Your 2019 – 2020 benefits!

The benefits you elected during Annual Open Enrollment are effective July 1, 2019.

Important information about your 2019 – 2020 benefits

Explore the changes for your location:

California benefit changes
  • Potential shortened plan year for medical coverage: Your medical plan options are not changing at this time. The Anthem or Kaiser medical coverage you elected during this year’s Annual Open Enrollment is effective July 1, 2019. (If you didn’t make new elections, your existing coverage continued.) The length of the plan year that begins July 1, 2019, depends on potential plan and/or contribution changes. If there are any plan and/or contribution changes, you will have another opportunity to enroll in your medical coverage for the rest of the 2019 – 2020 plan year in late August 2019, with changes effective October 1, 2019. However, if there are no plan changes, there will not be an opportunity to make election changes unless you qualify for a mid-year life event. (Note: The dental, vision, life, and disability coverage elections you made will continue through June 30, 2020, regardless of whether there are medical changes.) For a summary of your medical plan options, click here.
  • IngenioRx: Prescription drug benefits in the Anthem medical plans will be administered by IngenioRx, an Anthem Blue Cross company. You should have received a welcome letter and a new Anthem ID card that provides the information you will need to present to your retail pharmacy so your prescription drug claims can be processed. Please be advised that your current Anthem ID card will not be accepted by pharmacies after June 30, 2019. Anthem members using home delivery and/or specialty prescriptions should have received additional information from Anthem in mid-May.
  • Opt-out credit for electing “no coverage”: The opt-out credit if you waived Green Dot medical coverage will be $62.50 per pay period with no opt-out credit provided on the 7/1–7/15 pay period. If you were previously enrolled in the opt-out credit, you must have actively waived coverage to maintain your opt-out credit as well as completed a waive attestation form through Workday upon submitting your elections. If you are on a leave of absence and elected the opt-out credit, you will not receive it while on leave, but you can request the opt-out credit upon returning to active status.
  • Contribution rates: Please refer to the contribution rates for 2019 – 2020  to see your benefit costs for this plan year.
Tennessee benefit changes
  • Aetna medical plans: The plan details for our PPO, EPO, and HMO options have changed for the 2019 – 2020 plan year, effective July 1, 2019. Below are key details. For complete plan details, refer to your benefits summary and SBC:
2019 – 2020 Plan Details Aetna HMO Plan
In-Network
Aetna EPO Plan
In-Network
Aetna EPO Plan
Out-of-Network
Aetna PPO Plan
In-Network
Aetna PPO Plan
Out-of-Network
Annual Deductible (Individual/Family) $100/$200 $750/$1,500 $5,000/$10,000 $750/$1,500 $1,000/$2,000
Member Coinsurance 0% 10% 50% 20% 40%
Out-of-Pocket Maximum (Individual/Family) $3,000/$9,000 $3,000/$9,000 $8,000/$24,000 $3,500/$7,000 $7,000/$14,000
PCP Required Yes No N/A No N/A
Preventive Care Covered in full Covered in full 50% after deductible Covered in full 40% after deductible
Office Visits (Primary Care/Specialist) $20 copay/
$40 copay
$20 copay/
$40 copay
50% after deductible $20 copay/
$20 copay
40% after deductible
Urgent Care $25 copay $25 copay 50% after deductible $25 copay 40% after deductible
Emergency Room $200 copay
(waived if admitted)
$200 copay
(deductible waived if admitted)
$200 copay
(waived if admitted)
$150 copay
(waived if admitted)
$150 copay
(waived if admitted)
Inpatient Hospital (including inpatient maternity care) $100 per day for first 3 days, then covered 100%, after deductible $200 per day for first 3 days, then covered 100%, after deductible 50% after deductible 20% after $250 copay, after deductible 40% after deductible
Outpatient Surgery $150 copay after deductible $200 copay after deductible 50% after deductible 20% after $150 copay, after deductible 40% after deductible
Prescription Drugs
Retail (30-day supply)
Tier 1 $20 copay $20 copay 20% coinsurance (maximum $250) $20 copay 20% coinsurance (maximum $250)
Tier 2 $40 copay $40 copay 20% coinsurance (maximum $250) $40 copay 20% coinsurance (maximum $250)
Tier 3 $70 copay $70 copay 20% coinsurance (maximum $250) $70 copay 20% coinsurance (maximum $250)
Tier 4 20% coinsurance (maximum $250) 20% coinsurance (maximum $250) Not covered 20% coinsurance (maximum $250) Not covered
Mail Order (90-day supply)
Tier 1 $40 copay $40 copay N/A $40 copay N/A
Tier 2 $80 copay $80 copay N/A $80 copay N/A
Tier 3 $140 copay $140 copay N/A $140 copay N/A
Tier 4 20% coinsurance (maximum $250) 20% coinsurance (maximum $250) N/A 20% coinsurance (maximum $250) N/A
  • Opt-out credit for electing “no coverage”: The opt-out credit if you waived Green Dot medical coverage will be $75.00 per pay period with no opt-out credit provided on the 7/1–7/15 pay period. If you were previously enrolled in the opt-out credit, you must have actively waived coverage to maintain your opt-out credit as well as completed a waive attestation form through Workday upon submitting your elections. If you are on a leave of absence and elected the opt-out credit, you will not receive it while on leave, but you can request the opt-out credit upon returning to active status.
  • Contribution rates: Please refer to the contribution rates for 2019 – 2020  to see your benefit costs for this plan year. Only medical contribution rates changed as of July 1, 2019; dental and vision remained the same.
Washington benefit changes
  • Special enrollment for 2020: The benefits you elected during this year’s Annual Open Enrollment (May 14 – 28) are effective July 1, 2019, and will end on December 31, 2019. Effective January 1, 2020, all charter schools in Washington State are required to participate in the state-sponsored benefits plan. You will receive information about how to enroll in 2020 benefits through the School Employees’ Benefits Board (SEBB) later this year. The benefits you elect for 2020 through SEBB will take effect January 1, 2020, and last through December 31, 2020. For more information about the SEBB benefits, please visit the SEBB website.
  • Opt-out credit for electing “no coverage”: The opt-out credit if you waived Green Dot medical coverage will be $75.00 per pay period with no opt-out credit provided on the 7/1–7/15 pay period and the 7/16–7/31 pay period. If you were previously enrolled in the opt-out credit, you must have actively waived coverage to maintain your opt-out credit as well as completed a waive attestation form through Workday upon submitting your elections. If you are on a leave of absence and elected the opt-out credit, you will not receive it while on leave, but you can request the opt-out credit upon returning to active status.
  • Contribution rates: Please refer to the contribution rates for 2019 – 2020  to see your benefit costs for this plan year. Only dental rates changed as of July 1, 2019; all others stayed the same.

Plan documents and legal notices

For a PDF of the Summary of Benefits and Coverage (SBC) for each of your benefit plans, click on the plan names below:

California plans

For more information about the dental and vision plans, see the Health page and the documents posted on the left side of the page.

Tennessee plans

For more information about the dental and vision plans, see the Health page and the documents posted on the left side of the page.

Washington plans

For more information about the dental and vision plans, see the Health page and the documents posted on the left side of the page.

See the Green Dot Public Schools Legal Notices.