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CA Health Plans
Overview
To support your health and financial wellness, Green Dot Public Schools provides valuable benefits that help you and your family stay healthy and pay for care in the event of illness or injury.
Learn about your California Green Dot benefits:
Enroll on Workday.
Medical
Green Dot Public Schools offers a choice of medical plans with a range of coverage levels and costs, so you have the flexibility to select the option that’s best for you.
2019 – 2020 medical plan options for CA employees:
- Anthem Vivity HMO Plan
- Anthem HMO Plan
- Kaiser HMO Plan
- Anthem EPO Plan
- Anthem PPO Plan
Compare the plans below and CA Contributions Rate sheet - Effective October 1 for coverage.
Opt-out credit for electing “no coverage”
You can receive a $125 monthly payment if you waive Green Dot medical coverage because you and your covered tax dependents have other coverage that is not through the individual market — for example:
- You are covered by your spouse or domestic partner’s employer group health plan.
- You are covered by your parent or guardian’s employer group health plan.
To receive the payment, you must actively log in to Workday, elect “decline medical plan,” and complete the Opt-Out Payment Attestation Form to certify that you meet the above requirements. You will not receive the payment if you miss the enrollment deadline and default to Employee Only coverage in the following plans:
- Anthem Vivity HMO Plan
- MetLife DHMO Plan
- VSP Vision Plan
Please note: If a family member is a Green Dot employee covered under any Green Dot medical plans and you are covered as a dependent under their plan, the waive incentive does not apply.
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 Dental and Vision pages or documents posted on the left side of the page.
Key features
All five CA medical plans offer:
- Comprehensive, affordable coverage that exceeds the requirements of the healthcare reform law — see your contribution rates. Tip: If you need extra protection from large or unexpected medical expenses, you may also choose to enroll in Aflac supplemental medical coverage.
- Free in-network preventive care, with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.
- Prescription drug coverage included with each medical plan. Prescription benefits are provided by your medical plan carrier: Anthem or Kaiser. Learn more.
- Large network of providers that have agreed to negotiated rates, which saves you money. All of the medical plans cover the same services, but each plan’s network is a little different, so be sure to find in-network providers for your specific plan.
- Choice of four coverage levels:
- Employee Only
- Employee + Spouse/Domestic Partner
- Employee + Child(ren) up to age 26
- Employee + Family
Compare the medical plans
The following two charts provide an overview of coverage under the CA medical plans. For complete details, please review the plan documents in the left menu.
Medical Plan Comparison Chart – HMO Plans
California employees
| Plan Details | Anthem Vivity HMO Plan In-Network |
Kaiser HMO Plan In-Network |
Anthem HMO Plan In-Network |
|---|---|---|---|
| Annual Deductible (Individual/Family) |
$0 | $0 | $0 |
| Out-of-Pocket Maximum (Individual/Family) |
$1,500/3,000 | $1,500/3,000 | $1,500/3,000 |
| PCP Required | Yes | Yes | Yes |
| Preventive Care | Covered in full | Covered in full | Covered in full |
| Office Visits: Primary Care/Specialist |
$10 copay/ $20 copay |
$10 copay/ $20 copay |
$10 copay/ $20 copay |
| Urgent Care | $10 copay | $10 copay | $10 copay |
| Emergency Room | $100 copay | $100 copay | $100 copay |
| Maternity Care (Inpatient) | $200 copay | $200 copay | $200 copay |
| Inpatient Hospital | $200 copay | $200 copay | $200 copay |
| Outpatient Surgery | $100 copay | $100 copay | $100 copay |
| Prescription Drugs | |||
Retail (30-day supply)
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|
|
|
Mail Order (Anthem is 90-day supply; Kaiser is 100-day supply)
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Medical Plan Comparison Chart – EPO and PPO Plans
California employees
| Plan Details | Anthem EPO Plan In-Network |
Anthem EPO Plan Out-of-Network* |
Anthem PPO Plan In-Network |
Anthem PPO Plan Out-of-Network* |
|---|---|---|---|---|
| Annual Deductible (Individual/Family) |
$100/$200 | $3,000/$6,000 | $300/$900 combined in- and out-of-network | $300/$900 combined in- and out-of-network |
| Out-of-Pocket Maximum (Individual/Family) |
$2,000/$6,000 | $9,000/$18,000 | $2,500/$5,000 | $6,000/$12,000 |
| PCP Required | No | No | No | No |
| Preventive Care | Covered in full | 50% after deductible | Covered in full | 30% after deductible |
| Office Visits: Primary Care/Specialist |
$10 copay/ $20 copay |
50% after deductible | $10 copay/ $20 copay |
30% after deductible |
| Urgent Care | $10 copay | 50% after deductible | $10 copay | 30% after deductible |
| Emergency Room | $100 copay | $100 copay | $100 copay | $100 copay |
| Maternity Care (Inpatient) | $200 copay | 50% after deductible | $100 + 10% after deductible | 30% after deductible |
| Inpatient Hospital | $200 copay | 50% after deductible | $100 + 10% after deductible | 30% after deductible |
| Outpatient Surgery | $100 copay | 50% after deductible | $100 + 10% after deductible | 30% after deductible |
| Prescription Drugs | ||||
Retail (30-day supply)
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|
|
|
|
Mail Order (90-day supply)
|
|
N/A |
|
N/A |
*Out-of-network coverage is based on the negotiated rate. If your provider's rate is higher, you will be responsible for paying the difference.
