2021 Employee Benefits: Frequently Asked Questions
When is Open Enrollment and when are the new plans effective?
Open Enrollment is October 1-15th. All elections will be effective January 1 - December 31, 2021.
Am I required to take action this Open Enrollment?
For most employees, Open Enrollment will be a passive event unless you would like to make plan or dependent changes. Employees that waive medical coverage are always required to take action to provide proof of other coverage to be eligible to opt out. In addition, it is recommended that all employees log into BenXcel to review their elections to ensure themselves and their dependents are covered as they intended.
3. If I take no action, will my coverage automatically carry over from last year?
Yes, if you take no action your plan enrollment and dependents covered will automatically carryover to the following year. Contribution elections for Flexible Savings Accounts (FSA) and Health Savings Accounts (HSA) will not carry over and must be re-elected each year.
How do I complete Open Enrollment?
Visit www.BenXcel.net during open enrollment to review and make changes to your benefits. BenXcel login instructions are available here. Once you have logged in follow the system prompts to review your demographic information, dependent information, benefits options and begin making elections. When you are finished, print and review your confirmation statement. Always double check your confirmation statement to ensure you made the correct elections and your dependents are covered as you intended. In January, always review your paystub to confirm the correct deductions are being taken.
What is my BenXcel login ID?
BenXcel login instructions can be found here. If you cannot remember your password, you can reset it at BenXcel.net by clicking the "Forgot Password?" button. If you are still having trouble logging in to BenXcel, contact BCC at 1-800-685-6100 for assistance.
How do I know if I completed my enrollment or if I did it correctly?
A personal confirmation statement is generated based on your current and future enrollment elections. You can access your confirmation statement anytime by logging into BenXcel. It is your responsibility to review your confirmation statement in detail to ensure you have enrolled in the correct plans and have included your dependents as you intended. You will be enrolled in your benefits based on your confirmation statement. You will not be able to change your enrollment elections until next open enrollment unless you experience a qualifying event. If you have questions on how to read your confirmation statement, click here.
I waive medical coverage, what documents are acceptable for proof of other coverage?
In order to opt-out of County medical coverage you must submit proof of other group coverage. Proof of other coverage documents should contain the insurance carrier name, group/employer name, member name and covered dependent names, plan name and plan effective date. Example of acceptable documents include:
- A copy of your medical insurance ID card indicating you are a covered member and that coverage is effective for the upcoming plan year
- A letter from your insurance carrier stating your name as a covered member and your coverage effective date
- A letter from the employer that states that plan name and that you are a covered member for the upcoming plan year
- A recent open enrollment confirmation statement from an employer stating the plan name, covered members and coverage effective dates
Documents that are not acceptable include:
- COBRA documentation
- Medical ID cards without your name or a coverage tier (ex: family) listed on them or a plan effective date
- Medi-Cal Paperwork (Employees are not eligible for Medi-Cal)"
Do I have to provide eligibility documents for my dependents?
Eligibility documents such as a marriage or birth certificate are required for dependents you are adding to your insurance plans for the first time. You do not have to submit eligibility documentation for dependents that are already enrolled on your County insurance plans.
What are the group numbers, phone numbers and website addresses of the health insurance carriers?
Group numbers and contact information for all carriers are available on the back of the Employee & Retiree Benefits Brochure and can also be viewed on our Employee Benefits webpage.
What is the County's Cafeteria Contribution?
The County contributes a fixed dollar amount toward employee medical, dental and vision premiums monthly which is called a cafeteria contribution. The monthly cafeteria amount is determined by your bargaining unit.
If I take no action, will my coverage automatically carry over from last year?
Yes, if you take no action your plan enrollment and dependents covered will automatically carryover to the following year. Contribution elections for Flexible Savings Accounts (FSA) and Health Savings Accounts (HSA) will not carry over and must be re-elected annually.
What is Carrum Health and am I eligible for this benefit?
