Frequently Asked Questions

ELIGIBILITY/ENROLLMENTS

• I forgot to enroll in Health or Dental benefits within my 60-day deadline, can I still enroll?

  If you miss your eligibility period, you will be able to enroll in Health or Dental:

  • During an Open Enrollment period (mid-September to early October), and your benefit coverage will take effect January 1st of the following year.
  • Request a Late Enrollment, and your benefit coverage will take effect the 1st of the month following a 90-day waiting period.

  Submit a completed Benefit Enrollment Worksheet, along with a copy of any required Supporting Documentation to hrbenefits@csusm.edu.

• Qualifying Life Events - What do I need to know?

  Life events such as marriage, registration of domestic partnership, birth or adoption of a child, divorce, termination of domestic partnership, or death of a family member will impact dependent benefit eligibility.

  You will need to contact the Benefits Office if any of these life events occur.  Failure to notify the Benefits Office of a family status change may result in financial liability for any costs due to late notifications and corrections of retroactive benefits coverage.
  
  Review the CalPERS Health Program Guide for details on eligibility, deadlines and family status changes.

• I'm having a baby. When can I add my newborn child to my coverage?

  Adding a new born is a mandatory event, and therefore processes the 1st of the month following birth, regardless of when the request is submitted. The child is covered under the mother's benefits for the month of birth.

  Submit a completed Benefit Enrollment Worksheet, along with a copy of the  Government Issued Birth Certificate to hrbenefits@csusm.edu.  (Note: If you do not have the Birth Certificate or Social Security Number at time of the request, please include a copy of the Hospital's Record of Birth, and submit the Birth Certificate and Social Security Number to the Benefits Office once issued - within 90 days)

  When completing the Benefit Enrollment Worksheet:
  Type of Action = Add/Delete Dependents
  Permitting Event = Birth/Adoption
  Permitting Event Date = Date of Birth

  Effective Date will be the 1st of the month, following birth of the child.  If you submit your request after the baby's birth month, you may owe health premiums for coverage processed retroactively.

• I'm getting married soon. When can I add my new spouse and/or stepchild(ren) to my coverage?

  You have 60 days from the date of marriage to add your spouse and/or stepchild(ren) to your Health, Dental and/or Premier Vision coverage (Basic Vision is automatic). After 60 days, you may be able to enroll under a "special enrollment" or "late" enrollment", or during an Open Enrollment period.

  Submit a completed Benefit Enrollment Worksheet, along with a copy of your Government Issued Marriage Certificate and Birth Certificates for any stepchildren to hrbenefits@csusm.edu.

  When completing the Benefit Enrollment Worksheet:
  Type of Action = Add/Delete Dependents
  Permitting Event = Marriage/Domestic Partnership
  Permitting Event Date = Date of Marriage

  Effective Date will be the 1st of the month, following date of marriage and Benefit Office receipt of request.

• I'm getting divorced. How do I remove my ex-spouse and stepchildren from my coverage?

  It is a mandatory event to remove an ex-spouse from your coverage, so it's important to submit your paperwork as soon as possible to avoid any financial liability that may occur from late notifications and correction of retroactive benefits coverage.

  Submit a completed Benefit Enrollment Worksheet, along with a copy of the first page of the Divorce Decree or Dissolution of Marriage Court document to hrbenefits@csusm.edu.

  When completing the Benefit Enrollment Worksheet:
  Type of Action = Add/Delete Dependents
  Permitting Event = Divorce
  Permitting Event Date = Date of Divorce/Dissolution of Marriage

  Effective Date will be the 1st of the month, following date of divorce/dissolution of marriage regardless when it's received by the Benefits Office. 

  The Benefits Office will also be required to provide a COBRA Continuation notification to the ex-spouse, so a current mailing or email address will also be needed, if known.

• Can I enroll my Domestic Partner or their children?

  A Domestic Partner or children of your Domestic Partner are eligible dependents, as discussed on the Eligibility and Enrollment page.
  
  If your partnership is newly established, you have 60 days from the date of the State Registration of Domestic Partnership to add your Domestic Partner and/or their child(ren) to your Health, Dental and/or Premier Vision coverage (Basic Vision is automatic). After 60 days, you may be able to enroll under a "special enrollment" or "late" enrollment", or during an Open Enrollment period.

  Submit a completed Benefit Enrollment Worksheet, along with a copy of your State Registered Domestic Partnership and Birth Certificates for any their children to hrbenefits@csusm.edu.

  When completing the Benefit Enrollment Worksheet:
  Type of Action = Add/Delete Dependents
  Permitting Event = Marriage/Domestic Partnership
  Permitting Event Date = Registration Date of Domestic Partnership issued by the State

  Effective Date will be the 1st of the month, following date of registration date of Domestic Partnership and Benefit Office receipt of request.

