Health Benefits Info
Connecting employees to benefits. BenefitSolver is our online health benefits enrollment platform, available to you 24/7. To enroll and/or change your benefit elections, including changing your beneficiary, login or create an account by selecting the button below and get started on making your elections or changes for you and your family on insurance coverage. If you need to change your name or address, please contact the Central USD Human Resources Department.
For questions concerning your benefit election changes, enrollment or MyChoice Flex Spending Account, please contact BenefitSolver Customer Service at 888-907-1395.
LIFE EVENTS: You can get or make a change in health coverage if you have experienced a qualifying life event. A qualifying life event is a change in family status as defined by the IRS. Examples include, but are not limited to, the following: marriage, divorce, birth or adoption, death of a spouse or child, loss of coverage from another health plan. You will have 30 days from the date of the event to make your change. Login to www.benefitsolver.com to make your change.
Annual Open Enrollment is in November for an effective date of January 1st.
Form 1095-C or 1095-B has been made available to you and can now be obtained electronically. To view your document, log in to www.benefitsolver.com and visit your 'Personal Documents' from the upper right-hand corner under your name.
Health Benefits Department
Letty Dominguez
Benefits Specialist
5652 W Gettysburg
Fresno, CA 93722
Phone: (559) 274-4700 Ext. 12103
FAX: (559) 276-5515
Central Unified School District maintains a self-insured bundled plan for medical, prescription, dental, vision and life Insurance benefits. The Benefit Document & Summary Plan Description of the Health Care Benefits (SPD) provides information on these benefits.
All contract employees, trustees, and their dependents, as defined in the SPD, are eligible for coverage. The employee must enroll in the health plan within 30-days from their employment date.
***For dependent (see definition of "dependent" in the SPD) status changes, such as adding or deleting dependents, there is a 30-day window from the eligibility date to add/delete dependents. Please login to www.benefitsolver.com to make your change. ***
- Flu
- Sore throat
- Pink eye
- Bronchitis
- Sinus infection
- Rashes
- Allergies
- and more
NEED A DOCTOR, MEDICAL FACILITY, OR DURABLE MEDICAL EQUIPMENT? We are contracted with Anthem Blue Cross to access their network of preferred providers (for in-network mental health therapists, please scroll down to Halcyon). Before scheduling your visit, follow the instructions below to search for an in-network provider from the Gold or Bronze plan; see flyers below. Bronze Plan members must use an in-network provider otherwise, not covered.
Advantek Member Services: 866-556-7655
Halcyon EAP/MHSA: 888-425-4800
PhysMetrics By Simple Therapy: 877-519-8839
RX Benefits: 800-334-8134
Delta Dental: 866-499-3001
EyeMed: 844-409-3401
HealthiestYou: 866-703-1259
Advantek Member Benefits: 866-556-7655
You will use your Advantek Member ID card to access your pharmacy benefits.
RxBenefits LCV Drug Alternatives
RxBenefits Premium Formulary - January 2024
RxBenefits Tier Changes - January 2024
January 2024 - 90 day Retail Drug List
RxBenefits Member Portal Instructions
Premium Formulary Link:
https://www.optumrx.com/oe_premium/prescription-drug-list
By registering for My RX Benefits members will be able to:
- View pharmacy benefits coverage
- Establish and manage your communication preferences
- Access real-time prior authorization status, including explanations of decisions, and view 18 months of previous prior authorization activity
- Receive timely communication and personalized updates for alternative medication therapies related to anti-inflammatory and dermatological conditions
- View 18 months of pharmacy claims (including claims for eligible dependents)
- View, download, and email a copy of your ID card for yourself or covered family members
- Access your pharmacy information from different devices, including desktops and mobile browsers
SAVE THE DATE!
HALCYON OPEN FORUM - FRIDAY, APRIL 26, 2024
FROM 3:30PM TO 4:30PM AT CENTRAL USD DISTRICT OFFICE ROOM 4;
FOR THOSE WHO CANNOT ATTEND IN PERSON, A ZOOM LINK WILL BE MADE AVAILABLE.
EMPLOYEE ASSISTANCE PROGRAM (EAP) AND MENTAL HEALTH BENEFITS INFORMATION
You will use your Advantek Member ID card to access your benefits through Halcyon.
Halcyon Employee Assistance Program (EAP) provides Central Unified Health Plan members, including dependents, with no-cost confidential counseling services (three sessions every six months).
