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MANAGEMENT
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MANAGEMENT
Human Resources

Eligibility and Enrollment

Eligibility for Employees and their Dependents

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  • STAFF/MANAGEMENT EMPLOYEES
    • Must be appointed at least half-time (.50 timebase or greater), and
    • Initial appointment duration of more than six months (at least six months and one day)
    • Qualifying appointments may be either permanent or temporary.
    • There is currently no exclusion for pre-existing physical conditions.

    Once an employee has acquired eligibility and has enrolled in a plan, he/she may continue enrollment during subsequent continuous appointments of at least half-time (.50 timebase) regardless of the duration of the new appointment.

    Affordability Care Act (ACA) Eligibility -
    An employee who does not meet the eligibility criteria above may be eligible to enroll in a CalPERS health plan or FlexCash Health under the Affordability Care Act (ACA) if:

    •  Appointed with at least a .75 timebase regardless of length of appointment (duration) or initially hired to work at least 130 hours per month; or,
    • Works an average of 130 hours per month based on an annual review of computed timebase or reported hours during a 12 month measurement period.

    ACA does not provide dental or vision coverage.

  • FACULTY (Tenure, Tenure-Track, Librarians & Counseling)
    • Must be appointed at least half-time (7.5 WTU's or greater), and
    • Initial appointment duration of more than six months (at least six months and one day)
    • Qualifying appointments may be either permanent or temporary.
    • There is currently no exclusion for pre-existing physical conditions.
  • FACULTY (Part-Time Lecturers & Coaches)
    • If employed in a Unit 3 Lecturer or Coach Academic Year position, employee must be appointed for at least six (6) weighted teaching units (.40 timebase or greater) for at least one semester, or two consecutive quarter terms.
    • Qualifying appointments may be either permanent or temporary.
    • There is currently no exclusion for pre-existing physical conditions.

    The HR Benefits Office will send Benefit Eligibility/Enrollment emails to newly eligible Part-Time Lecturers & Coaches a couple weeks after the start of a semester.

    Click to view: Benefit Coverage Period

  • NON-ELIGIBLE EMPLOYEES

    Employees excluded from health benefits include:

    • Intermittent Employees
    • Student Assistants
    • Graduate Assistants
    • Faculty employed solely to teach summer session, extension or intersession
    • An employee paid from funds not controlled by the California State University or from revolving or similar functions from which a regular California State University premium payment cannot be made.
  • DEPENDENTS

    Supporting documentation and a Social Security Number are required.

    Dependent Relationship Type Supporting Document
    Spouse Copy of Government Issued Marriage Certificate
    Domestic Partner

    Copy of Registered Declaration of Domestic Partnership issued by CA of State or comparable agency in another state jurisdiction.

    Domestic Partner Taxation Forms - provided by HR Benefits Office. (See Notation Below)
    Natural Born Child
    (until child reaches age 26)    		 Copy of Government Issued Birth Certificate
    Adopted Child
    (until child reaches age 26)    		 Copy of Adoption Paperwork/Certificate or Government Issued  Birth Certificate
    StepChild/Registered Domestic Partner's Child
    (until child reaches age 26)    		 Copy of Government Issued Birth Certificate listing current Spouse/Domestic Partner

    Economically Dependent Child
    (until child reaches age 26)

     

    		 Copy of Government Issued Birth Certificate; Completion of Parent/Child Affidavit & proof of dependent financial responsibility as indicated on the form.

    Disabled Dependent Child
    (Age 26 and incapable of self-support)

    Completion of the Disabled Dependent Member Questionnaire and Medical Report (HBD-34) and the Authorization to Disclose Protected Health Information (PERS-BSD-35) and submitted directly to CalPERS, NOT the Benefits Office.

    Initial Certification must occur during one of these following two periods (whichever applies):

    -  For an enrolled dependent, within 90-days before and ending 60-days after the dependents 26th birthday.

