PYLUSD Health Benefit Information
All current PYLUSD Health Benefits information and rates are located on the menu on the right side of this page.
The 2024-25 Health Benefits Guide is linked below for your convenience.
- Please Note: If you are a PPO member it is IMPORTANT to read information about PPO Outpatient Fees and Surgical Requirements. **Not all procedures will be covered if the authorization process was not complete prior to the procedure**
- Review and learn about additional SISC benefits (e.g. TELEDOC, MAVEN, VIDA, HINGE that may be impactful for you or your family
Enrollment Requirments & Important Information - MUST READ!
- Employees working between 90% - 100% of a 1 FTE are required, per SISC rules, to enroll in a minimum of single medical coverage unless an employee has other coverage. Effective 10/1/24, employees who prefer to decline SISC medical coverage, may elect the *Waiver of Active Benefits (WABE) option at no cost. Employees electing WABE must provide documentation with coverage dates to show proof of an active health plan
- Certificated or Management employees working 50% to 89% of a 1 FTE may decline coverage
- Classified employees working 7.2 (permanent position) hours per day or 36 hours per week may decline coverage
- Certificated and Management employees who work less than 100% FTE pay a higher cost for their benefits (rates are available upon request)
- If an employee declined benefits when the District transitioned to SISC in 2018, they were approved by SISC to be grandfathered, allowing them to continue to decline medical benefits. This allows those employees to decline medical coverage, each year, even though they are considered a mandatory enrollee. If one of those employees chooses coverage at any time in the future, they will no longer be eligible to be considered a grandfathered employee and they must select at least single-party coverage in the future or select the WABE option and provide proof of coverage in another health plan.
- Employees have 31 days from their hire date or return to work to elect coverage or coverage is not guaranteed.
- Termination of Coverage will be effective on the first of the month following the date of termination/resignation/retirement, or the last day worked. The date of resignation or retirement with PYLUSD cannot exceed the last day worked. Any excess premiums paid will be adjusted on the employee's final paycheck.
- Employees are hired on a temporary contract or in the second semester benefits terminate on June 30. However, if a contract for the following school year is assured by Human Resources benefits will continue over the summer months. If an employee during the summer months chooses not to return to PYLUSD, benefits will be terminated retroactively to June 30. The employee will be responsible for all medical services and payments from the date of termination of coverage.
For further information, please contact Viveka (Vee) Rodriguez, Benefits Technician, at 714-985-8476 or [email protected].
Self-Insured Schools of California (SISC) is the District's medical insurance provider