Health Benefits

California State University, San Bernardino offers a comprehensive package of health benefits including medical, dental, vision, flexible benefits program and more.

Benefits Orientation
Benefits Eligibility
Loss of Eligibility - COBRA
Benefits Enrollment
Health Care

• Medical Insurance Plans
• Flexcash Program
• Dental Insurance Plans
• Vision Plan

Flexible Benefits Programs

• Tax Advantage Premium Plan (TAPP)
• Health Care Reimbursement Account (HCRA)
• Dependent Care Reimbursement Account (DCRA)

Health Insurance Portability and Accountability (HIPAA)

Benefits Orientation

Orientations are conducted monthly to assist eligible employees in making informed decisions regarding their benefit choices. Employees eligible for benefits (see Benefits Eligibility Section for details) who have not been scheduled for an orientation, should call extension 75143 (or if off campus, (909) 537-5143) or e-mail lwhite@csusb.edu for a reservation. Attendance at a Benefits Orientation is not mandatory to enroll in the benefits program; however, it is highly recommended.

Benefits Orientation Schedule

Benefits Elibility

Employees qualified for benefits have 60 days from the date of their appointment to sign-up for benefits.

Staff, Teaching Associates & Tenured Faculty (or Tenure Track), and Management Personnel Plan (MPP) employees are eligible for benefits if appointed half-time or more for a period of more than six (6) months.

Lecturers and Coaches appointed based on the Academic Year (AY) calendar for two (2) or more consecutive quarters (one appointment letter) at .4 time base or greater are eligible for benefits. Coaches and Lecturers (Non-academic calendar year) are eligible for benefits if appointed half-time or more for a period of more than six (6) months.

Employees appointed on an hourly, intermittent basis do not qualify for benefits.

An enrolled employee may carryover coverage into a position with an appointment of less than 6 months as long as the time base is half-time or more (.4 for lecturers/ academic-year calendar), and there is no break in service in excess of a full pay period or more. The coverage will continue indefinitely when subsequent appointments of less than 6 months apply, as long as the time base does not fall below half time (.4 for lecturers/ academic-year calendar), there are no breaks of a full pay period or more, and the appointment is a salaried position.

Note: Eligibility for retirement plan membership in the California Public Employees' Retirement System differs from the eligibility for health benefits. See the Retirement Plans section of this site for more information.

Loss of Eligibility

Employees and/or their dependents who lose eligibility for benefits may elect to temporarily continue the medical, dental and/or vision insurances through COBRA (Consolidated Omnibus Budget Reconciliation Act). Under the provisions of COBRA, the member pays the full premium cost plus a 2% administrative fee. Once established, the employee and/or dependent pays the premiums directly to the carrier.

COBRA

Federal Law requires that employers sponsoring group health plans with more than 20 employees offer their employees and their families the opportunity for a temporary extension of health coverage (called "continuation coverage") at group rates, in certain instances, where coverage under the plan would otherwise end.

As an employee, if you are covered by a health, dental and/or vision plan, you have the right to choose this continuation coverage if you lose your group coverage because of a reduction in your hours of employment or the separation of your employment (for reasons other than gross misconduct on your part.)

If you are the spouse/dependent of an employee covered by the health, dental and/or vision plans, you have the right to choose continuation coverage for yourself if you lose group coverage under the health, dental, and/or vision plans for any of the following reasons:

1. The death of your spouse,
2. Separation of your spouse's employment (for reasons other than gross misconduct) or reduction in a spouse's hours of employment, or
3. Divorce or legal separation from your spouse.

In the case of a dependent child of an employee, he/she has the right to continuation coverage due to the following reasons:

1. The death of a parent,
2. Termination or reduction in a parent's hours of employment,
3. Parent's divorce or legal separation,
4. The dependent ceases to be a "dependent child" (age 23, unless permanently disabled and unable to be self supporting).

