Risk Management Department

Frequently Asked Questions 

Employee Benefits 

WHEN DOES A NEW EMPLOYEE HAVE TO ENROLL IN BENEFITS AND HOW DO I ENROLL?
A new employee has 30 days from their start date to enroll in health coverage.  Coverage becomes effective the first of the month following the start date.  It is the employee’s responsibility to call the Benefits Department to schedule a new hire benefits orientation.  Your benefit options will be explained to you in this meeting.  All new hires, including those previously employed at RUSD, must attend a new hire benefits orientation even if your intent is to waive benefits.

I JUST HAD A NEW BABY………HOW DO I ADD HIM/HER TO MY BENEFITS?
You have 30 days from the date of birth of a newborn to add your baby to your plans.  Please call the Benefits Department to add your baby within this timeframe.  A certificated copy of the birth certificate will be required, but it’s not necessary right away.  We will give you time to acquire this certificate after enrolling the baby.

I JUST GOT DIVORCED……..HOW DO I DROP MY SPOUSE FROM MY BENEFITS?
You must supply a copy of the final divorce decree that shows date of the divorce.  We will drop your spouse when you supply this information to the Benefits Department.  Please call the Benefits Department within 30 days of the effective date of the divorce.

HOW DO I DETERMINE IF A PARTICULAR DOCTOR OR FACILITY IS COVERED UNDER MY PPO OR EPO PLAN?
Log on to www.Anthem.com.  From the MENU, Click on “Find a Doctor”, then under Search as a Guest click on “Search by Selecting a plan or network”.  Then, select “Medical” in the type of care drop-down, and “California” under the State dropdown, then click on either “Select PPO” if you are on our EPO plan (do NOT select “EPO” in the drop down), or “Blue Cross PPO (Prudent Buyer) – Large Group” if you are on the PPO plan.  For our EPO plan, it is critical that you make the selection exactly as noted (Select PPO), as there is NO coverage if you go to a doctor or facility that is not contracted under the Select PPO.  Note also that many doctors’ offices are not familiar with these differences in plans, and may say “yes, we accept Anthem”, when in fact they may only be contracted with a certain plan within the large range of Anthem PPO/EPO plans.  So, use the website as described, or call Delta Health Systems (see your ID card) for verification.  These steps are also listed on the District web site under Employee Benefits.

WHY DOES MY DOCTOR’S OFFICE ALWAYS WANT TO VERIFY COVERAGE WHEN I GO THERE, WHEN I HAVE AN ID CARD THAT SHOWS MY COVERAGE?
Medical Insurance fraud is a growing problem, and they are simply protecting their business.  It is best if they use the Delta Health Systems web site to verify your coverage rather than calling because it is MUCH faster than calling.  Tell them to look at the front of your ID card for the web site (www.deltahealthsystems.com) – it will save them a LOT of time compared to calling!  Also, some offices move too fast and simply see the “Anthem” logo on your ID card, and try to verify coverage via the Anthem web site or by calling Anthem.  That will not work!  It’s complicated, but has to do with the fact that the District EPO/PPO plans are self-insured, and we simply “rent” the Anthem provider networks – we are not insured by Anthem, so the doctor will not find you in Anthem’s system, but they will find you in our third party administrator’s system, Delta Health Systems.  It’s all on the ID card if they pay close attention.

WHAT IS “OPEN ENROLLMENT”?
Open Enrollment is the one time during each year that benefit-eligible employees may change their benefit plan choices and re-enroll in a different plan.  This occurs once each year, and changes may not be made at any other time unless there is a “qualifying life event.”  New employees do not have to wait for the annual Open Enrollment period, as they enroll shortly after start of employment.

WHEN IS OPEN ENROLLMENT?
Open Enrollment typically occurs in the Fall (Oct/Nov) each year for new benefits choices that would take effect on January 1st.  Announcements are sent out as reminders.

WHAT IS A “QUALIFYING LIFE EVENT” (QLE)?
A change in your life that can make you eligible for a “Special Enrollment Period” that falls outside of Open Enrollment to enroll in health coverage.  Examples include:  moving to a new state, certain changes in your income (transfer from FT to PT or PT to FT status), changes in family size due to marriage, divorce or having a baby/legal guardianship/adoption (See page 18 of the “Employee Benefits Guide” for more info).  If an employee had coverage through a spouse or parent and experiences a “loss of coverage”, proof of loss of coverage is needed (i.e a letter on company letterhead with affected covered member name and coverage termination date).

WHAT IS THE DEADLINE TO CHANGE (ENROLL IN OR DROP) HEALTH COVERAGE DUE TO A QLE?
An employee must notify the Benefits Department within 30 days of the QLE.  The effective date for dropping coverage is the last day of the month in which the qualifying event occurred, while the effective date of a change to new or different coverage is the first of the month following the date of the qualifying event.  If the employee misses the 30 day window, they must wait for open enrollment period to enroll in health coverage.

