Medical, Dental & Vision Benefits

Health | Dental | Vision | FlexCash | COBRA | HIPAA | Additional Resources

Medical Insurance Plans

SFSU employees that are benefits eligible may enroll in one of several medical plans for themselves and their eligible dependents:

Health Maintenance Organizations (HMOs)

Employees select a primary care physician who coordinates all care including referral to specialists.

Anthem Blue Cross Traditional HMO California and Anthem Blue Cross Select HMO California

Dedicated to delivering quality care and great value.

Both plans offer 360° Health, a program that helps members become involved in their health and wellness.  

For more information, call (855) 839-4524.

Blue Shield Access+ HMO

Access to more than 11,000 personal physicians and 300 hospitals.

No annual deductible; copayment at each physician visit.

For more information, call (800) 334-5847.

Health Net Salud y Mas California and Health Net SmartCare California

Budget-friendly HMO plans with a tailored list of quality providers for selected California counties.

Ideal for employees who want one primary care physician to coordinate all their medical care. 

For more information, call (888) 926-4921.

Kaiser

Integrated health care system.

No annual deductible; copayment at each physician visit.

For more information, call (800) 464-4000.

Sharp Performance Plus California

Local HMO plan serving residents of San Diego.

Commitment to healthcare delivered in a convenient and cost-effective manner. 

For more information, call (855) 995-5004.

United Healthcare Alliance HMO California

Quality patient-centered healthcare at lower costs.

Distinct network of providers offers collaborative care and health management. 

For more information, call (877) 359-3714.

Western Health Advantage HMO

Offers an affordable health plan with a quality network and flexibility.

Access to Mercy Medical Group, Woodland Clinic, Hill Physicians, NorthBay Healthcare, and Meritage Medical Network.​

For more information, call (888) 942-7377.

Preferred Provider Organization (PPO)

PERS Choice and PERSCare (administered by Anthem Blue Cross of California) 

Choose your health care providers and pharmacy without referral.

Offers significant savings through a preferred provider network (doctors and hospitals that agree to charge a pre-negotiated rate for everyone on the plan). Non-network providers may be used, but co-payments will be higher.

PERS Choice pays 80 percent of allowable amount (in-network), member pays 20 percent; cop-pays are applicable.

PERS Care pays 90 percent of allowable amount (in-network), member pays 10 percent; co-pays are applicable.

Annual deductibles must be met before some benefits apply.

For more information, call (877) 737-7776.

PERS Select (administered by Anthem Blue Cross of California)

Same level of benefits as PERS Choice at a lower monthly premium cost.

Not available or out-of-state.

Access a list of preferred providers through the PERS Select network.

For more information, call (877) 737-7776.

Prescription Drug Information

OptumRx

·        Is the Pharmacy Benefit Manager  effective January 1, 2017, for PERS Select/Choice/Care PPO, Anthem Blue Cross HMO, Health Net HMO, United HealthCare HMO

·       For more information, call (855) 505-8110

 

Dental Insurance Plans

Employees that meet benefits eligibility may enroll in one either:

·       Delta Dental PPO; or DeltaCare USA for themselves and their eligible dependents.

·       Both plans are administered by Delta Dental of California.

·       The premiums for these dental plans are paid by the CSU.

·       When you have made your choice, fill out a Dental enrollment form, return the completed form to Benefits and Retirement Services.

·       When you go to your dentist, be sure to provide them with your group number.

 

Delta Dental (Indemnity and PPO)

·       Enrollees may select a dentist of their choice.

·       Members may choose a dentist in the Delta Premier or Delta Dental PPO network and pay less.

·       The plan sets the limits it pays for each specific type of dental treatment. Members are responsible for paying any remaining balance.

·       You may read the Evidence of Coverage​​ for information on covered benefits.

·       You will need to complete and submit your own claim forms for services provided by a non-Delta dentist.

·       Register online for member services and to view your claims.

 

DeltaCare USA (Dental HMO)

·       Enrollees and their eligible dependents are required to use a dentist who is a contracted DeltaCare USA provider.

·       Most basic services are covered at no cost.

·       View either the Basic or Enhanced Evidence of Coverage for information on covered benefits.