Under the law, the employee or family member has the responsibility to inform the Human Resources Department of a divorce, legal separation, a child losing dependent status, or Social Security Disability determination within sixty (60) days of the event or the date on which coverage would be lost under the health, dental and/or vision plans, whichever is later.

COBRA Rates

Benefits Enrollment

New Enrollment
To enroll in benefits, newly eligible employees should complete a Benefits Enrollment Worksheet and submit it to the Human Resources Department within 60 days of the effective date of their qualifying appointment. If an employee submits the completed request by the end of the pay period in which their qualifying appointment begins, coverage may begin the first of the following month. The coverage effective date will be delayed if the Benefits Enrollment Worksheet, including all necessary enrollment information, is not submitted in a timely manner.

Note: If you miss the initial 60-day enrollment period, you can still enroll, however, your coverage will not be effective until the first of the month following a 90-day waiting period.

Benefit Enrollment Changes
Employees are allowed to make changes to their benefits during the year if a "major life event" occurs. Such events include:

• marriage,
• divorce,
• birth or adoption of a child,
• gaining or losing custody of an economically dependent child, and
• and death of a family member.

Other events that warrant a change to the employee's benefits are:

• a spouse moving out of the household,
• a child turns 18 years of age, and
• a family member enters the military or obtains other coverage.

To request a change in benefits due to a "major life event" a Benefit Change Worksheet must be completed and submitted to Human Resources within 60 days of the event.

Open Enrollment
An open enrollment period is scheduled each year to allow employees to make changes in their benefits. Currently, the open enrollment period is scheduled from September 17, 2007 through October 12, 2007 with changes effective January 1, 2008. During Open Enrollment, employees can make the following changes:

• Enroll self and all eligible dependents
• Change health or dental carriers
• Enroll in the Flexcash Plan
• Enroll/Re-enroll in the Dependent Care Reimbursement Account
• Enroll/Re-enroll in the Health Care Reimbursement Account
• Enroll/Opt out of the Tax Advantage Premium Plan

Open Enrollment Worksheet | Medical Plan Rates (Excel Spreadsheet)

Family Members Eligible to Enroll

Eligible employees may enroll themselves only, or themselves and all eligible family members (who are not otherwise enrolled as an employee, annuitant or dependent under the Public Employees' Medical and Hospital Care Act-PEMHCA).

The following family members are eligible to be covered by an employee's plan:

• Spouse
• Registered Domestic Partner - Same sex if both are over the age of 18 or opposite sex if at least one is over the age of 62.
  Note: You must include your Spouse or Domestic Partner's Social Security Number on the Benefits Enrollment Worksheet. You must also provide Human Resources with your original Marriage Certificate or Declaration of Domestic Partnership
• Children (Natural, adopted or stepchildren under age 23 who have never married whether or not they may be living with the employee.
  Note: Children under age 23 who marry and subsequently divorce, and the spouse of an employee's child are not eligible.
• A child other than the employee's natural, adopted or step-child, who is living with the employee in a parent-child relationship and of whom the employee has been granted custody or joint custody. Also eligible is a grandchild living in the employee's household in absence of their natural, adopted, or step parent.
  Note: Completion of an Affidavit of Eligibility is required for the addition of a child other than the employee's natural, adopted or stepchild. If the employee's existing enrollment includes a child under this eligibility criteria and the employee requests to add an additional child under this provision, then an Affidavit will be required for the new child, and an updated Affidavit for each existing child currently enrolled.
• An eligible child over age 23 who has never married and who is incapable of self-support because of a mental or physical disability that existed prior to age 23 (refer to the CalPERS Health Program Guide, available through Human Resources).

Medical Insurance Plans

Medical coverage for eligible CSU employees is provided through the California Public Employees' Retirement System (CalPERS) and is governed by the provisions of the Public Employees' Medical and Hospital Care Act (PEMHCA).