I WANT TO CHANGE MEDICAL AND/OR DENTAL PLANS……..HOW DO I DO THAT?
You can only change medical and/or dental plans at open enrollment unless you’ve experienced a Qualifying Life Event, in which case you should contact the Benefits Department right away.

WHAT IS THE RATE FOR “EMPLOYEE ONLY” COVERAGE?
RUSD premiums (rates) are “Composite Rates,” which means that Employees will pay one rate regardless of how many dependents they have enrolled.  We do not currently offer “tiered” rates for Employee only, Employee + Spouse, Employee + Children or Family, etc.

WHAT IF THE EMPLOYEE IS A 10 MONTH RATHER THAN 12 MONTH EMPLOYEE?  HOW ARE BENEFIT PREMIUMS PAID?
All RUSD employees, regardless of whether they are a 10 or 12 month employee, pay benefit premiums 10 months out of the year, and ARE fully covered year round.  There are no deductions in July & August.

I’VE HAD AN INCREASE OR DECREASE IN MY WORK HOURS…WHAT HAPPENS TO MY BENEFIT PAYROLL DEDUCTIONS?
If you have had an increase or decrease in hours that affects your benefit deductions, the Benefits Department will change your deductions.  You do not need to do anything.  The payroll deduction amounts for various work week hours are listed on page 10 of the Employee Benefits Guide .

WHEN WILL THE EMPLOYEE RECEIVE THEIR MEDICAL ID CARDS?
Typically about two weeks.  Our insurance carriers and Third Party Administrators (TPA’s) receive a weekly electronic file feed that contains all employee benefits adds/changes/deletes from entries that the RUSD Benefits Department staff enters into our systems, or that are entered into the online “AFenroll” system during Open Enrollment.  It typically takes the carriers two business days to update their systems.  ID Cards will be mailed 7 to 10 business days following the carrier system update. 

The employee can always call their Kaiser (VEBA) or PPO/EPO (Delta Health Systems) administrator for their Group# and ID# should they require it prior to receiving the actual ID card.

HOW LONG WILL MY CHILD DEPENDENT BE COVERED?
Child dependents are covered until age 26 and will be terminated from health coverage on the first of the month following their 26th birthday.

WHAT ARE “VOLUNTARY PRODUCTS”?
In addition to the standard medical and dental insurance offerings available at enrollment, employees may elect some non-standard, and optional (or “voluntary”) benefits.  These may include extra life insurance, disability insurance, and specialty cancer, critical care and accident insurance products offered through either Pacific Educators or American Fidelity companies.  There is an additional cost to the employee for choosing any of these products.

HOW ARE VOLUNTARY PRODUCTS PREMIUMS PAID?
Employees who enroll in voluntary products described above will have the additional premiums deducted from their paychecks. The premiums vary depending on which product or products are purchased.  For American Fidelity products, premiums are deducted in the same month as the coverage is for, while premiums for Pacific Educators’ products are taken out a month in advance of the effective coverage date.

WHAT IS A FLEXIBLE SPENDING ARRANGEMENT?
A Flexible Spending Arrangement, or “FSA”, is essentially a spending account (AKA: Flexible Spending Account) which the IRS regulation section 125 (thus the term “Section 125 plans”) allows employees to make payroll deduction deposits into in order to later pay for eligible medical (via an “Unreimbursed Medical Account” / “Health Care FSA”) or dependent care expenses (via a “Dependent Care Account”) on a pre-tax basis.  This creates an income tax savings for the employee.  The amount each employee may contribute to such accounts is limited by IRS regulations, and is subject to “use-it-or-lose-it” provisions, so it is important to carefully estimate your planned expenses in order to not lose your contributions at the end of the year.  At RUSD, unused account balances over $500 cannot be carried over into the next calendar year and are forfeited, while at some employers, all unspent amounts are forfeited.

WHAT IS “VEBA”?
Generically, a VEBA is a Voluntary Employee Beneficiary Association.  Such associations are trust funds permitted under US tax law, whose purpose must be to provide employee benefits.  Locally, RUSD is associated with the California Schools VEBA, based out of San Diego.  While this VEBA trust offers a variety of employee benefit plans, RUSD currently only purchases its Kaiser HMO plan through this VEBA, as we self-insure our other medical plans.

WHAT IS A “DEDUCTIBLE” AND HOW LONG DOES IT COMPARE TO A “CO-PAYMENT”?
A deductible is an amount you must pay each year for covered health care services before your medical plan begins to pay claims in that year (though some services are exempt from the deductible, depending on your plan).  A co-payment is an amount (either a fixed dollar amount or a percentage of allowed charges) that you pay even after your deductible is met.  For example, you may have met your deductible for the year, but you would still owe your plan’s $20 co-payment amount for each office visit.