    - For an unenrolled dependent age 26 or over, within 60-days of the newly eligible employee's initial enrollment in the CalPERS Health Program

    Upon expiration of the certification, the recertification of the disabled dependent must be received no earlier than 90 days prior to the expiration date, and no later than the expiration date.

    Employee must verify dependent eligibility every three years based on their birth month.  For further information, please view the Dependent Eligibility Verification (DEV).

    Domestic Partners
    State law allows, under specific conditions, for persons in the State of California to register non-marital relationships with the Secretary of State. This law also will recognize same-sex legal unions, other than marriage, validly formed in another jurisdiction that is substantially equivalent to a registered domestic partnership in California. Consequently, CalPERS will require information specific to the domestic partnership to determine whether or not a particular state/jurisdiction law will be recognized. Having obtained registration of the relationship, the law allows the registered individuals to obtain health benefits under the standard eligibility rules of the Public Employees' Medical and Hospital Care Act (PEMHCA). The California State University (CSU) elected to adopt the provisions of this law offering health care coverage (medical, dental and vision) for domestic partners of CSU employees and annuitants subject to the Secretary of State approval process and the CalPERS' acceptance process.

    Internal Revenue Service guidelines state that adding a domestic partner to your benefits will result in taxable income to the employee for Federal tax purposes only. The State of California does not tax the imputed value of domestic partner health related benefits. Federal regulation requires domestic partnership benefits to be taxed unless the employee claims the domestic partner as a dependent for federal income tax purposes. 

    Contact the HR Benefits Office for additional information and refer to the State Controller's Office (SCO) Domestic Partner FAQ.


Additional Information

You have 60 days from the date of the eligible appointment to enroll in a health plan(s). After 60 days, an employee has the opportunity to request enrollment either as a "Special Enrollment", "Late Enrollment" or during any Open Enrollment period. Under Late Enrollment, there is a 90-day waiting period before the benefit coverage takes effect.  Open Enrollment occurs annually (mid-September to early-October) and benefit coverage takes effect the January 1st of the following year.

A change in the employee's family status (i.e., birth, adoption, marriage, domestic partnership, legal separation, divorce, death etc) must be reported to the HR Benefits Office within 60 days of the event to avoid delays in benefit effective dates.  Failure to not notify could result in adverse consequences such as financial liability for any costs due to late notification and correction of retroactive benefits coverage.

Enrollment Process

  1. Review the Health Plan Options (Medical, Dental, Vision & FlexCash)
  2. Complete the Benefits Enrollment Worksheet and VSP Premier Enrollment (for enhanced vision)
  3. Attach copies of any applicable dependent supporting documentation
  4. Submit Enrollment Forms to the OHR Benefits Office via
    Email - hrbenefits@csusm.edu
    or
    Drop off - OHR Office/Administrative Bldg. Ste. 4800
  5. Submission Deadline -  OHR Benefits Office must receive enrollment forms within 60 days of hire date/eligiblility date/life event
  6. The OHR Benefits Office will:
    • Review enrollment forms/supporting documentation and confirm receipt of the employee's request.
    • Notify employee of pending information (Incomplete form(s) and/or lack of supporting documentation may delay or prevent benefit coverage.)
    • Confirm effective date of coverage.
    • Provide an email confirmation once enrollment has been completed to include information on how to access/manage benefit coverage(s).

Benefit Coverage Effective Dates

  • Health, Dental and Premier Vision - 1st of the month following eligibility date/hire date AND OHR Benefits Office receipt of enrollment form(s)
  • Basic Vision (Automatic Enrollment) - 1st of the month following eligiblity date/hire date
  • FlexCash - 1st of the month following eligibility date/hire date, OHR Benefits Office receipt of enrollment form(s), and processing deadline dates:  if able to process by the 9th of the month, the plan will begin the 1st of the following month; Otherwise the plan will begin the 1st of the second month.