Carrum Health is a voluntary surgery benefit program that offers specific surgeries at Centers of Excellence with top-quality hospitals and surgeons for no out of pocket costs. This benefit is separate from and in addition to the benefits already provided under Anthem medical plans. This benefit is not administered by Anthem and must be accessed directly through Carrum Health or by contacting them at 888.855.7806. Eligible members include Early Retirees (Non-Medicare), COBRA participants and their dependents who are enrolled in PPO or EPO health plans. For more information on Carrum Health, please click here.
What is Rx 'n Go and am I eligible for this benefit?
Rx 'n Go is a free pharmacy benefit that will deliver up to 90 days of generic maintenance medications straight to your door. Non-Medicare Retirees only are eligible for this benefit. For more information, visit this page here.
Do I need to select a Primary Care Physician (PCP)?
No, none of our medical plans require you or your dependents to have a Primary Care Physician (PCP). You also do not need a referral from a PCP to see a specialist.
Do I have out of network benefits?
Network benefits vary based on the plan you are enrolled in. Always review your Summaries of Benefits of Coverage (SBC) documents to verify your coverage levels. For 2021, most plans have some level of out of network coverage except the Anthem EPO plan. If you utilize an out of network provider on the Anthem EPO plan you are responsible for the full provider services cost. Out of network charges do not count toward your calendar year deductible and out of pocket maximum (OOPM for all plans.
Do I have Out of State Coverage?
Yes, all of (all) our plans have access to Anthem's Nationwide Bluecard PPO network. You and your dependents will have access to this network. To search for a provider, visit Anthem's website.
Do I have to enroll in the Carrum Health Benefit separately?
No you do not have to enroll in Carrum Health. You and your dependents are automatically enrolled in Carrum Health when you enroll in a County medical plan. There is not action you need to take and no separate ID card. If you would like to utilize the Carrum Health benefit, you must contact Carrum Health directly at 1-888-855-7806.
Is the pharmacy benefit changing?
Express Scripts will continue to be the Pharmacy Benefits Manager. Annually, the formulary of covered medications will change. The Medicare pharmacy plan will remain unchanged.
I have a claims question; what should I do?
Claims questions should first be addressed with your provider. Always verify that you are utilizing your newest ID card and that the provider HSA billed the correct group number and member ID. If your provider is having an issue verifying your eligibility they are able to (can) contact Anthem directly to resolve any billing issues. When your provider bills Anthem an Explanation of Benefits (EOB) will be generated outlying the amount that you owe. If your provider bills you a different amount than what is on your EOB, contact your provider to resolve. If you believe there is an error on your EOB, contact Anthem.
How do I find a medical provider?
You have several options to find an in-network provider.
- Create an account and Login to Anthem's website to complete a provider search.
- Call Anthem at 1.800.967.3015 and ask them to run a provider search for you
- Login as a Guest and utilize Anthem's provider search by selecting your network
- Give your Anthem plan group number and member ID found on your medical ID card to the provider and ask them to see if they are in your network.
Go to: www.anthem.com/ca/EIAHealth
- Click on Find a Doctor or skip to the next step
- Select Search as a Guest unless you are a member
- Select Through my Employer under “How do you get Insurance?”
- Select Medical, under “What type of care are you searching for”?
- Select California, or the state you are searching for a provider in
- Select the network you are searching for
- Network information: Blue Cross PPO (Prudent Buyer) Large Group- Plan Names: Anthem Choice PPO, Anthem Care PPO, Network information: Select PPO- Plan Name: Anthem Select PPO
- Network information: National BlueCard PPO Network- Plan Name: All plans out of state
- On the next screen, enter the type of doctor, specialty, and location of where you are searching. The defaults are Doctor/Medical Professional in Family/General Practice, Internal Med.
- If you want to find a specialist, you will have to search by their specialty from the drop-down list
You can also search by a specific doctor by entering the name and click search
I live out of state, do the County plans cover areas outside of California?
Yes, all medical plans have access to Anthem's Nationwide PPO network. Contact Anthem at 1.800. 967.3015 to find an in-network provider in your area.
Am I covered by my medical insurance when I travel internationally?
If you are enrolled in an Anthem medical plan, you have access to emergency care while traveling internationally. For more information, please call Anthem's customer service number found on the back of your ID card or 1.800-967-3015.