WHAT IS MEANT BY “OUT-OF-POCKET MAXIMUM"?
This is the largest amount you would have to pay for covered services in a plan year, in the form of deductibles and co-pays, before your plan begins to pay 100% of allowed charges.

I’M ON A LEAVE OF ABSENCE….HOW DO I PAY FOR MY BENEFITS WHILE I’M NOT WORKING?
Call the Benefits office so we can discuss your options.  Some leaves allow continuation of benefits, and other leaves do not.

I’VE RETIRED OR I’M GOING TO RETIREE SOON……WHAT DO I NEED TO DO TO CONTINUE MY BENEFITS?
Once the Personnel Dept. has notified the Benefits Dept. of your retirement, we will send you a letter asking you to call the Benefits Department and schedule an appointment to switch to retiree benefits.

I’M RESIGNING…….HOW DO I CONTINUE MY BENEFITS ON COBRA?
Once the Benefits Department has been notified of your termination, a COBRA letter will be mailed to you.  If you want to enroll in COBRA, please call the Benefits Department to make an appointment to come in and fill out the appropriate paperwork.

WHO DO I CALL TO FILE A DISABILITY CLAIM?
You will need to call the company that you have your disability policy with to request a claim form.  There are different companies that have disability plans.  If you are not sure what company you have, you can call the Benefits Department for more information.

HOW DO I FILE A LIFE INSURANCE CLAIM?
Please contact the Benefits office to fill out the forms to request a payout of a life insurance (death) claim.  You will also need a “certified” original copy of the death certificate to process the claim. 

I WANT TO CHANGE MY BENEFICIARY ON MY LIFE INSURANCE…….HOW DO I DO THAT?
You can change your life insurance beneficiary at any time during the year.  You may either come into the Benefits Department to fill out a new beneficiary form, or download the beneficiary change form from the RUSD Benefits website and return the completed form to the Benefits Department.

WHY WON'T THE DISTRICT CONTRIBUTE MORE TO MY MEDICAL PLAN, IF MY SPOUSE AND I ARE BOTH EMPLOYEES OF THE DISTRICT, AND ONE OF US IS WAIVING BENEFITS?
The short answer is that this is a negotiated item.  There is a stipend available when both parties are RUSD employees and the one waiving benefits is certificated or management (see page 10 of the Employee Benefits Guide for amounts).  The bottom line is that since both parties receive the same coverage under one partner’s insurance, there is little reason to raise the cost of insurance for everyone by allocating an unnecessary premium allowance for the second party who is already covered.

 

Workers’ Compensation

WHAT IS WORKERS' COMPENSATION? 
When an employee is injured on the job, California law requires the employer to pay for medical treatment (and some other related expenses) necessary to cure or relieve the symptoms of the condition caused by the injury.  In that sense, in its most basic form, workers’ compensation (or “work comp”) is like medical insurance, but it’s limited to treating the condition caused by work.  There are other benefits involved for employees who are temporarily or permanently disabled as a result of the injury, but those can be explained on a case-by-case basis by our Work Comp Department.

WHO IS COVERED UNDER THE DISTRICT'S WORKERS' COMPENSATION? 
All employees, substitutes and authorized adult volunteers are covered by workers’ compensation from day one of their employment.

WHAT DO I DO IF I'M INJURED AT WORK? 
If the injury is severe enough to require an ambulance, call 9-1-1 first.  Otherwise, immediately call the RUSD Workers’ Compensation office at 951-788-7135, ext. 80610.  Also, be sure to report the incident/accident to your supervisor.

WHAT IF I DON'T FEEL THE NEED FOR MEDICAL TREATMENT? 
Report it anyway!  You never know when something minor can turn into something major.  Reporting an incident doesn’t mean you have to go for immediate medical care, but is an important step for protecting your workers’ compensation benefits.  You can always decline medical treatment.

WILL I GET FIRED FOR FILING A WORKERS' COMPENSATION CLAIM? 
No, you cannot be fired or discriminated against for filing a legitimate workers’ compensation claim.  Filing a fraudulent claim (i.e., claiming an injury occurred at work when you’re not really injured, or it happened elsewhere) however is a crime, and can of course cause you both legal and employment issues.

WHAT IF I HAVE WORK RESTRICTIONS? 
The district has an excellent Temporary Modified Work program.  You may be able to continue working with restrictions, and we can frequently arrange temporary modified duties.  Please call the district Workers’ Compensation office with questions.