• How can I enroll myself and/or dependents if losing coverage held outside of the CSU?

  You have 60 days from the date of involuntary cancellation of coverage to enroll or add  an eligible dependent in a CSU Health and/or Dental coverage. After 60 days, you may be able to enroll under a "special enrollment" or "late" enrollment", or during an Open Enrollment period.

  Submit a completed Benefit Enrollment Worksheet, along with a copy of your Government Issued Marriage Certificate and Birth Certificates for any children, and documentation showing the cancellation of outside coverage to hrbenefits@csusm.edu.

  When completing the Benefit Enrollment Worksheet:
  Type of Action = Enroll or Add/Delete Dependents
  Permitting Event = Loss of Coverage
  Permitting Event Date = Date current coverage ends

  Effective Date will be the 1st of the month, following date of coverage cancellation and Benefit Office receipt of request.

• Can my grandchild or niece/nephew be coverage under my benefits?

  Another person's child under age 26 may be eligible for coverage if you have assumed a primary parental role and can provide specific documentation based on dependent age, along with the Parent-Child Relationship Affidavit at time of initial request, and annually thereafter.
  
  You have 60 days from the date you've assumed the relationship of the dependent, involuntary loss of dependent's other coverage, or during an Open Enrollment period

  Initial Request:  Submit a completed Benefit Enrollment Worksheet,  a copy of the Birth Certificate, a completed Parent-Child Relationship Affidavit, and the supporting document as described on the Affidavit to hrbenefits@csusm.edu.

  Annual Certification:  Submit a completed Parent-Child Relationship Affidavit and the supporting document as described on the Affidavit before the end of your birth month to hrbenefits@csusm.edu.

• When is the annual Open Enrollment Period?

  Our annual Open Enrollment Period begins mid-September and ends mid-October.  The 2023 Open Enrollment period will begin September 18, 2023 and end at 4:00 pm PST on October 13, 2023.

  Open Enrollment allows enrollment, changes, or cancellations to benefits without the need of a life/permitting event.  The effective date of Open Enrollment elections is January 1st of the following year.

  Open Enrollment communications begin in early September.

• Do I have to enroll if coming from another CSU?
  Yes, you need to follow the enrollment process of the CSUSM campus, as the previous campus is required to process your benefit cancellation. It is recommended to reach out to the Benefits Office and identify that you've coming from another CSU campus, to assist with the transition of all benefits between the systems.
• What if I already have health coverage, outside of the CSU?

  You are not required to enroll in a CSU health or dental plan, however if your health coverage is through Covered CA, there may be tax implications involved and should be address directly with Covered CA.

  Provided you have group coverage outside the CSU, you may be eligible to enroll in FlexCash which offers cash in lieu of CSU Health ($128/mo) and/or Dental ($12/mo) coverage.  The FlexCash monthly payment is treated as taxable income and will be subject to the same payroll taxes (i.e. Federal, State, Social Security, Medicare) as regular salary and is reported as income on Form W-2 for the year it's received.  FlexCash, however, will not be considered compensation for retirement purposes.

  For more information about the program please go to FlexCash .

• When is the annual Open Enrollment Period?

  The Open Enrollment period begins mid-September and ends mid-October, and the effective date of Open Enrollment elections is January 1st of the following year.
  
  Open Enrollment allows enrollment, changes, or cancellations to benefits without the need of a life/permitting event.

• Can medical benefits continue if a family member or I become ineligible for coverage?

  Yes.  The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows continued coverage for yourself and/or eligible dependents for a certain number of months (18, 29 or 36), based on the reason for ineligibility. 

  The Benefits Office will automatically notify employees of the COBRA Continuation option.  You must submit your COBRA Election form to the Benefits Office within sixty (60) calendar days of the event date. Coverage must be continuous beginning the 1st of the month following Employer Coverage ending. The monthly rate is the full premium amount (employer/employee shares) plus a 2% administrative fee.  Rates are provided with the COBRA Continuation Notice or can be found on our COBRA web page.

• How long can my dependent child be covered?

  Eligible dependent children can stay on your plan up to age 26, regardless if they do not reside in the same household* or are married**.  At the end of the month of their 26th birthday, their coverage ends and COBRA Continuation will be offered as an option by the Benefits Office.

  If you have a child reaching age 26 that is incapable of self-support because of a mental or physical condition, they may be able to continue coverage as a Disabled Child.  The initial certification documents must be provided within 90 days before and ending 60 days after the child's 26th birthday.  For more information and forms.

• Can my parents be covered under my benefits?

  No. Parents, even if totally dependent on you, are not eligible for coverage.

HEALTH

• Will I receive an insurance card?