At some point in our lives, each of us faces a problem or situation that is difficult to resolve. When these instances arise, Halcyon will be there to help. Halcyon EAP is there to help you deal with life’s challenges and the demands that come with balancing home and work. The program provides confidential, professional counseling for a wide array of personal and work related concerns.
Access Halcyon Employee Assistance Program Services:
Toll-free: 888-425-4800
web: www.halcyoneap.com
Login for Patient Web page: centralusd
Halcyon Behavioral provides Central Unified Health Plan members with mental health, nervous and substance abuse disorder behavioral health services. To use your mental health benefits, please call: 559-400-6240. A licensed mental health clinician will assess your needs and will provide a referral to a contracted therapist who provide appropriate care. You can also visit: https://centralmhsa.com/ to find an in-network mental health provider.
Have you used an out-of-network provider? You can request a partial reimbursement of your out of pocket expenses. Members can ask for a "superbill" from the provider. The superbill should contain all the information needed to complete the Halcyon Medical Claim Form. This will include a diagnosis code, a CPT code, and a charge for the service provided. You will need to send a copy of the form along with a paid receipt to Halcyon Behavioral.
You may send the form via fax, mail or secure email:
- Fax number: 855-486-1341
- Mailing address: Halcyon Behavioral, P.O. Box 25159, Fresno, CA 93729-5159
- Secure email link (click to access) : Halcyon Behavioral Secure Message Center - You will need to Register for secure email access.
Questions? Call Customer Support: 559-400-6240
Please click here for information about Attention-Deficit/Hyperactivity Disorder (ADHD) treatment.
CONTACT PHYSMETRICS MEMBER SERVICES FOR PHYSICAL MEDICINE OR CHIRO BENEFITS: 877-519-8839
You will use your Advantek Member ID card to access your Physical Medicine and Chiro benefits.
PHYSICAL MEDICINE INFORMATION
Contracted provider search link is www.centralusd.physmetrics.com
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- Outpatient Physical Therapy
- Outpatient Occupational Therapy
- Outpatient Speech Therapy
- Acupuncture (For Pain Management Only)
CHIROPRACTIC BENEFITS INFORMATION
Contracted provider search link is www.centralusdchiro.com
Visit: https://www1.deltadentalins.com/members.html to find a dentist in the Delta Dental PPO network.
Important note: When searching for an in-network dentist, the results will show Dentists who participate in the network You searched. When calling a dental office for an appointment, please be sure to schedule it with a Dentist on this list in order to receive coverage under Your preferred network.
You will use your Advantek Member ID card to access your dental benefits.
Click: Delta Dental PPO Highlights to view your dental benefit summary.
Be sure to ask for a Pre-treatment estimate before you schedule your procedure. Feel free to browse through the Delta Dental flyers below!
DELTA DENTAL FLYERS - Resources at your fingertips
To maximize your benefits, schedule your visit with an in-network provider. Register for an account with www.eyemed.com to search for a Plus Provider and/or in-network provider.
You will use your Advantek Member ID card to access your vision benefits.
Advantek Benefit Administrators is our third-party administrator who handles claims processing, Explanation of Benefits (EOB), medical/lab billing issues, member ID cards, and questions concerning your medical benefits. When you enroll in benefits with Central USD, you will receive your medical ID card from Advantek. You will use this member ID card to access all of your benefits. If you have not received your medical ID card or need a replacement, please contact Advantek Member Services or login to your Advantek Member Portal to access a digital member ID card. If you need to change your name or address, please contact Central USD Human Resources Department.
The Advantek Member Portal is available around the clock and offers access to the following:
- View Health Plan Benefit Summaries
- View Eligibility Cards
- Order Eligibility Cards
- View Claims / Explanation of Benefits (EOB)
- Sign-up for Paperless Explanation of Benefits (EOB)
- Message Customer Service
- Links to Ancillary Vendors
- Other Self-help Resources
Please visit www.advantekbenefits.com to create an account.
The information available in the below link is provided in good faith to comply with the Machine-Readable Files (MRF) provision of the Transparency in Coverage Final Rule (TCFR). These files are extensive collections of data to be ingested and read by machines and are not intended for member use. Access files [link]. To learn more about the TCFR and the MRF provision, refer to the Centers for Medicare & Medicaid Services webpage.