WHAT IF I'M TAKEN OFF WORK?  DO I HAVE TO USE MY SICK LEAVE?  WHAT IF I DON'T HAVE SICK LEAVE?   
It depends.  One of the benefits of workers’ compensation is temporary disability benefits.  These benefits may replace a portion of your pay as compensation for lost wages.  Eligible employees may also be able to use Workers’ Compensation Leave Time.  Please call the District Workers’ Compensation office with questions.

AM I ABLE TO GO TO MY OWN DOCTOR FOR A WORK RELATED INJURY? 
You will have to go to the designated work comp clinic unless you have predesignated your personal physician to treat you in the event of a work related injury, and have done so prior to any injury.  To predesignate, your physician must accept workers’ compensation patients (many do not), and must have your records as a patient already.  If you have predesignated a personal physician (forms available from the Work Comp Office) and you suffer a work injury, you must advise the Work Comp Office that you have a physician pre-designation form on file PRIOR to obtaining any medical treatment.

SHOULD I GET AN ATTORNEY WHE I HAVE A WORK COMP CLAIM?  DO I NEED AN ATTORNEY? 
You have that right, but that’s a question you have to answer for yourself.  The District Workers’ Compensation Office is here to help you navigate what can sometimes be a complicated system and should be able to help you through the entire process.  However, should you feel your issues are not being properly addressed, you have options besides hiring an attorney.  Besides working with the District’s Work Comp Office, you may also contact your claims administrator (York Risk Services Group) at 951-231-6826 or your local Information & Assistance (I&A) Officer (Riverside) at 951-782-4347.

DO I HAVE TO PAY FOR TREATMENT OR PRESCRIPTIONS, OR ARE THERE ANY CO-PAYS OR DEDUCTIBLES?  
No.   Workers’ Compensation medical care is paid for 100%, with no cost to you.

 

Risk Management

A GROUP OR TEAM AT OUR SCHOOL IS ATTENDING AN EVENT, AND THE HOST IS REQUIRING A "CERTIFICATE OF INSURANCE."  HOW DO I GET A CERTIFICATE OF INSURANCE? 
Provide Risk Management with the following information: 

(1) Name and contact information of requesting party;

(2) Type(s) of insurance they are asking to certify for (usually just General Liability, or not stated, but advise if other);

(3) Brief description of event in question, along with its date, location, time; and

(4) Are they are also requesting to be named as an “Additional Insured” or asking for “Additional Insured Endorsement” (or no mention of either). 

Please be sure to make your request at least one week prior to the event.

OUR SITE OR DEPARTMENT EXPERIENCED PROPERTY DAMAGE (E.G., FIRE, VANDALISM) OR THEFT.  HOW  DO WE GET THE REPAIR OR REPLACEMENT PAID FOR?
You will need to obtain an RUSD Property Loss Form from Risk Management.  Please complete the form and have it signed by the site administrator, then return it to Risk Management along with a quote to repair/replace the property that was damaged or stolen.  Please remember that there is a $250 deductible the site/dept. will be responsible for.  Also note that larger items are reimbursed only at “actual cash value” (i.e., the value it had at the time of loss) rather than “replacement cost” (i.e., the cost of a new item).

A STUDENT WAS INJURED ON CAMPUS, AND PARENT WANTS TO BE REIMBURSED FOR MEDICAL EXPENSES OR CLAIM DAMAGES.  HOW DO THEY DO THAT?
If they are seeking to only be reimbursed for medical expenses (e.g., ambulance, deductible) not covered by their own insurance, provide them with the ASCIP “AG Administrators Student Injury” insurance form.  Make sure you complete and sign the top portion of the form before giving it to the parent.  Parent then completes the bottom section and submits per instructions.

If they are seeking remuneration of any sort above and beyond non-covered medical expenses, they would need to file a claim against a public entity.  They may obtain a Claim for Damages Form from Risk Management.  An investigation and legal process will then ensue to determine whether or not the District has any liability in the situation.

A PARENT/VISITOR WAS INJURED ON CAMPUS AND WANTS TO BE REIMBURSED FOR MEDICAL EXPENSES OR CLAIM DAMAGES.  HOW DO THEY DO THAT?
They would need to file a claim against a public entity.  They may obtain a Claim for Damages Form from Risk Management.  An investigation and legal process will then ensue to determine whether or not the District has any liability in the situation.

A THIRD PARTY (I.E., NOT THE SITE/DEPT) EXPERIENCED PROPERTY DAMAGE (E.G., AUTO ACCIDENT) AND CLAIM THE DISTRICT IS RESPONSIBLE.  WHAT DO THEY DO?
They would need to file a claim against a public entity.  They may obtain a Claim for Damages Form from Risk Management.  An investigation and legal process will then ensue to determine whether or not the District has any liability in the situation.