Dental & Vision
How do I find an in-network dental provider?
To view a list of in-network Aetna dental providers within in the County of San Luis Obispo, please click here. To run a search of in-network Delta dental providers, please click here. Please note that there are several tiers of Delta dental providers that have different reimbursement structures.
- Delta Dental PPO: Visit a dentist in this network to maximize your savings. In general, you should expect to save about 30% on contracted services which will help reduce any out of pocket costs you may experience. PPO dentists have pre-negotiated their fees with Delta and have agreed not to balance bill Delta patients.
- Delta Dental Premier: You will experience a smaller savings of 8-16% on contracted services by visiting a Premier dentist. Premier dentists have pre-negotiated their fees with Delta and have agreed not to balance bill Delta patients.
- Non-Delta Dental Dentists: While you will still receive a benefit from Delta while seeing an out-of-network dentist, these dentists do not have pre-negotiated rates with Delta. In addition, an out-of-network dentist may balance bill you the remainder of the bill Delta does not pay.
- How do I find an in-network vision provider?
- To run a search of in-network VSP providers, please click here.
I have general questions on my FSA account, who do I contact?
Contact the FSA administrator BCC at 1.800.685.6100 for general FSA account questions.
Will I get a new debit card for my FSA account if I choose to re-elect for 2021?
No, if you re-enroll in a health and/or dependent care FSA you will not receive a new debit card. The debit cards do expire after three years. Your FSA contribution amounts do not automatically rollover and you must elect a new contribution amount each year during Open Enrollment. Your existing debit card will be re-loaded with your new 2021 contribution amount.
Do I need to take action to keep my FSA contribution amounts or will they rollover?
Action is required to continue to contribute to an FSA each year. Your FSA contribution amounts do not automatically rollover. You must elect a new contribution amount each year during Open Enrollment.
What is a HDHP & HSA? How is it different than other medical plans?
A High Deductible Health Plan (HDHP) is a health plan product that combines a Health Savings Account (HSA) with traditional medical coverage. It provides insurance coverage and a tax-advantaged way to help save for future medical expenses. The HDHP & HSA gives you greater flexibility and discretion over how you use your health care dollars. HDHPs have higher annual deductibles and out-of-pocket maximum limits than other PPO plans. With a HDHP, the annual deductible must be met before plan benefits are paid for services other than in-network preventive care services, which are covered 100%. HDHPs also protect you against catastrophic out-of-pocket expenses for covered services. Once your annual out-of-pocket expenses for covered services from in-network providers, including deductibles, copayments and coinsurance, reaches the pre-determined out-of-pocket limit, the plan pays 100% of the allowable amount for the remainder of the calendar year. The ability to fund an HSA account is another way how this plan is different from other PPO plans offered.
A Health Savings Account allows individuals to pay for current health expenses and save for future qualified medical expenses on a pre-tax basis. Funds deposited into an HSA are not taxed, the balance in the HSA grows tax free, and that amount is available on a tax free basis to pay medical costs. While most employees will qualify for an HSA, the IRS does have certain eligibility requirements to be able to take advantage of the triple tax savings an HSA account provides.
How does an HDHP with an HSA work?
- You enroll in an HDHP
- You have the option to make pre-tax payroll contributions into your HSA, up to a maximum amount determined by IRS rules. Your HSA contributions earns tax-free interest.
- When you need preventive care, your plan will cover 100% of the costs, subject to any limits outlined in the plan's brochure
- When you need non-preventive health care, you pay the full cost of that care with funds from your HSA or out of pocket, up to your plan's high deductible
- If you reach the out of pocket maximum, your HDHP will provide needed care with no charge to you
- Other Key Features:
- Distributions from your HSA are tax-free for qualified medical expenses for you, your spouse and your dependents, even if they are not covered by an HDHP.
- You may withdraw money from your HSA for items other than qualified medical expenses, but it will be subject to income tax and, if you are under 65 years old, an additional 20% penalty tax on the amount withdrawn.
- You may allow the contributions in your HSA to grow over time, like a savings account.
- The HSA is portable – you may take the HSA with you if you leave the County or switch to another plan.