   Yes, cards will be mailed to your address on file within 7 - 10 business days from the enrollment recorded by the carrier.  This card will also serve as your "prescription card". 
  
  You may also access your information and print a temporary card by registering on the carrier website.

• Can I change my health plan?

  You can change your health plan, as follows:

  • During an Open Enrollment period (mid-September to early October), and your benefit coverage will take effect January 1st of the following year.
  • Within 60-days of a residential move, and your benefit coverage will take effect the 1st of the month after the reported address change and Benefits Office receipt of the request.

  Submit a completed Benefit Enrollment Worksheet to hrbenefits@csusm.edu. And if applicable, report your address change in MyCSUSM/My HR Resources/Personal Information/Update Address.

• What is the difference between using your residential or work zip code?

  RESIDENTIAL ZIP CODE
  A residential zip code allows family members to be assigned providers and clinics in different areas.  If a residential zip code is used, all enrolled family members must reside in the health plan's service area.
  
  Example: You live in Southern California and are enrolled in Kaiser, and you have a dependent living in Northern California.  If the Kaiser plan services the residential area of the dependent in Northern California, the dependent can be assigned a provider or clinic in Northern California, while you are assigned a provider or clinic in Southern California.
  
  You should contact the HR Benefits Office to update the dependent's residential address so they can be assigned a provider or clinic within their respective health plan's service area.

  WORK ZIP CODE
  A work zip code allows an employee and family members to be enrolled in a plan, that is not available under their residential zip code.  If a work zip code is used, all enrolled family members must receive all covered services (except emergency and urgent care) within the health plan's service area, even if they do not reside in that service area.

  Example: You live in Southern California and are enrolled in Kaiser, and you have a dependent living in Northern California.  Under the work zip code rule, all family members must receive covered services in the Kaiser Southern California service area, including the dependent living in Northern California.

• I've moved out of the carrier service area?
  If you've moved out of the carrier service area, you will need to submit a Benefit Enrollment Worksheet to the Benefits Office to request a Plan Change or request to change to the "Work Zip Code" to remain covered under your current plan, if available under the work zip code.
  
  If you fail to change your plan, CalPERS will automatically change your coverage to the Anthem Blue Cross PERS Platinum PPO plan and adjust monthly premiums accordingly, as the default plan coverage.

DENTAL

• Will I receive an insurance card?

  Dental Dental PPO #04018 -
  No, Delta Dental does not issue cards; However, you can register on the carrier site and print a card.  Dental cards are not required.  A dental office can verify coverage, by providing Plan Name/Group #, Members Name, Social Security Number and Date of Birth.

  DeltaCare USA Network HMO #72034 -
  You will receive an identification card in the mail, listing the Facility ID/Primary Care Dentist elected.  If you need to change contracted dentist/facility, you can do so with DeltaCare by registering on their website or by phone.  DeltaCare must receive the change by the 21st of the month for the change to take effect the 1st of the following month.

• Can I change my dental plan?

  You can change your dental plan, as follows:

  • During an Open Enrollment period (mid-September to early October), and your benefit coverage will take effect January 1st of the following year.
  • Within 60-days of a residential move, and your benefit coverage will take effect the 1st of the month after the reported address change and Benefits Office receipt of the request.

  Submit a completed Benefit Enrollment Worksheet to hrbenefits@csusm.edu. And if applicable, report your address change in MyCSUSM/My HR Resources/Personal Information/Update Address.

• What is the difference between Delta Dental PPO and Delta Premier?
  You'll save the most money when you visit a PPO dentist, as they have agreed to discounted fees, which means added savings and no unexpected out-of-pocket costs.
  
  Delta Premier dentists have also agreed to set fees, but the fees tend to be a bit higher than PPO dentists.
  
  Either way you won't pay more than your expected share using the in-network PPO or Delta Premier dentists.

VISION

• Will I receive an insurance card?

  No, VSP does not issue cards; However, you can register on the carrier site and print a card.  VSP network doctors verify  using your Member ID (your ssn without dashes - all dependents use your id).  Eligibility cannot be verified by a non-VSP provider (out-of-network), and services must be paid in full with reimbursement provided after you submit a claim for reimbursement form.

• Why are my dependents not reflected on my VSP Basic Vision coverage?

  VSP Basic Vision coverage is processed automatically at time of benefit .  The coverage code is "A-Family" so all eligible dependents are covered, however the names of dependents are not provided to VSP.
  
  Dependents when using the plan for the first time, should tell the Provider's Office they have VSP insurance as a dependent and provide the following plan information:

  VSP Basic Vision
  Group Plan #: 30059426
  Primary Member ID:  Employee's Social Security Number without Dashes (not their own)
  Coverage Code: A-Family

  The Provider's Office can contact VSP to verify the dependent's eligibility, as well.  Once the dependent has used the coverage and a claim has been submitted, VSP will update their system to reflect the dependent's information.
  