How the HMO plans work
- Provide in-network coverage only. You’ll pay the full cost if you seek out-of-network care.
- Unlike the EPO and PPO plans, you must select a Primary Care Physician (PCP) and use that provider each time you need care. If you need to see a specialist, a referral by your PCP is required. Search for providers in your HMO plan’s network.
- Cover 100% after copay. The HMO plans pay 100% after you pay a $10 copay for office visits and most services ($20 copay for specialists).
- Have limitations on dependent coverage. If you have a dependent who attends college or resides outside the plan’s network service area, he or she will not have coverage under the plan except in the case of emergency or urgently needed care. If this applies to you, consider electing the EPO plan or PPO plan, which both offer in- and out-of-network coverage. This will ensure your dependent has coverage for preventive and non-emergency medical care.
Use your HMO plan wisely
Here are ways to make the most of your Anthem or Kaiser HMO all year long.
- Track your stats. Log in to Anthem’s or Kaiser’s website to review claims, use helpful tools, and more.
- Pair it with a Healthcare Reimbursement Account. During a separate enrollment in November, you may choose to enroll in the Healthcare Reimbursement Account, which allows you to set aside before-tax dollars to help pay for your eligible medical, prescription, dental, and vision expenses. Keep in mind, you can only carry over up to $500 of unused money in your FSA to the next calendar year; amounts over $500 will be forfeited.
- Get a referral. Referrals are required for specialist care. In addition, you must have a written referral from your PCP to access X-rays, laboratory testing, rehabilitation facilities, and mental health care. If you seek treatment without first obtaining a written referral from your PCP (except in emergency situations), you must pay the bill yourself.
How the EPO plan works
- Provides both in-network and out-of-network coverage. However, you’ll pay less out of pocket when you use Anthem network providers.
- For in-network care, no deductible applies, and you’ll pay a $10 copay for most office visits and other services ($20 copay for specialists).
- For most out-of-network care, you must first satisfy a deductible before benefits begin. After you meet the deductible, you pay 50% coinsurance for care.
How the PPO plan works
- Provides both in-network and out-of-network coverage. However, you’ll pay less out of pocket when you use Anthem network providers.
- You pay copays for office visits and urgent care when you stay in network. For other types of in-network care, you must first meet a deductible and then you pay 10% coinsurance.
- For most out-of-network services, you must first satisfy a deductible before benefits begin. After you meet the deductible, you pay 30% coinsurance for care.
Use your EPO or PPO plan wisely
Here are ways to make the most of your Anthem EPO or PPO all year long.
- Track your stats. Log in to Anthem’s website to see how much of your deductible you’ve met, review claims, use helpful tools, and more.
- Pair it with a Healthcare Reimbursement Account. During a separate enrollment in November, you may choose to enroll in the Healthcare Reimbursement Account, which allows you to set aside before-tax dollars to help pay for your eligible medical, prescription, dental, and vision expenses. Keep in mind, you can only carry over up to $500 of unused money in your FSA to the next calendar year; amounts over $500 will be forfeited.
- Be cost-conscious. Visit Anthem’s website, where you can search for in-network providers and use cost estimating tools to figure out what you may have to pay for care before you go to your doctor.