What advantages are there from a HDHP?
- Premiums are typically lower than PPO plans.
- If you are a low utilizer of your medical & prescription benefit you may able to save money.
- You can combine your HDHP with a Health Savings Account that HSA a triple tax benefit. The triple tax benefit for the HSA is 1. Pre-tax payroll deductions, no tax on any interest accrued, and tax-free withdrawals for any qualified medical expenses. You may also withdraw your funds at the normal tax rate for non-qualified medical expenses when you are 65 or older without a penalty.
Are there any risks with a HDHP?
While you will never pay more than your out-of-pocket maximum, HDHPs have higher annual deductibles and out-of-pocket maximum limits than traditional health plan options. With a HDHP, you pay for all of your health expenses except preventative care until you meet your annual deductible. Once your annual deductible is met the plan will begin cost sharing until you meet the annual out-of-pocket maximum. Once you meet the out-of-pocket maximum the plan will pay 100% for the plan year.
One key difference to note from a traditional PPO health plan is that you are required to meet your medical annual deductible before prescription drugs are covered under a coinsurance cost sharing. You are likely to pay more for your prescription drugs with a HDHP than a traditional PPO health plan.
Is my pharmacy and prescription drug benefit the same as other County plans?
No, your pharmacy benefit is not the same as the other County plans. Please click here to see the pharmacy benefit for the HDHP.
How much will I pay for prescription medications?
Under this plan you are responsible for the full cost of your medications until you reach your annual deductible, there are no co-pays.
Are there any resources to help me manage my prescription costs?
Under a HDHP you are responsible for the full cost of your prescription drugs until you reach your annual deductible. To help manage the costs of your prescriptions, there are resources like GoodRX that will help you find a pharmacy near you with the lowest cost for your prescription.
How does the annual deductible and out-of-pocket maximum (OOPM) work for the HDHP?
- The HDHP Plan has an aggregate deductible and embedded out-of-pocket maximum.
- For Employee only coverage this means you will have to pay for medical and pharmacy expenses up to the individual deductible amount until the plan co-insurance, or cost sharing, benefits begin. You will pay no more than the plans individual out-of-pocket maximum.
- For employees with dependents, your family will have to pay for medical and pharmacy expenses up to the family deductible amount anytime anyone utilizes services. You can meet the family deductible because of medical care to one person or from expenses incurred by the entire family. Once the family deductible is met, the co-insurance or cost sharing benefits of the plan begin until the out-of-pocket maximum limits are met. Once an individual meets the individual OOPM, the plan will pay 100% of all covered expenses for that person, even if the family OOPM has not been met. Once the family OOPM is reached the plan must pay 100% of all covered expenses for everyone — regardless of whether each family member has reached the individual maximum.
What network of providers can I utilize? Do I have access to out of network providers?
Those enrolled in the HDHP will have access to Anthems Blue Cross PPO Prudent Buyer PPO network. This comprehensive nationwide network will give you access to both in-network and out-of-network providers. To reduce out-of-pocket costs, it is always encouraged to access in-network providers.
If I enroll in the HDHP, will I automatically be enrolled in the HSA?
No, if you elect the HDHP plan, you will have the option to contribute a specified amount to your HSA from your paycheck. While it is strongly recommended that you contribute to your HSA, it is not required and you will not be automatically enrolled in the HSA. The IRS has specific requirements about who is eligible to contribute to an HSA.
Is a HDHP right for me?
HDHPs are not right for everyone and there are many factors to consider before enrolling in this plan type. While many people may initially be skeptical of HDHPs, they can be a reasonable choice for many and can be particularly valuable if you know how to use them effectively. For individuals covered by a HDHP, an HSA offers a number of (several) benefits. Money that may otherwise be lost to high premiums could be invested in a tax-free, interest-bearing HSA and withdrawn tax-free for qualified medical expenses, resulting in a triple-tax savings. For those with higher medical expenses who are also financial planners, a HDHP combined with an HSA still may provide overall cost savings as compared to a traditional plan with higher premiums and out of pocket maximums. A HDHP can also be a good option for a healthy young employee with few anticipated medical needs.