  The employee can also contact VSP Member Services and request the dependent's information be added to the system prior to seeking services.

LEAVING THE UNIVERSITY

• I'm leaving CSU employment. When will my health benefit coverage(s) end?

  In most cases, if you leave your position for reasons other than retirement, your benefit coverage will continue through the end of the month following separation and you'll be offered COBRA Continuation Coverage, as an option.

  As an example, if your separation date is May 5th, your employer group coverage will end June 30th at 11:59 pm.

• What happens to my Flexible Spending Account(s) - HCRA and/or DCRA?
  Health Care Reimbursement Account (HCRA) -
  You have the option to enroll in COBRA to continue the program through the end of the Plan Year.  The cost is your monthly contribution amount plus an additional 2% administrative fee.
  If you do not elect to continue through COBRA, your eligible expenses will only be reimbursed for services provided through the end of the month your benefits cancel, and your FSA Debit card will automatically cancel on this date.
  
  Dependent Care Reimbursement Account (DCRA) -
  This program is not eligible for COBRA Continuation. You can continue participating in this program until the end of the plan year or when your account is exhausted, whichever comes first.
• What happens to my CalPERS Membership at separation?
  You'll have the option to:
  

  • Elect a Refund of your Contributions
    Receive your accumulated contributions as a direct deposit or rollover. Electing a refund terminates your CalPERS membership.  Tax implications may apply.
  • Retire
    Leave your accumulated contributions in your account and receive a retirement benefit as soon as you meet the minimum retirement eligibility requirements.
  • Leave Contributions on Deposit and Elect to Retire When Eligible
    Leave your accumulated contributions on account until you meet the minimum retirement eligibility requirements or become employed with another CalPERS Agency to begin contributions again. 

  Detailed information will be provided at time of separation, or you can review the CalPERS Publication:  Options at Seperation

• What happens to my Part-Time, Seasonal, Temporary (PST) Retirement account at separation?

  You can - and should - close your PST account. You are eligible to withdraw your full account balance 90 days after the last transaction posts into or out of your account.
  
  Information about your payment options are online at Savings Plus Now or contact Savings Plus at (855) 616-4776.

HOW DO I...

• How will I know when my enrollment has been completed?

  The Benefits Office provides an email confirmation when an enrollment request has been received and when the enrollment has been completed.  Please contact the Benefits Office if you do not receive a confirmation that your enrollment request has been received to avoid enrollment delays or missed deadlines.

• I recently moved, how to I update my address with my insurance carriers?

  You need to update your address through MyCSUSM/My HR Resources/Personal Information, and the information will be updated with the State Controller's Office and transmit to the various carriers.  The transmission of information to each carrier occurs over different time periods, and can take up to a month.

  You can send an email to hrbenefits@csusm.edu to identify that you've updated your address and the HR Benefits Office will monitor the systems to ensure the address is updated with the various carriers.  

  You may be required to change Health Plans, if you've moved out of the Residential Service area.  You can use the CalPERS Health Plan by Zip Code tool to determine if your plan is available in your new residence.

• I recently got married, how do I change my name with my insurance carriers?

  You need to have an issued Social Security Card reflecting the new name.  Then come to the Office of Human Resources to complete an Employee Action Request (EAR) form to request a name change, and bring your new Social Security Card.

  The name change will be entered into the State Controller's Office system and transmit to the various carriers. The transmission of information to each carrier occurs over different time periods, and can take up to a month.

  You can send an email to hrbenefits@csusm.edu to identify that your name has changed and the HR Benefits Office will monitor the systems to ensure the address is updated with the various carriers.

• I noticed my dependent's information is wrong with an insurance carrier?

  Contact the HR Benefits Office to discuss the information identified as being incorrect, and the HR Benefits Office will determine the process to get it corrected and may require supporting documentation to make the correction.

  Correction Type	Required Document
  Dependent Name	Dependent's Social Security Card
  Dependent Date of Birth	Dependent's Birth Certificate or Driver's License
  Dependent Social Security Number	Dependent's Social Security Card

• How do I update Beneficiary Information due to a Life Event

  Life Events may or may not change your benefit needs, however it is important that you maintain current Employee and Beneficiary Records.
  
  Use this Reference Sheet for helpful links:  Employee Status Update Guide
  
  (Note:  The Benefits Office does not update these records for an employee.)

• How do I start/stop/change the 403(b) Supplemental Retirement Plan account?

  The 403(b) SRP is administered through Fidelity. The enrollments and contribution changes can be completed by logging onto Fidelity NetBenefits.  All contribution changes must be received at Fidelity by the 5th of the month, before 9PM, to reflect on the next month's pay warrant.