FAQs for Health Plans

If the deductible or a portion of it is met in the last quarter of the year will those expenses apply toward the following year’s deductible?

No, you must meet a new deductible every calendar year.

What is preventive care?

Allowable expenses, also known as preventive care, fall under section 502 of the IRS Code.  Most descriptions of preventive care can be found at Department of Managed Health Care and HealthCare.gov.  

Do benefits for Durable Medical Equipment under the Aenta POS plan apply to the deductible and out-of-pocket maximum?

The Durable Medical Equipment benefit under the POS plan is first subject to the deductible. Once the deductible is met, the member is liable for the coinsurance amounts and it will apply towards the out-of-pocket maximum.

Will I receive my new insurance ID card by the beginning of the new plan year on June 1st? If not, will this affect my ability to access benefits?

Every attempt will be made to ensure that your new ID cards will be delivered by June 1st. However, if you do not receive your card by that date, you may continue to access benefits. Since your information has been sent to the carriers, your information is on file and your health care providers will be able to verify your coverage. You may also download the mobile apps for Aetna and Kaiser to access your ID card(s) electronically.

Can my dependents enroll in a different plan than the one I select for myself?

No, if you are enrolling your dependents, they must enroll in whichever plan you have selected for yourself.

How long may my dependent children remain on my benefits plans?

Dependents are covered until the end of the month in which they turn age 26.

What is a Qualifying Life Event (QLE)?

A qualifying life event (QLE) is a change in your or your dependent's personal lives which may allow you to add, change or terminate some of your benefit elections. If you have experienced a qualifying life event, you must notify us within thirty (30) days of the qualifying life event date in order to make a change to your benefits. If the thirty (30) days has past, you must wait until the next open enrollment period to make the change. Some examples of qualifying life events are:

  • Change in your marital or domestic partner status, including marriage or meeting the six (6) month requirement for domestic partnership, death of spouse/domestic partner, divorce or dissolution of partnership, legal separation, or annulment.
  • Change in the number of your dependents, including a change due to birth, adoption, or loss of dependent status (e.g., a child reaches the age limit under the plan, at the end of the month in which they turn age 26, or is no longer eligible as a dependent).
  • Change in your employment status, including beginning or termination of employment, beginning or returning from an unpaid leave of absence, sabbatical, and a change to/from part-time employment.
  • Change in your spouse/domestic partner or dependent's employment status, causing a gain or loss of health coverage for you or your dependent. Some examples are beginning or ending employment, increasing or decreasing hours, strike or lockout.
  • Changes associated with your spouse/domestic partner's open enrollment period, including changes in the type and cost of their coverage like a gain or loss of eligibility for you, your spouse/domestic partner, or your dependents.
How do I make changes to my benefits if I experience a qualifying life event?

Please notify the Human Resources Department of the change; you will be asked to complete a qualifying life event update in Manage My Benefits.  You must complete the process on Manage My Benefits within thirty (30)  days of the qualifying life event date. You will also need to provide the required documentation for your qualifying life event in order for the change to be effective. We will accept a letter with the effective date from the new/former insurance company or another new/former HR department.

Please contact us for more information about qualifying events, as this list is not inclusive of all events.

What is the plan year for Cal Lutheran's benefits plans and when do my calendar year deductibles and annual out of pocket maximums renew?

The Cal Lutheran medical, dental, vision, life, accidental death and dismemberment (AD&D) and long-term disability (LTD) plans operates on the June 1st through May 31st plan year. However, for the purposes of deductibles and annual out of pocket maximums, these plans operate on a calendar year. That means beginning every January you must meet your deductible again.

How/when can I add or drop health/dental/vision insurance coverage?

Generally, you can only add or drop health, dental and/or vision insurance coverage during our plans' open enrollment period, which is from April to May each year for a June 1st effective date. However, if a change in your or your spouse's employment or qualifying life event, such as marriage, divorce, birth, or death, then coverage may be added or dropped during the plan year provided the request is made within 30 days of the change and provided the appropriate paperwork is received from you.

Is my doctor/dentist participating in our healthcare/dental plans?

You can check if your doctor and/or dentist is participating in our plans by either looking in the plan's provider directory which is available on-line (links available on the Employee Benefits page). Since doctors may change participation, it is also a good idea to ask the doctors/dentist office when scheduling your appointment whether or not they are a "contracted provider" in your medical, dental, or vision plan.

When is open enrollment for benefits?

Annual Open Enrollment for benefits is from April to May for a June 1st to May 31st plan year. Annual Open Enrollment for the Flexible Spending Account will be in November for January 1st to December 31st plan year.

Do our medical insurance plans have restrictions for pre-existing conditions?

Cal Lutheran's Kaiser HMO, Aetna HMO's, and Aetna POS + HSA medical plans do not have any restrictions for pre-existing conditions.

What's the primary difference between the POS and the HMO?

A Health Maintenance Organization (HMO) only provides care from a network of physicians and hospitals which is authorized in advance by an individual's primary care physician. We currently offer three HMO options; Kaiser HMO, Aetna HMO, Aetna HMO Deductible.

A Participating Provider Organization (PPO) is a network of physicians and hospital providers offered by Aetna to POS members. These providers have agreed to accept the Aetna payment schedule as payment in full for covered services. POS benefits are higher when provided by an in-network provider than by an out-of-network provider.

What is an Health Savings Account (HSA)?

A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit.

What is the Mail Service Prescription Drug Program?

In addition to purchasing prescriptions from your local pharmacy, when you are part of Aetna HMO's or Aenta POS + HSA plans you may order maintenance medications via the mail. It's easy to do! Register with Aetna Rx Home Delivery at https://www.aetna.com/individuals-families/pharmacy/rx-home-delivery.html.  You have three options to send your prescription; ask your doctor to send an electronic prescription for a 90-day supply known as e-prescribing,  by fax directly to (877) 270-3317, or by mail to Aetna Rx Home Delivery, P.O. Box 417019, Kansas City, MO. 64179-7019 with using the Aetna Rx Home Delivery form  .

When does my coverage end after I leave employment at Cal Lutheran?

Coverage ends at 11:59 p.m. on the last night of the month in which your employment with Cal Lutheran terminates. For example, if your end date is June 15th, your coverage ends June 30th at 11:59 p.m.

How do I find out more about Cal Lutheran benefits?

Contact the Human Resources Department with additional questions regarding your Health and Welfare benefits, Workers' Compensation and 403(b) retirement plans. Call extension 3185 for more information.