Benefits - Health Care

Through its collective presence, the California State University system is pleased to be able to offer a selection of medical benefit plans to eligible employees. Employees may choose coverage through either an HMO (Health Maintenance Organization), or a PPO (Preferred Provider Organization).

If eligible, your coverage may include:

• You, the employee
• Your spouse
• Registered Domestic Partner
• Your children and step-children under age 26 who depend on you for economic support and who have never been married.
• A parent-child relationship.
• Children under age 18, in your legal custody.
• Children over age 26 who became disabled before age 26 and who depend on you for economic support.

HMO (Health Maintenance Organizations

In these plans you must go to certain health care facilities and receive medical care from the doctors at those facilities.

• Blue Shield HMO
• Kaiser Permanente HMO
• Anthem Blue Cross HMO
• Health Net Salud y Mas HMO
• United HealthCare HMO

PPO (Preferred Provider Organizations)

In these plans you may receive medical care from the doctor of your choice and at the hospital of your choice. Certain doctors and hospitals, however, are part of the PPO network. If you use those doctors and hospitals, the PPO will pay a higher percentage of your bills.

• PERS Platinum
• PERS Gold
• Peace Officers Research Association of California (PORAC) (only for Unit 8 employees belonging to the Association and paying dues)

Employee Premium contributions are based on the plan and the number of individuals covered. The following chart outlines plan rates, employer (CSU) premium contribution amounts, and employee (you) premium contribution rates.

Health Care Premium Comparison Chart

Benefit eligible employees are provided coverage under Delta Dental. Specific coverage is based on the employee's collective bargaining unit. Participating dentists in the Dental Plan networks can be identified through the Delta Dental website. Employees can also request a list by contacting Delta Dental directly.

DeltaCare Basic & Delta Dental Basic

Eligible employees in the following Categories: Unit 8, (Excludes E99), and Annuitants, can choose between either the DeltaCare Basic or Delta Dental Basic Plan, based on the plan which best meets their needs.

DeltaCare USA Basic & Delta Dental Level I Enhanced Plans

For eligible employees in the following categories: Unit 10, Unit 11 (Teaching Associates), and Unit 13 can choose between either the DeltaCare USA Basic or Delta Dental Level I Enhanced Plans, based on the plan which best meets their needs. Unit 12 employees are eligible for Delta Dental Level I Enhanced Only.

DeltaCare USA Enhanced & Delta Dental Level II Enhanced Plans

For eligible employees in the following categories: Units 1, 2, 3, 4, 5, 6, 7, 9 and C99, M98, M80 & FERP Annuitants can choose between either the DeltaCare Basic or Delta Dental Basic Plan, based on the plan which best meets their needs.

The employer-paid California State University (CSU) Vision Plan is administered by Vision Service Plan (VSP). VSP provides the administration of vision benefits and claims on behalf of all eligible employees. Under VSP, the frequency of benefits is based on a calendar year perspective. For example, if an employee has an eye exam in July 2014, he/she will be eligible for another eye exam on January 1, 2015, or thereafter.

Founded in 1955, VSP is dedicated solely to providing eye care wellness benefits through an exclusive network of independent eye doctors. These independent eye doctors are an important component of VSP’s focus on eye health, diseases and conditions, and are grouped in the VSP Select Network, which has approximately 17,000 providers.

If you already have a VSP doctor, call and make an appointment. If you're new to VSP and need a doctor, visit VSP.com or call 800.877.7195. Group Number 30059426.

VSP Out-of-Network Program

If you obtain vision care from a doctor outside of the VSP Network, you can obtain reimbursement through either of the following methods:

Option A

1. Log on to http://www.vsp.com.
2. Create a user ID and password.
3. Under "Benefits Resources", click on Out-of-Network Reimbursement.
4. Follow instructions for submitting your claim.

Option B

If you prefer to submit your claim via mail, please contact Member Services at 800.877.7195 to obtain a VSP Member Reimbursement Form.

Once you have completed the requested reimbursement form, please mail it to:

Vision Service Plan
Attention: Claims Services
PO Box 385018
Birmingham, AL 35238-5018

Once your claim is received, please allow for up to ten business days (plus mailing) for processing.

