10 Generic 30 PB50% 40 min 175 max NPB 5 copayG / B: 10 copay(up to a 100‐day supply) 20 Generic 60 PB50% 80 min 350 max NPB 20 Generic 60 PB50% 80 min 350 max NPBNot availableG / B: 10 copay(up to a 100‐day supply)Mercy Physicians,Primary Care Associates,Rady Children's,Scripps Clinic, Scripps Coastal MedicalCenter, Scripps Physicians Medical,UCSD MedicalMercy Physicians,Primary Care Associates,Rady Children's,Scripps Clinic, Scripps Coastal MedicalCenter, Scripps Physicians Medical,UCSD MedicalSIMNSAKAISERNo charge 10 copay20% coinsurance (after deductible)20% coinsurance (after deductible)20% coinsurance (after deductible)Infertility services are excluded/not covered under non‐Kaiser HMO plans and are included/covered under Kaiser HMO (excluding Kaiser Bronze) plans, please see your policies for details.*Chiropractic services have no annual visit maximums, must be medically necessary and may be subject to prior authorization from OptumHealth. This also applies to Acupuncture services if elected by your employer, as it is optional.**Pay standard copays if you fill your prescription at an EAN Pharmacy (EAN Pharmacies include Rite Aid, Costco, Ralphs, Kmart, Vons, Haggen, Safeway, SuperValue, WinnDixie, Walmart, and many independent pharmacies) visit www.Express‐scripts.com for a complete listof EAN pharmacies.**Pay standard copays plus 5/prescription if you fill your prescription at a non‐EAN Pharmacy (Non‐EAN Pharmacies include CVS, Walgreens, and certain independent pharmacies).**You will pay the Retail Refill Allowance (RRA) penalty (equal to 2 times short‐term medication copay for 30‐day supply) if you fill long‐term prescriptions at a network pharmacy other than Smart90.**Copays waived for preferred generic hypertension and hypoglycemic purchased at mail or Smart 90. This does not include normal retail use or brand drugs.***G Generic, P Preferred, B Brand, PB Preferred Brand, NPB Non‐preferred Brand, S SpecialtyDisclaimer: Prepared by Gallagher Benefit Services, Inc. on behalf of VEBA.This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all the terms, coverages, exclusions, limitations, and conditions of the actual contract language. The policies themselves must be read for those details. The intent of thisdocument is to provide you with general information about your employee benefit plans. It does not necessarily address all the specific issues which may be applicable to you. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be directed to yourHuman Resources/Benefits Department.7
Sweetwater Union High School District: NAGEEffective Period: January 1, 2022 ‐ December 31, 2022No plan design changes for 2022UMR NexusACO PPO ‐ No HRABenefit SummaryIn NetworkWhat You PayOut of NetworkWhat You PayMedical Deductible(individual/family) 2,000 / 4,000 2,000 / 4,000Medical Out‐of‐Pocket Maximum (individual/family) 5,000 / 10,000 5,000 / 10,000NoneHealth AccountPCP Office VisitSpecialist Office VisitTier 1 Physician: 30 copayTier 2 Physician: 20% coinsurance (after deductible)Tier 1 Physician: 50 copayTier 2 Physician: 20% coinsurance (after deductible)No chargePreventive Care20% coinsurance(after deductible)Inpatient Hospital Care 30 copay /20% coinsurance(after deductible) 30 copay /20% coinsurance(after deductible)Mental Health Services(outpatient/inpatient)Substance Abuse Services(outpatient/inpatient)Outpatient Diagnostic Laboratory and Radiology(standard procedures)Freestanding Facility or Physician Office ORHopital‐based Lab or Radiology50% coinsurance(after deductible)50% coinsurance(after deductible)No coverage fornon‐network services50% coinsurancewith Prior Authorization(after deductible)50% coinsurance(after deductible)50% coinsurance(after deductible)No charge50% coinsurance(after deductible)20% coinsurance(deductible does not apply)Complex Radiology(PET & MRI)Freestanding Facility or Physician Office OR20% coinsurance(after deductible)50% coinsurance(after deductible)20% coinsurance(after deductible)20% coinsurance(after deductible)20% coinsurance(after deductible) and 100 copaymentHopital‐based Complex RadiologyOutpatient SurgeryAmbulatory Surgery Center or Physician's OfficeOutpatient Hospital‐based Surgical Center50% coinsurance withPrior Authorization(after deductible)50% coinsurance(after deductible)50% coinsurance(after deductible)Outpatient Physical/Rehabilitation Therapy(Office Visit) 30 copayChiropractic and Acupuncture Services* 30 copayUrgent Care(office visit only) 50 copay50% coinsurance(after deductible)Emergency Room(Copay waived if admitted) 100 copay 100 copayRx Deductible(individual/family)NoneRx Out‐of‐Pocket Maximum(individual/family) 1,600 / 3,200PerformanceExpress Advantage Network**Rx Formulary ListRx Pharmacy NetworkShort‐Term Prescription Drugs***(up to 30‐day supply) 10 Generic 30 PB50% 40 min 175 max NPBRetail: with submission of a paper claim, member will be reimbursed at therate the Plan would have paid had the member used an in‐network pharmacyless the member’s copay.Long‐Term Prescription Drugs***(up to 90‐day supply) 20 Generic 60 PB50% 80 min 350 max NPBNo coverage fornon‐network pharmacyCheck umr.com to locate aTier 1 Physician near youAll othersAvailable Medical GroupsInfertility services are excluded/not covered under PPO and non‐Kaiser HMO plans and are included/covered under Kaiser HMO (excluding Kaiser Bronze) plans, please see your policy for details.*Chiropractic and Acupuncture services have no annual visit maximums, must be medically necessary and may be subject to prior authorization from OptumHealth for HMO, UMR for PPO, and Kaiser.**Pay standard copays if you fill your prescription at an EAN Pharmacy (EAN Pharmacies include Rite Aid, Costco, Ralphs, Kmart, Vons, Haggen, Safeway, SuperValue, WinnDixie, Walmart, and many independent pharmacies)visit www.Express‐scripts.com for a complete list of EAN pharmacies.**Pay standard copays plus 5/prescription if you fill your prescription at a non‐EAN Pharmacy (Non‐EAN Pharmacies include CVS, Walgreens, and certain independent pharmacies).**You will pay the Retail Refill Allowance (RRA) penalty (equal to 2 times short‐term medication copay for 30‐day supply) if you fill long‐term prescriptions at a network pharmacy other than Smart90.**Copays waived for preferred generic hypertension and hypoglycemic purchased at mail or Smart 90. This does not include normal retail use or brand drugs.***G Generic, P Preferred, B Brand, PB Preferred Brand, NPB Non‐preferred Brand, S SpecialtyDisclaimer: Prepared by Gallagher Benefit Services, Inc. on behalf of VEBA.This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all the terms, coverages, exclusions, limitations, and conditions of the actual contract language. The policies themselves mustbe read for those details. The intent of this document is to provide you with general information about your employee benefit plans. It does not necessarily address all the specific issues which may be applicable to you. It should not be construed as, nor is it intendedto provide, legal advice. Questions regarding specific issues should be directed to your Human Resources/Benefits Department.8
1. Contact Optum at 888-625-4809 or VEBA Advocacy at 888-276-0250 or email advocacy@mcgregorinc.com for an authorization code 2. Call PCSD at 619-528-4600 ext. 7878 with your authorization code to schedule your appointment Optum Emotional Well-being Resources and Expedited Appointments 2022 Open Enrollment weetwater Union High chool istrict: NAGE 2