Before making your selection, you might want to:

• Review the Medical Plan Rates
• Review the CalPERS Health Benefit Summary for variations between the plans
• Utilize the CalPERS Health Plan Chooser to rank the plans based upon your criteria
• Review the Evidence of Coverage for each plan

Health Maintenance Organizations (HMOs)
HMOs offer a range of health benefits including preventative care. Employees select a primary care physician who coordinates all care including referral to specialists. If you go outside the HMO's provider network without a referral, you may be responsible for the total cost of the services.

• Blue Shield NetValue HMO
  Evidence of Blue Shield Coverage
  Group #:
  Telephone #: 800-334-5847
• Blue Shield Access+ HMO
  Evidence of Blue Shield Coverage
  Group #: PH0001
  Telephone #: 800-334-5847
• Kaiser Permanente HMO
  Evidence of Kaiser Permanente Coverage
  Group #: 105701
  Telephone #: 800-464-4000

Preferred Provider Organization (PPO)
PERS Choice, PERS Care and PERS Select

Plan Details: List of doctors/hospitals in the PPO network. Non-network providers may be used, but co-payments will be higher. Members may select a primary care provider and specialists without referral. Annual deductibles must be met before some benefits apply.

• PERS Choice (Blue Cross PPO)
  Evidence of PERS Choice Coverage
  Group #: CB010A
  Telephone #: 877-737-7776
• PERS Care (Blue Cross PPO)
  Evidence of PERS Care Coverage
  Group #: KB010A
  Telephone #: 877-737-7776
• PERS Select (Blue Cross PPO)
  Evidence of PERS Select Coverage
  Group #:
  Telephone #: 877-737-7776

Medco Prescription Drug Information
Telephone #: 1-800-939-7091

FlexCash Program

Employees who are eligible for medical/dental insurance can elect to waive CSU coverage in exchange for a monthly cash payment:

• Medical and dental: $140
• Medical only: $128
• Dental only: $12

FlexCash Basics

• Proof of other non-CSU coverage must be provided on the Benefits Enrollment Worksheet.
• Coverage as a dependent of another CSU employee causes ineligibility.
• FlexCash payment is treated as taxable income and is subject to payroll taxes.
• Eligible employees have 60 calendar days commencing with their appointment date to enroll in the FlexCash plan.

FlexCash Brochure

Dental Insurance Plans

The CSU offers two Dental Plans for eligible employees and their eligible dependents.

• Both plans are administered by Delta Dental of California.
• The premiums for these plans are paid by the CSU

Delta Dental PPO of California (Comprehensive Dental Plan)
Group #: 4018

• Enrollees may select a dentist of their choice.
• Members may choose a dentist in the Delta Premier or Delta PPO network and pay less.
• The plan sets the limits it pays for each specific type of dental treatment. Members are responsible for paying any remaining balance. This plan has a deductible.
• You may read the Evidence of Delta Dental PPO Coverage for information on covered benefits.
• You will need to complete and submit your own dental claim form for services provided by a non-Delta dentist.

DeltaCare USA (Dental HMO)
Group #: 2M77

• Enrollees and their eligible dependents are required to use a dentist who is a contracted Delta Care provider.
• Most basic services are covered at no cost.
• Evidence of Coverage - Basic Benefits
• Evidence of Coverage - Enhanced Benefits

Vision Insurance Plan

All eligible employees and their eligible dependents are automatically enrolled in the Vision Services Plan (VSP).
Group #: 12292796

• Premiums are paid by the CSU.
• Any licensed ophthalmologist, optometrist or dispensing optician can be used.
• By choosing a participating provider in the Vision Service Plan (VSP) network, the insurance will cover more out-of-pocket costs.
• Vision Services Plan (VSP) is the Plan Administrator.