Prescription Drugs
All of the medical plans include retail and mail order prescription drug coverage. Benefits are provided by:
- Anthem if you enroll in an Anthem medical plan. See how drugs are covered by Anthem. (To view the Essential Formulary, click on “Essential Drug List 4-Tier (Searchable).")
- Kaiser Pharmacy if you enroll in a Kaiser medical plan. See how drugs are covered by Kaiser.
Paying for prescriptions
There is no annual deductible for prescription drugs, so you begin paying copays with your first prescription purchase. The category, or tier, your drug is in determines the amount you pay. See the Medical Plan Comparison Chart for coverage amounts.
Anthem Pharmacy Programs
The following pharmacy programs are designed to help save you money on prescriptions.
- Anthem Essential Formulary: The Anthem medical plans use the Essential Formulary, which is a smaller, cost-saving formulary drug list compared to the National Formulary. The Essential Formulary is meant to control costs while maintaining quality. You can view the Essential Formulary on the Anthem website. Click on “Essential Drug List 4-Tier (Searchable)."
- Anthem Tiered Choice pharmacy network: With Anthem’s Tiered Choice, network pharmacies are grouped into Level 1 and Level 2. Anthem medical plan members will pay their current prescription drug copays at over 25,000 pharmacies in Level 1, including CVS, Costco, Target, Walmart, and more. For even more options, members can choose from many more pharmacies in Level 2; however, they will pay an additional $10 copay (or an additional 10% for specialty drugs).
Save money
The cost of prescription drugs is rising faster than many other healthcare services and supplies. But, there are ways for you to save:
- Ask your doctor about generics. Generic medications are generally just as effective as brand-name medications, but they cost between 30% and 75% less.
- Use mail order. If you regularly take medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — using the mail order prescription service will save you time and money. Visit your medical plan carrier’s website or call the number on the back of your insurance ID card to use this service.
Dental
Healthy teeth and gums are important to your overall health. That’s why it’s important to have regular dental checkups and maintain good oral hygiene. Green Dot Public Schools offers a choice of dental plans through MetLife so you can select the level of coverage that best fits your needs.
2019 – 2020 dental plan options for CA employees:
- MetLife Dental HMO (DHMO) Plan
- MetLife Low Plan
- MetLife High Plan
Compare the plans below and see your contribution rates for coverage.
Under the DHMO plan, you choose a primary care dentist and receive all of your care within the plan’s network — there is no out-of-network coverage. There is also no deductible or annual maximum benefit under the DHMO plan.
Under both the High and Low plans, you can see any dentist you want, but you must first meet a deductible before coverage begins. These plans also include an annual maximum benefit. The difference between the two is in the deductibles, annual maximums, out-of-network coverage, and orthodontic lifetime maximums.
Key features
All the dental plans include:
- Affordable coverage that helps you manage the cost of dental treatment — see your contribution rates
- Wide network of providers that have agreed to negotiated rates, which helps you save money (reminder: the DHMO plan only pays benefits for care received in network)
- Choice of four coverage levels:
- Employee Only
- Employee + Spouse/Domestic Partner
- Employee + Child(ren) up to age 26
- Employee + Family
Find a network dentist
You’ll generally pay less when you use a dentist in your carrier’s network.
- Visit MetLife’s website to locate in-network providers.
- See step-by-step instructions for finding a provider in the MetLife DHMO network.
Compare the dental plans
The following chart provides an overview of coverage under the CA dental plans. For complete details, please review the plan documents in the left menu.
Dental Plan Comparison Chart
California employees
| Plan Details | MetLife DHMO Plan In-Network |
MetLife Low Plan In-Network |
MetLife Low Plan Out-of-Network |
MetLife High Plan In-Network |
MetLife High Plan Out-of-Network |
|---|---|---|---|---|---|
| Primary Care Dentist | Yes | No | No | No | No |
| Annual Deductible (Individual/Family) |
None | $50/$150 | $75/$225 | $25/$75 | $50/$150 |
| Annual Maximum Benefit | None | $1,500 | $1,000 | $1,500 | $1,500 |
| Diagnostic and Preventive Care Services | Fee schedule | Covered in full | You pay 20%, no deductible | Covered in full | Covered in full |
| Basic Services | Fee schedule | 20% after deductible | 50% after deductible | 20% after deductible | 20% after deductible |
| Major Services | Fee schedule | 50% after deductible | 50% after deductible | 50% after deductible | 50% after deductible |
| Orthodontics (adults and children) |
Fee schedule | 40% after deductible | 40% after deductible | 40% after deductible | 40% after deductible |
| Orthodontic Lifetime Benefits (adults and children) |
Fee schedule | $1,000 | $1,000 | $2,500 | $2,500 |
Use your dental benefits wisely
Here’s how to make the most of your dental benefits:
- Choose a provider – Each time you need dental care, you have a choice of providers. Selecting a participating dentist in the MetLife network will ensure you receive the highest benefits from your plan.
