SISC Questions and Answers

1. We have several employees who take medical coverage for themselves as a single coverage. They have been allowed in the past to cover their families on dental and vision only without covering them on medical. Will this be allowable with SISC?

We only require 100% participation of full time employees on all products. They can have any eligible dependents on any of the products, or not.

2. Employees who work less than full time and are eligible for benefits (4 hours or more), would be required to either take all benefits or waive all benefits, with current employees being "grandfathered" into the same benefits package they currently have. Is this correct?

That is correct. We would require a list of those "grandfathered" employees. Furthermore, if they decide to enroll in all benefits at some point, they would no longer be able to waive partial benefits at a subsequent time.

3. Can an employee take single medical coverage concurrently with two party or family dental and vision?

Yes, if the rate structures are set up that way.

4. As a district, do we select one dental plan, one vision plan, or does each employee get the choice of which plan they select?

As a bargaining unit, you select the plans you want to offer including dental and vision. You can only offer one vision plan. But on the dental you can have one Premier Incentive and one PPO.

5. The cost breakdowns for dental and vision are confusing, is there a set rate or does each employee pay the rate according to the plan they select?

The rates are set for the plan you select. Both tiered and composite rates are listed. But everyone in the same bargaining unit would have one or the other. The rate and plan choice is not at the individual level.

6. Is each employee required to take orthodontia, or is this a case by case basis?

If orthodontia is included, everyone would have it. It is not an individual voluntary benefit. However, you can have the Premier Incentive without the ortho and the PPO with ortho, or vice versa. Then the employee can choose from one of those two.

7. Can the District's current Delta Dental history be transferred to SISC's dental so they retain their 70-80-90-100% status?

SISC has been able to accommodate this request in the past as long as there has been no break in coverage.

8. Can we get network exceptions for distance limits to providers? We have members who are very rural. Currently there is a 50 mile exception from Anthem, does Blue Shield offer the same kind of exception?

These requests are done on a case by case basis. But yes, it has been done in the past.

9. Is air ambulance covered?

Both air and ground ambulance is covered when medically necessary.

10. SISC requires copies of Marriage Certificates, Birth Certificates and Domestic Partnership. Are these required to be certified?

Yes, we require these for proof of eligibility. This is to protect our pool from enrolling individuals that are not eligible.

11. We have several employees who are married and working full time. Are they required to carry individual policies?

Yes, we require 100% participation of all full time employees.

12. We have several spouses who are retired and take two medical plans. Are spouses required to take two separate plans?

We don't require them to take separate plans unless one is over 65 and the other is under 65.

13. Can current retirees add spouses to their medical?

Yes. Retirees can opt out of medical at the time they retire, but cannot opt back in at a later time.

14. The cost breakdowns for dental and vision are confusing, is this a set rate or does each employee pay the rate according to the plan they select?

The rates are set for the plan you select. Both tiered and composite rates are listed. But everyone in the same bargaining unit would have one or the other. The rate and plan choice is not at the individual level.

15. Is each employee required to take orthodontia, or is this a case by case basis?

If orthodontia is included, everyone would have it. It is not an individual voluntary benefit. However, you can have the Premier Incentive without the ortho and the PPO with ortho, or vice versa. Then the employee can choose from one of those two.

16. Retired certificated employee.

Teachers unit chooses plan E and Plan A both composite, what would retirees take since you have previously stated that retirees would go tiered? 

Retiree rates are always tiered regardless of what structure the actives have chosen.

Clarification needed. Do the units have to go all tiered or all composite? Each unit can have different rate structures. But the products all have to be the same structure. For example, all medical plans for a unit have to be one or the other, composite or tiered. The same goes for their dental and vision. It has to be one or the other. Or could it happen that the certificated chose one plan composite and one plan tiered? No, not within the same product. You can have the medical composite and the dental tiered, but not both structures for the same product.

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