Insurance

Danville School District No. 118 Health and Vision Insurance Information


Important Documents (Click links to open):

Plan Summary
HIPPA Health Alliance
Enrollment Form



District employees can register an account online to see claims, create provider directory, preauthorization status and much more by following these simple steps:

-Go to www.healthalliance.org
-click on “Your Health Alliance Login”
-Click on “register” and follow the on-screen instructions for setting up your account. You will need your member ID handy.

Under the “Plan Detail” tab is where you can see claims, preauthorization status, create a provider directory, request a new ID card, etc. For questions or assistance, call Health Alliance at 1-800-851-3379.

Group Health Plan Information
If you need information for Health Alliance, utilize their website www.healthalliance.org or contact Health Alliance at 1-800-851-3379

All claims should be mailed to the following address within 120 days:
Health Alliance
PO Box 6003
Urbana, IL 61803-6003


Please call Health Alliance at 1-800-851-3379 for assistance with any questions you have regarding covered services or the payment of claims.

Pre-Certification Requirement
CLICK HERE to see the pre-authorization requirements from Health Alliance

Notice of Group Health Coverage Continuation Rights
The Consolidation Omnibus Budget Reconciliation Act (COBRA), known as Public Law 99-272, requires that the District notify you of coverage available under this federal law. Please read the following information carefully so that you can make an informed choice about the benefits available to you.

WHEN CONTINUED COVERAGE APPLIES
You may elect up to 18 months of continued health coverage for yourself and your dependent if your coverage would otherwise end due to:
1. Your voluntary or involuntary termination of employment (unless for gross misconduct); or
2. A reduction in your work hours to fewer that the minimum needed to remain eligible for the plan.

You may elect up to 36 months of continued health coverage for yourself if you are an employee’s dependent whose coverage would otherwise end due to:
1. The employee’s death
2. The employee’s divorce or legal separation from his or her spouse
3. The employee’s eligibility for Medicare
4. Dependent child’s attainment of limiting age

You may elect up to 36 months of continued health coverage for yourself if you are an employee’s child whose coverage would otherwise end because you no longer qualify as the employee’s dependent as defined under the plan.

If you or your dependents qualify under one of the conditions listed above, you must complete the election form within 60 days of eligibility. You will be required to pay the full cost of the coverage plus 2% of the premium as a handling expense.

Extended coverage may be stopped if the following conditions apply:
1. You obtain coverage under another group plan or Medicare
2. You so not pay the required premium
3. Coverage for a dependent may be stopped if the spouse remarried and has other group coverage, becomes entitled to Medicare or does not pay the required premium.

Vision Service Plan Documents (Click on link to open):

Coverage At A Glance
VSP Remove Dependent Form
Vision Service Plan Enrollment Form
Out of Network Reimbursement Form

Provider Contact Information

Medical Coverage
Health Alliance
PO Box 6003
Urbana, IL 61803-6003
1-800-851-3379

Benefit Planning Consultants (BPC)
1-217-531-9000
www.bpcinc.com

 Prescription Coverage
Catamaran
PO Box 968022
Schaumburg, IL 60196-8022
1-800-851-3379
Vision Service Plan (VSP)
PO Box 997105
Sacramento, CA 95899-7105
1-800-877-7195
Group # 12-001821-001-001
www.vsp.com
Eye Care Providers

Chittick Family Eye Care
1104 N. Vermilion
Danville, IL 61832
217-442-2631

Gailey Eye Clinic
478 E. Liberty Lane
Danville, IL 61832
217-446-3937


 

No claim form or card is necessary. Just contact the providers above and let them know you are a District 118 employee with the VSP plan.

Danville School District No. 118 Health Insurance Rates Health Insurance and Vision Plan Rates

Employee Expense Per MONTH for Health Insurance (26 pays per year, lesser pays are higher premiums) Effective January 1, 2015

  Health Plan Vision Service Plan
Monthly Premiums    
Employee Coverage $11.00 Board Paid
Optional Dependent Coverage    
   One Dependent
   Two Dependents
   Three or More Dependents
$300
$325
$350
$11.00
$11.00
$11.00 
Deductions PER PAY when
both husband and wife are
District No. 118 employees
and elect family coverage
$0 $3.38

All Union Custodial and Food Service employees, please refer to your contract for your rates and co-pays.

POSC Plan In-Network Out-of-Network
Summary of Plan Benefit    
Co-pay Primary Care Physician
Co-pay Specialist
$25.00
$50.00
50%
50%
Annual Deductible    
Individual
Family
$500.00
$1,000.00
$15,000
$45,000
Maximum Out of Pocket    
Individual
Family
$2,100
$4,200
$45,000
$120,000
Note: Absolutely all co-pays apply to the maximum out of
pocket including pharmacy co-pays.

Co-pay Emergency Room $200 $200
Maternity
Routine prenatal care
Maternity inpatient
Newborn Care
0%
0%
0%
50%
50%
50%
Preventative and Wellness Services
Immunizations, adult and child annual physical
Exams, mammograms, PAP smears, prostate
screening and more.
Age/frequency schedules apply 
 $0 50%
Prescription Drugs    
30-day Supply    
Rxtra - must use participating pharmacy for Rxtra
drugs. CLICK HERE for an Rxtra drug list.
$0 Not Applicable
Generic - Tier 1
Brand - Tier 2
Non-preferred Brand - Tier 3
$7
$25
$50
50%
50%
50%
Specialty Pharmacy/Medical    
Preferred - Tier 4
Non-preferred - Tier 5
Non-formulary - Tier 6
$100
$150
50%
50%
50%
50%

All union Custodial and Food Service employees, please refer to your contract for rates, co-pays, plan description, etc.


Women's Health and Cancer Rights Act
December 1998

Dear Participant or Beneficiary,

On October 21, 1998, Congress passed a bill called the Women’s Health Care and Cancer Rights Act, also known as “Janet’s Law”. This law imposes new requirements on group health plans to provide benefits for reconstructive surgery following a mastectomy when mastectomy is a covered benefits under the plan.

As you know, for a number of years, the Danville Community Consolidated School District 118 Group Health Plan has provided coverage for mastectomies. As part of this coverage, the Plan also covered the procedures necessary to effect reconstruction of the breast on which the mastectomy was performed. As well as the cost of prostheses (implants, special bras, etc.) and physical complications of all stages of mastectomy; including lymph edemas, as recommended by the attending physician of any patient receiving Plan benefits in connection with the mastectomy in consultations with the patient. However, the Plan did not cover any surgery and reconstruction of the other breast to achieve a symmetrical appearance.

Effective for the Plan year beginning February 1, 1999 for any participants or beneficiary of the Plan who currently is receiving Plan benefits for a mastectomy, the Plan will provide coverage for any necessary surgery and reconstruction of the breast on which a mastectomy was not performed in order to produce a symmetrical appearance.

This new coverage will be subject to the same deductibles and co-payments that apply to mastectomies under the Plan’s current terms (see the Danville Community Consolidated School District 118 Group Health Plan Summary Plan Description for details of the Plan’s deductible and co-payment requirements for mastectomies).

 






 

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