- If your service will exceed $300, submit for a pretreatment estimate. You should always submit a request for a pretreatment estimate for procedures and services your dentist believes will exceed $300 (such as crowns, inlays, bridges, and periodontics). For more information about pretreatment estimates, call your dental carrier.
- Check your claim status and other information on MetLife’s website. You can review Explanation of Benefits (EOB) statements, check if claims have been paid, and more.
Vision
Having an annual eye exam is one of the best ways to make sure you’re keeping your eyes healthy. Green Dot Public Schools offers vision coverage through VSP to save you money on expenses such as eye exams, glasses, and contact lenses.
Key features
- Affordable coverage that helps you manage the cost of vision care and supplies — see your contribution rates
- Eye exam covered every year, with only a small copay charged to you
- Coverage for prescription eyeglasses or contact lenses so you can choose the method of correction you prefer
- Freedom to see any vision provider you want; however, you will get the best value from your plan benefits when you receive care from a VSP network provider
- Choice of four coverage levels:
- Employee Only
- Employee + Spouse/Domestic Partner
- Employee + Child(ren)
- Employee + Family
Find a network provider
You’ll get the best value by using a provider in the VSP network.
Coverage details
The following chart provides an overview of coverage under the VSP Vision Plan. For complete details, please review the plan documents in the left menu.
VSP Vision Plan
California employees
| Plan Details | In-Network | Out-of-Network |
|---|---|---|
| WellVision Eye Exam (every 12 months) |
$10 copay | Reimbursed up to $45 |
| Prescription Glasses | $25 materials copay for frame and lenses combined (lens enhancements have separate copays) |
See frames, lenses, and lens enhancements |
| Frames (every 12 months) |
|
Reimbursed up to $70 |
| Lenses (every 12 months) |
|
Single vision: Reimbursed up to $30 Lined bifocal: Reimbursed up to $50 Lined trifocal: Reimbursed up to $65 |
| Lens Enhancements (every 12 months) |
|
Progressive: Reimbursed up to $50 |
| Contact Lenses (instead of glasses) (every 12 months) |
|
Reimbursed up to $105 |
| Diabetic Eyecare Plus Program | $20 copay for services related to diabetic eye disease, glaucoma, and age-related macular degeneration (AMD); retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details. | N/A |
| Extra Savings | ||
| Glasses and Sunglasses |
|
N/A |
| Retinal Screening | No more than a $39 copay on routine retinal screening as an enhancement to a WellVision exam | N/A |
| Laser Vision Correction | Average 15% off regular price or 5% off promotional price; discounts only available from contracted facilities | N/A |
Contribution Rates
Click on the Contribution Rates Sheet below to view the CA employee contribution amounts by plan and coverage level for the 2019 – 2020 plan year.
Looking for premium-free coverage?
Green Dot Public Schools pays 100% of the premium if you elect any level of coverage for:
- Medical: Anthem Vivity HMO Plan
- Dental: MetLife Dental HMO Plan
- Vision: VSP Vision Plan
LiveHealth Online
With our convenient LiveHealth Online benefit, you and your covered family members can see the doctor without leaving the house! It’s an affordable, easy alternative to urgent care and ER visits when you need non-emergency medical care.
LiveHealth Online gives you 24/7/365 access to board-certified physicians who will consult with you by phone or via live video on your mobile phone or computer. LiveHealth Online physicians can provide fast, convenient diagnosis and treatment for many common conditions.
| LiveHealth Online: 24/7 virtual doctor visits | |
|---|---|
| Use it for: | Use it when: |
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Access LiveHealth Online
To get started, simply set up an account on the LiveHealth Online website and you’ll be ready the next time you need care in a hurry!