The vision plan includes:

• One comprehensive eye exam per calendar year
• One pair of lenses every other calendar year (or every calendar year if your prescription changes) and one frame every calendar year
• One pair of contact lenses every other calendar year (or every calendar year if there is a prescription change) when contact lenses are provided in lieu of other eyewear
• Discounts of approximately 15% for laser correction surgery are available
• No Claim Forms is required prior to access standard in-network benefits
• Polycarbonate lenses are covered in-network for dependent children up to age 23

More Information:

• Quick Summary of Benefits
• Member Coverage Details
• Evidence of Vision Services Plan Coverage
• Video Display Terminal (VDT) Form
• Out of Network Reimbursement Form

Tax Advantage Premium Plan (TAPP)

The Tax Advantage Premium Plan (TAPP) allows employees to have required health plan premiums withheld from their paychecks on a pre-tax basis, reducing federal and state income and Social Security/Medicare taxes.

Eligibility
All CSU employees enrolled in a CalPERS health plan, and who have health care contributions withheld from their paycheck, are eligible to participate.

Enrollment
Eligible employees are automatically enrolled in the program unless non-participation is requested at the time of enrollment. There is a 17 cent/month service charge which is automatically collected by the State Controller's Office through a payroll deduction.

TAPP Brochure

Health Care Reimbursement Account (HCRA)

This voluntary benefit plan offers employees the ability to pay for eligible out-of-pocket health care expenses with pre-tax dollars:

• Employees may contribute between $20 to $416.66 each month ($5,000 maximum per year) to personal account.
• Contributions are deducted from the employee's pay before federal, state and Social Security (FICA) taxes.
• Employee must complete an enrollment form during the annual Open Enrollment period to continue participation for the following calendar year. The contribution amount can be changed at that time.

Reimbursement Information:

• File claim for reimbursement by completing HCRA / DCRA claim form, attaching documentation and mailing to:
  ASI
  P.O. Box 6044
  Columbia, MO 65205-6044 or fax to: (573) 874-0425
• Expenses eligible to be reimbursed must be:
  • medically necessary,
  • incurred by an employee, employee's spouse, or eligible dependents (including domestic partner), and
  • not covered by the employee's own or another insurance plan.
• Refer to CSU HCRA Brochure for a list of reimbursable and non-reimbursable expenses.
• Any money left in employee's account after expenses have been paid for the year is forfeited.

Dependent Care Reimbursement Account (DCRA)

This voluntary benefit plan offers employees the ability to pay for eligible out-of-pocket for dependent care expenses with pre-tax dollars.

• The care must be necessary for the employee (and spouse, if married) to work.
• Contributions of $20 to $416.66 each month ($5,000 maximum per year) are deducted from the employee's paycheck and are held in the employee's personal account.
• Contributions are deducted from pay before Federal, State and Social Security (FICA) taxes.
• Employees must complete an HCRA / DCRA enrollment form during the annual Open Enrollment period to continue participation for the following calendar year. The contribution amount can be changed at that time.)

Reimbursement Information:

• File claim for reimbursement by completing the HCRA / DCRA claim form, attaching documentation and mailing to:
  ASI
  P.O. Box 6044
  Columbia, MO 65205-6044 or fax to: (573) 874-0425
• For expenses to be eligible:
  • Dependent must be a child under age 13 for whom employee or spouse is entitled to claim dependent status on income tax return, or spouse who is unable to care for him/herself, or a financially dependent member of employee's household; and
  • Care must be required in order for employee to be gainfully employed and, if married, spouse also must be employed or actively looking for work.
  • Refer to DCRA Brochure for additional eligibility rules.
• Any money left in employee's account after expenses have been paid for the year is forfeited.

Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) protects the enrollment and policies for employees and family members who are eligible to enroll in a CalPERS-sponsored health plan.

HIPAA also protects the confidentiality between you and your health care provider. In accordance with HIPAA, should you need a CSUSB Benefits Coordinator to assist you with your health care claims, an Authorization to Use and/or Disclose Personal Health Plan Information Form is required.

Additional Information:

• CSU Privacy Act
• Authorization to Use and/or Disclose Personal Health Plan Information Form