VSP Truhearing® Memberplus Program

VSP is pleased to announce the TruHearing® MemberPlus Program. TruHearing is the first and only state-approved discount health medical organization (DHMO) for hearing, offering deep discounts to all VSP members and their covered dependents on state-of-the-art digital hearing aids and professional services from a nationwide network of audiologists and hearing instrument specialists.

There is no charge for joining the Program ($108 value). Members can combine this program with their current health coverage to maximize the benefit and reduce their out-of-pocket expense. In addition, VSP members may also add up to four (4) guest members (parents, grandparents, siblings) at no extra charge. Please note: Eligibility for the TruHearing® MemberPlus Program is not extended to VSP vision coverage.

To take advantage of TruHearing® Discounts VSP members can call TruHearing at 877-396-7194.

FlexCash is an optional benefit plan that allows employees to waive CSU medical and/or dental insurance coverage in exchange for additional cash in their paycheck each month. If you decide not to keep the CSU medical and/or dental coverage, you will be required to certify on the Benefit Enrollment/Change form that you have alternative non-CSU medical and/or dental coverage and provide proof of other non-CSU coverage.

Eligibility

You are eligible for the FlexCash plan if:

• You meet the eligibility requirements for CSU medical and dental benefits
• You are an active non-represented employee or an active represented employee in a bargaining unit which allows participation
• You have other, non-CSU medical and/or dental coverage through private group coverage, or coverage related to employment outside the CSU system

You are not eligible to participate if you are covered as the dependent of another CSU employee. Employees enrolled in individual health plan coverage, such as Tricare, Medicare, Medi-Cal, and Covered California, are not eligible to receive FlexCash in lieu of CSU health coverage.

If you choose to receive cash in lieu of medical and/or dental coverage, the payment is as follows:

• Waive Medical only $128.00 per month
• Waive Dental only $12.00 per month
• Waive Medical and Dental $140.00 per month

These amounts may change subject to the collective bargaining agreement.

FlexCash is treated as taxable income and is subject to the same payroll taxes as your regular salary. This additional income will be reported as income on your W-2 form.

You may not start or stop your FlexCash election in the middle of a plan year, except for allowable family status changes as defined by IRS regulations. These regulations specify that changes in FlexCash elections must be necessary or appropriate as a result of the family status changes. The enrollment changes must be requested within 60 days of the status change.

If allowable family status changes occur, you can make the following changes by completing new enrollment forms within 60 days of the status change:

• If you chose cash, you can now choose medical and/or dental coverage.
• If you kept your other medical and/or dental coverage, you can now choose cash.

Allowable family status changes include:

• Marriage or divorce;
• Death of a spouse or dependent (or loss of dependent status);
• Birth or adoption of a child;
• Termination or commencement of your spouse's employment;
• Change from full-time to part-time employment (or vice versa by either you or your spouse, if that change affects your medical and/or dental coverage);
• Start or return from an unpaid leave of absence by either you or your spouse;
• Gain or loss of alternative non-CSU coverage; or
• A significant change in the alternative non-CSU coverage.

Brochure

Flex Cash Brochure (PDF)

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It requires employers to offer eligible employees continued health coverage for a period of up to 36 months after separation. The purpose of this Act is to ensure access to health coverage for employees who would otherwise lose group coverage under specified circumstances called “qualifying events.”

COBRA provides continuous health care coverage, provided that the employee elects to participate, completes the enrollment process, and continues paying premiums to the insurance carrier.

Eligibility

Employees covered by a CSU health plan may continue coverage of group health insurance when they lose coverage due to:

• A reduction in work hours, or
• A termination of employment for reasons other than gross misconduct.

A spouse or domestic partner of an employee covered by a CSU health plan may choose to enroll in COBRA if coverage is lost for any of the following reasons:

• The death of the employee;
• Termination of employee's employment or reduction in employee’s work hours;
• Divorce, legal separation, or dissolution of domestic partnership from the employee; or
• Employee becomes entitled to Medicare.

A dependent child of a covered employee may continue coverage if group health coverage is lost for any of the following reasons:

• The death of the parent (employee);
• The termination of the parent's employment or reduction in the parent's work hours with the CSU;
• The parents' divorce, legal separation, or dissolution of domestic partnership;
• The parent (employee) becomes entitled to Medicare; or
• The dependent reaches age 26.

FAQs

COBRA Health Coverage FAQs