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Staff & Faculty Health Benefit Programs
Benefit Plan Enrollment
Employees appointed half-time or more for a period of more than six months are eligible to enroll themselves, their spouses, and unmarried dependents under the age of 26, in the benefit plans. There is currently no exclusion for pre-existing physical conditions.
The deadline for enrollment in benefits is 60 calendar days from the date of hire or eligibility. If the deadline is missed, employees may enroll in health insurance after a 90-day waiting period under the Health Care Portability and Accountability Act (HIPPA), or during the annual open enrollment period with coverage effective the following January 1. Changes to plans may be made during the open enrollment period.
Monthly plan premium costs are shared by the CSU and the employee. Employee contribution rates vary depending on the plan selected and the number of dependents enrolled. It is essential to evaluate each plan against your personal and family needs prior to making a selection.
2014 CalPERS Health Benefit Plan Rates
FlexCash Plan and Tax Advantage Premium Plan (TAPP)
The CSU offers two plans that help employees manage their benefit needs and save valuable tax dollars. If an employee has medical and/or dental coverage not offered by the CSU, the FlexCash Plan pays cash in lieu of CSU coverage, allowing the employee to receive only the coverage needed. If an employee elects health coverage through the CSU, the Tax Advantage Premium Plan (TAPP) allows for the payment of health insurance premiums on a pre-tax basis, reducing federal, state and FICA taxes.
Employees who have non-CSU health and/or dental coverage can elect to participate in the FlexCash plan to obtain cash in lieu of CSU coverage. The money is taxed.
Benefit Waived Payment
Medical and Dental $140
Medical Only $128
Dental Only $ 12
The CSU may change these amounts in the future, subject to collective bargaining.
Health Plan Enrollment
The following health plans are available to CSU employees:
Three Health Maintenance Organizations (HMOs): Blue Shield HMO, Blue Shield Net Value and Kaiser. Blue Shield is an individual practice plan where contracted doctors and hospitals provide all services. Kaiser is a clinic/hospital-based plan where one specific clinic or hospital provides the services.
Three Preferred Provider Organizations (PPO): PERSChoice, PERSCare and PERSSelect (administered by Blue Cross of California).
To assist employees with open enrollment choices, a Health Plan Chooser tool has been implemented by CalPERS. This tool will allow employees to view health plans in side-by-side comparisons, and rank them based on personal references.Dental Plan Enrollment
Eligible CSU employees and dependents may enroll in dental coverage that is currently paid by the CSU. Premiums are generated through the payroll process and are paid on a monthly basis. Two plans are available: Delta Dental (indemnity plan) and USA DeltaCare (prepaid plan).
Delta Dental (Indemnity Plan)
The CSU Delta Dental Comprehensive Dental Program is an indemnity plan under the Delta Dental Plan of California. There are three benefit levels in this plan: basic, enhanced level I and enhanced level II. The plan sets the limits that it will pay for each specific type of dental treatment. Members are responsible for paying any remaining balance that might be due based on the type of dental treatment they receive.
Employees enrolled in the indemnity plan have the option of selecting a dentist of his/her choice from either the Delta Dental Premier Network in California, or a non-Delta dentist. Within Delta's Premier network, there is a select group of dentists who also are members of the Delta Dental PPO network. Dentists in the PPO network have agreed to charge significantly lower fees than other dentists, and employees who select a dentist from the Delta Dental PPO network will pay less out-of-pocket expenses and could save an average of 23 - 30% on most services. Additional information is detailed in the "Two Dental Networks - Two Ways to Save" brochure.
TO USE DELTA DENTAL
Your Delta coverage will take effect once the state dental deductions have appeared on your pay stub; no I.D. cards will be sent upon enrollment. Enrollees may go to any Delta Dentist for treatment; pre-designation is not required. Select a Delta Dentist (see Delta website below for dentist directory) and give the following information to your provider at the initial appointment:
1. Your Delta group number 4018 (on CSU Evidence of Coverage)
2. Employer's name: Cal State San Marcos
3. Primary Enrollee's Social Security Number (also to be used by Dependents)
4. Primary Enrollee's Date of Birth
5. Any other dental coverage you may have
Your Delta dentist will complete and submit your claim forms directly to Delta; Delta will pay the Delta Dentist directly. Members are responsible for the deductible and member portion of the payment, if applicable.
USA DeltaCare (Prepaid Plan)
There are two benefit levels in the prepaid plan: basic and enhanced. The prepaid plan requires the employee and their eligible dependents to use a dentist from a specific list of dentists who contract with the selected prepaid carrier. Most basic services are covered at low or no cost. Additional information is detailed in the USA Dental Care HMO materials.
TO USE DELTACARE USA
Under the DeltaCare USA plan, you must select one contract dental facility when you enroll. This facility will take care of all the dental care needs for you and your family. Enrollees will receive a DeltaCare membership packet and ID card with the name, address and phone number of your contract dentist.
California State University San Marcos provides a vision care benefit to eligible employees. The State pays the premium for the employee and any dependents. The provider is Vision Service Plan (VSP).
Under VSP, the following vision benefits are available to eligible CSU employees:
In-network frame allowance - $95.00;
Out-of-network frame allowance - $60.00;
In-network contact lens allowance - $120.00;
Polycarbonate lenses are covered for dependent children in-network up to age 23, instead of age 12; and
Discounts of approximately 15% for laser correction surgery are available
TO USE THE VSP VISION PLAN
Your VSP vision coverage will take effect once the state vision deductions have appeared on your pay stub; no I.D. cards will be sent upon enrollment. Enrollees may go to any participating vision provider for services covered under this benefit, including such providers outside of California. Claim forms are no longer required when using standard in-network benefits. Members are responsible for the co-payment and any charge for frame and lenses or contact lenses over the Allowable Amount as indicated in the Group Vision Insurance Evidence of Coverage. Employees that choose to use a non-VSP provider must submit an itemized bill to VSP in order to receive reimbursement based on out-of-network allowances. A claim form is still required for video display terminal (VDT) benefits whether using a VSP Select Network doctor or a non-VSP provider. Employees who meet the CSU requirement for VDT coverage must obtain the form from the campus Benefits Office.
VSP Online Access
Employees can complete an online member registration enrollment to create a user identification (ID) and password, for the purpose of viewing his/her vision benefits