Medical Program Overview

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered healthcare services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary.

SISC’s Proactive Care Plans through Anthem are designed to make healthcare easier to understand and encourage members to access important care when they need it.

Unlike traditional PPO plans that may include deductibles and coinsurance, Proactive Care Plans use a copay-based benefit structure, giving members greater predictability when accessing covered services. Many commonly used services are available at $0 cost to the member, including primary care visits, urgent care, outpatient mental health visits, physical therapy, and laboratory services.

The plans also include $0 prescription medications for certain health conditions, helping reduce financial barriers to medications used to manage and prevent complications from chronic conditions.

Proactive Care Plans continue to provide the flexibility of a PPO network, including access to specialists without a referral. Members can choose from different plan levels; including Gold, Platinum, and Diamond, where offered by their district or employee group. By reducing cost barriers for routine, preventive, and ongoing care, the Proactive Care Plans are designed to help members engage with the healthcare system earlier and more easily.

By reducing cost barriers for routine, preventive, and ongoing care, the Proactive Care Plans are designed to help members engage with the healthcare system earlier and more easily.

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary.

SISC’s Proactive Care Plans through Anthem are designed to make healthcare easier to understand and encourage members to access important care when they need it.

Unlike traditional PPO plans that may include deductibles and coinsurance, Proactive Care Plans use a copay-based benefit structure, giving members greater predictability when accessing covered services. Many commonly used services are available at $0 cost to the member, including primary care visits, urgent care, outpatient mental health visits, physical therapy, and laboratory services.

The plans also include $0 prescription medications for certain health conditions, helping reduce financial barriers to medications used to manage and prevent complications from chronic conditions.

Proactive Care Plans continue to provide the flexibility of a PPO network, including access to specialists without a referral. Members can choose from different plan levels; including Gold, Platinum, and Diamond, where offered by their district or employee group.

By reducing cost barriers for routine, preventive, and ongoing care, the Proactive Care Plans are designed to help members engage with the healthcare system earlier and more easily.

COBRA provides eligible employees and their covered family members the opportunity to temporarily continue group health coverage when coverage would otherwise end because of certain qualifying events, such as termination of employment, reduction in hours, divorce or legal separation, death of the covered employee, or a dependent child losing eligibility under the plan.

RESIG administers federal COBRA and California continuation coverage (Cal-COBRA) for eligible medical, dental, and vision benefits offered through participating member districts.

Our Employee Benefits team works directly with qualified beneficiaries throughout the continuation process, including providing required notices, processing elections, collecting premiums, and coordinating enrollment with the applicable health plans and benefit programs.

COBRA coverage generally allows qualified beneficiaries to continue the same group health coverage they had immediately before the qualifying event, provided applicable eligibility, election, and premium payment requirements are met. The length of continuation coverage depends on the qualifying event and applicable federal or California continuation requirements.

In some circumstances, Cal-COBRA may provide additional continuation rights after federal COBRA ends or may apply when federal COBRA does not. Eligibility and continuation periods depend on the specific health plan and individual circumstances.

RESIG offers medical coverage options for eligible retirees, including coverage before and after Medicare eligibility. The Employee Benefits team supports retirees through the transition from active employee coverage to retiree coverage and, when applicable, from non-Medicare coverage to Medicare-coordinated benefits.

Eligible retirees who are not yet Medicare-eligible may continue coverage for themselves and their eligible family members through RESIG.

Plan availability and eligibility requirements may vary by member district and retiree group.

For retirees and eligible dependents enrolled in Medicare, RESIG offers several Medicare-coordinated coverage options, including Kaiser Permanente Senior Advantage, Blue Shield of California PPO Medicare Coordination, and Anthem Blue Cross CompanionCare Medicare Supplement plans.

Enrollment in Medicare Parts A and B is required for Medicare-coordinated coverage. Available plans and eligibility may vary based on the retiree’s former district and other applicable program requirements.