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Group Health Plan
GROUP HEALTH PLAN (pre-tax or post-tax benefit)
Notice: The Ashland School District Group Health Plan
follows the requirements of the Affordable Care Act.
Eligibility:
All certified employees working 20 hours or more per week and a minimum of ten months per calendar year qualify for medical/dental/vision.
All classified, confidential and supervisor employees working 20-29.99 hours per week and a minimum of ten months per calendar year qualify for medical only.
All classified, confidential and supervisor employees working 30 hours or more per week and a minimum of ten months per calendar year qualify for medical/dental/vision.
All classified, confidential and supervisor employees working 30 hours or more per week and a minimum of ten months per calendar year qualify to add spouse, children and/or family coverage.
Classified employees only - may opt-out of the group health plan and receive a $200 per month cash incentive with proof of coverage through another plan. Opt Out Form
Medical coverage is provided by HMA (Healthcare Management Administrators). HMA provides access to claims and benefit information through our member portal, myHMA. Upon receipt of your ID card you can access HMA by going to www.accesshma.com and selecting the myHMA Member login button and then clicking on the “register now” link. For step by step directions on how to register in the member portal, CLICK HERE. For step by step directions on how to find a provider, CLICK HERE.
Medical Coverage Changes for 2022
The new out of pocket maximum will be $3000 per individual and $9000 per family.
Copays for PCP will be $20, specialist $35, urgent care $40 and ER $100.
Massage therapy visits will increase to 24 per calendar year retroactive to January 1, 2021.
All members will receive 2 new ID cards via US Postal Service in the later part of December to be used beginning January 1st. All members will have a single card that is shared between their dependents. If you need extra cards, you may order, print or download them online via the HMA website once you register at www.accesshma.com.
You do not have to complete new enrollment paperwork, as we have already provided HMA with your current information.
Only complete the HMA Enrollment Form and the Pre-Tax Benefits Deduction Authorization Form if you are enrolling or making any changes to your current benefits.
Benefit summaries and plan descriptions will be posted at a later date. Benefits for 2022 will be covered at the same in and out-of-network levels as 2021.
2022 Medical/Dental/Vision/Pharmacy Summary Plan Description
As required by Health Care Reform, a Glossary of Health Coverage and Medical Terms is provided.
Premiums will remain the same for 2022.
Dental Coverage:
There are no-changes to dental benefits.
Benefits will be administered by HMA.
HMA has a network of dental providers. Out of network dental providers will be reimbursed at 85% of the usual and customary rates. To find an in-network dentist go to www.accesshma.com. View the In-Network Dental Providers Guide
Vision Coverage:
There are no changes to vision benefits Benefits will be administered by HMA.
To find an in-network provider www.accesshma.com. View the In-Network Vision Provider Guide.
Pharmacy Coverage:
Navitus Health Solutions is our pharmacy provider. Member Brochure
You can register online with Navitus Health Solutions https://members.navitus.com
Navitus also has a mobile app for your convenience
Mail Order Program and Copays changes 2022:
Copays have decreased for preferred brand, non-preferred brand and specialty products.
Mail Order Pharmacy
Please send mail order prescriptions to Costco Pharmacy. It is easy to begin using Costco Pharmacy. You can register online at pharmacy.costco.com. Please allow 10 to 14 calendar days from the day you submit your order to receive your medication(s). You do not need to be a Costco member to use Costco Pharmacy.
Specialty Pharmacy
Navitus SpecialtyRx serves members who are taking medication(s) for certain chronic illnesses or complex diseases such as rheumatoid arthritis, multiple sclerosis, cancer and hepatitis C. To receive specialty medications through the pharmacy benefit, you will need to fill these prescriptions at Lumicera Health Services. Ordering new prescriptions through our specialty pharmacy partner, Lumicera Health Services is simple. Just call a patient care specialist at 1.855.847.3553 to get started. They will work with you and your prescriber to get your prescription set up.
$30 for generic products (90 day supply)
$60 for preferred brand products (90 day supply)
$90 for non-preferred brand products (90 day supply)
$120 for specialty products (90 day supply)