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Eligibilty

Eligible Employees

To be eligible for medical coverage:

  • An employee must be appointed at least half-time (equivalent to 7.5 Weighted Teaching Units for academic year appointments) for more than six months; or,
  • If employed in an R03 Lecturer or Coach Academic Year position, employee must be appointed for at least six (6) weighted teaching units for at least one semester, or two or more consecutive quarter terms.
  • 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 regardless of the duration of the new appointment.

An employee who does not meet the eligibility criteria above may be eligible for medical coverage or FlexCash under the Affordability Care Act (ACA) if any of the following criteria is met:

  • 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; or,
  • Appointed with at least a .75 timebase regardless of length of appoinment (duration) or intially hired to work at least 130 hours per month.
Non-Eligible Employees

Employees excluded from medical benefits include:

  • Intermittent employees
  • Student assistants
  • Graduate assistants
  • Faculty employed soley to teach summer session, extension or intersession
  • An employee paid from funds not controlled by the California State University or from revolving or similar funds from which a regular California State University premium payment cannot be made.
Eligible Dependents

Eligible dependents of an eligible employee included:

  • Spouse (unless legally separated or divorced)
  • Domestic partner (registered through the Secretary of State process), and
  • Dependent children from birth to the end of the month in which the child reaches 26. A dependent child includes a stepchild, a natural born child, or a child living with the employee in a parent-child relationship who is economically dependent upon the employee.

Dependents become eligible coincident with the Eligible Employee or upon attainment of dependent status. Newborn infants are eligible for medical coverage from and after the moment of birth. Adopted children are eligible for medical coverage from and after the moment the child is placed in the physical custody of the Eligible Employee for adoption.

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.