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New partnerships, ‘benefits navigator’ highlight 2016 annual enrollment

2015 October 28
by HISD Communications

HISD’s annual health benefits enrollment period is Nov. 5–19, and employees will be seeing a few changes in the district’s health partners.

Cigna will take over as the new dental provider and EyeMed will provide vision benefits for 2016. The good news for employees is that both offer larger networks than the previous vendor, so most people will be able to continue seeing their current dentist or eye doctor.

The district is also switching pharmacy providers. Express Scripts is the new vendor for 2016, and offers a larger network of pharmacies than CVS/Caremark. Employees can fill 90-day prescriptions at Kroger, H-E-B, Costco, Randalls, Sam’s and Walmart, or through Express Scripts’ mail-order service. However, 90-day prescriptions are not available through CVS/Caremark or Walgreens. The drug formulary is changing and that will affect some members, too, and affected members will receive letters from Express Scripts.

“We are excited that after giving employees a 20-percent reduction in benefits premiums in 2014, we’re keeping rates flat again this year,” said Benefits General Manager Brad Bailey. “But it is important that employees learn about the changes we have in store, as well as do their homework in order to make the best decisions for them and their families in 2016.”

Other changes employees need to know as annual enrollment approaches:

  • New virtual benefits navigator — “Ben 101” will guide employees through the various medical, dental, and vision benefits choices. By answering a series of questions, Ben 101 will offer suggestions on benefits choices that employees can consider during the annual enrollment period.
  • Reminder: HISD has in-network benefits only — Employees may be responsible for the entire bill if they use an out-of-network emergency room/urgent care clinic/providers if it is not a true emergency. Pay attention to your health insurance plan to see which clinics and providers are in your network to avoid being hit with a huge bill. Plan ahead and use the Aetna Navigator to see which clinics and providers are in your network in case you need to use them.
  • Medical and pharmacy out-of-pocket maximums are combined — Employees who frequently use medical services or purchase prescription medications will reach their out-of-pocket maximum quicker, after which they will no longer need to pay out-of-pocket expenses during the calendar year.
  • New wellness program provider — HISD is now partnering with Viverae for its wellness initiatives. Viverae offers free and easy-to-use resources to help employees get in shape, create personal goals, and compete in various health challenges.
  • Changes in rates/requirements — Some supplemental plans no longer require evidence of good health or exclude pre-existing conditions. Additionally, the “Critical Illness” coverage plan now includes different rates, depending on your age. Review the details for each plan to see the changes.

As always, employees who are happy with their current coverage do not need to re-enroll for medical, dental, and vision benefits. Since dental and vision providers are changing, employees who do not make changes will be moved to the most similar new plan.

However, if employees wish to continue contributing to a Flexible Spending Account and/or a Dependent Day Care Flexible Spending Account, they will need to re-enroll.

Additionally, the Affordable Care Act requires everyone, as well as employers, to verify they have health insurance. Employees must report their medical plan eligibility, coverage, and any covered dependents’ tax ID numbers (such as a Social Security number), so be prepared to provide this information during the annual enrollment period. Visit for additional information, and to review your current benefits in order to make the best decisions for 2016.

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