HDHP + HSA
How do I know if I am eligible for an HSA?
You are eligible for an HSA if you are:
- Enrolled in an HDHP and not covered by another health plan (including a spouse’s health plan, but not including specific injury insurance and accident, disability, dental care, vision care, or long-term care coverage)
- Not enrolled in Medicare
- Not covered by your own or your spouse’s flexible spending account (FSA), and are not claimed as a dependent on someone else’s tax return
What are the annual HSA contribution limits?
The Internal Revenue Service (IRS) establishes contribution limits for Health Savings Account's linked to a High Deductible Health Plan (HDHP). The 2021 contribution limit for an individual is $3,500 and the family limit is $7,000. For individuals who will be 55 or over by December 31st, 2021, there is an increased "catch-up contribution" limit of $4,500 for an individual and $8,000 for a family.
How is my HSA account funded?
Your HSA will be funded through pre-tax payroll deductions you make up to the annual limit.
Can I contribute to my HSA outside of payroll deductions?
Contributing to an HSA outside of payroll does not defeat the purpose – non-payroll HSA contributions are still tax deductible. In other words, the same tax benefits apply (outside of FICA), it’s just that they won’t be 100% realized until you complete your tax return.
If you do contribute to an HSA on your own, it may be wise to adjust your withholding tax allowances with your employer downward, so that less taxes are withheld over the course of the year and you don’t end up with an inflated refund.
Do the funds in an HSA account rollover?
Yes, unlike an FSA, any unused balance will rollover to the next plan year, it is not use-it-or-lose-it. If you have a relatively low-expense year you can roll over the funds and use them in a year where you may have more medical expenses.
How do I access my HSA funds and when can I utilize them?
You will have access to utilize your funds as they accrue from your payroll deductions through a debit card. Debit cards will be mailed to your address listed in BenXcel with instructions for how to register the card on the BCC My SmartCare Portal and how to download the Mobile App along with general information about the program. You will be able to access the available funds at the point of service utilizing your debit card.
What happens to the funds in my HSA if I separate or retire from the County?
In addition to your HSA funds rolling over year after year, you are also able to take those funds with you and access them after you separate from County employment.
What expenses qualify for an HSA?
Like an FSA account, HSA qualified expenses are determined by the IRS. To view a full list of qualified expenses, please click here.
Does the qualified expense have to occur in the same year the contribution was made?
No, because the funds roll over from year to year, the medical expense does not have to occur in the same year the contribution was made.
Are healthcare premiums a qualified expense? From other employers and/or Medicare?
Generally, you cannot treat insurance premiums as qualified medical expenses unless the premiums are for:
- Long-term care insurance, subject to IRS mandated limits based on age and adjusted annually (see IRS Publication 502: Long-Term Care).
- Healthcare continuation coverage (such as coverage under COBRA – see IRS Publication 502: COBRA Premium Assistance.
- Healthcare coverage while receiving unemployment compensation under federal or state law.
- Medicare and other healthcare coverage if you are 65 or older (other than premiums for a Medicare supplemental policy, such as Medigap).
- For (i) and (ii) above, your HSA can be used for your spouse or a dependent meeting the requirement for that type of coverage. For (iv) above, if you, the account beneficiary, are not 65 years of age or older, Medicare premiums for coverage of your spouse or a dependent (who is 65 or older) generally are not considered a qualified medical expenses. (Singular or Plural?)
Can I utilize the HSA for my dependents expenses? Even if they are not on my medical plan?
You can use an HSA to pay for qualified medical expenses for yourself, a spouse, and your dependents, even if they are not enrolled on your County medical insurance plan and covered by other insurance.
Can I cash out my HSA?
You may withdraw money from your HSA for items other than qualified medical expenses, but it will be subject to income tax and, if you are under 65 years old, an additional 20% penalty tax on the amount withdrawn.
I have no funds in my HSA account and I'm now responsible for my annual deductible and out-of-pocket maximum, is there any assistance for me?
For medical expenses you can ask your provider or the hospital for a payment plan where you pay a percentage of the bill each month until the balance is paid off if you have not accrued enough in your HSA to cover the expense.