More Information

·       Your Two Dental Plan Options

·       Benefits Highlights

 

Vision Plans

CSU Vision Plan - Basic

All eligible employees appointed half-time or more for a period of more than six months, and their eligible dependents, are automatically enrolled in the VSP Basic plan.

·       Premiums are paid by the CSU.

·       May visit any licensed ophthalmologist, optometrist or dispensing optician of choice.

·       By choosing a Advantage Network provider in the Vision Service Plan (VSP), the insurance will cover more out-of-pocket costs. To find a Advantage Network provider outside of California, log-in at www.vsp.com or call VSP at (800) 877-7195.

·       Administrator is Vision Service Plan (VSP).

The VSP Basic plan includes:

·       One comprehensive eye exam every calendar year.

·       One pair of lenses every other calendar year (or calendar year if your prescription changes) and one frame every other calendar year.

·       Contact lenses every other calendar year when contact lenses are provided in lieu of all other lens and frame benefits.

CSU Vision Plan - Premier

All CSU active employees eligible to participate in the CSU VSP Basic Plan are eligible to enroll in the Premier Vision Plan for a small monthly employee cost share. The Premier Vision Plan enables you to get a higher allowance for frames and contacts, fully covered standard progressive lenses, and more discounts.

Eligible employees must enroll through VSP directly by calling (800) 400-4569. The additional cost will be deducted directly from their pay warrant.

If the employee elects the Premier Plan, any dependents they wish to cover must also be enrolled into the Premier Plan coverage. Employees cannot choose to enroll in both the Basic and Premier vision plan coverage at the same time, or split their enrollment leaving any dependents on the Basic Vision Plan. 

 

The VSP Premier plan includes:

·       One comprehensive eye exam every calendar year.

·       One pair of lenses/frames every calendar year.

·       Contact lenses every calendar year when contact lenses are provided in lieu of all other lens and frame benefits.

·       Extra Savings on Retinal Screening.

 

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 at www.vsp.com​.

 

Accessing Benefits

·       Claim form is not required when using standard in-network benefits.

·       Services provided by a non-VSP provider must be paid in full by the employee. For reimbursement, complete a VSP Out-of-Network Reimbursement form

 More Information

·       VSP Benefit Summary

·       Vision Service Plan (VSP) Evidence of Coverage

 

FlexCash Program

Employees who are eligible for medical/dental insurance and have other non-CSU group coverage can elect to waive CSU coverage in exchange for a monthly cash payment:

·       Medical and dental: $140.00;

·       Medical only: $128.00;

·       Dental only: $12.00

Employee FlexCash Basics

·       Must certify that they have alternative non-CSU group medical and/or dental coverage

·       Provide proof of other non-CSU group coverage

·       Not eligible to participate if covered as the dependent of another CSU employee

·       FlexCash payment is treated as taxable income and is subject to payroll taxes

·       Eligible employees have 60 calendar days commencing with their appointment date to enroll in the FlexCash plan

NOTE: Under the Federal Patient Protection and Affordable minimum value standards. Care Act (ACA), the IRS has recently prohibited employers from offering cash to employees who choose to waive employer-sponsored medical coverage and enroll in "individual" medical coverage. Employees who are enrolled in individual medical coverage, such as Tricare, Medicare, Medi-Cal and Covered California, are not eligible to receive cash in lieu of other medical coverage even if the coverage provides minimum value. These requirements do not apply to dental coverage.

More Information

·       FlexCash and TAPP Brochure​

 

COBRA Enrollment

Employees who lose eligibility for medical, dental, and vision plans due to a reduction in work hours or termination of employment are eligible to continue benefit coverage under COBRA for a maximum of eighteen months. This benefit extends to dependents covered by the employee's medical, dental and vision plans. When dependent children turn 26, they are eligible for a maximum of up to 36 months of continuation coverage.

If continuation is elected, employees and/or dependents will be required to pay the full premium plus a 2% administrative fee. The coverage will end prior to the 18-month maximum if the premiums are not paid in a timely manner, or if the enrollee is covered under another health plan, or becomes entitled to Medicare.

For more information contact the Benefits and Retirement Services Unit at (415) 405-4004 or benefits@sfsu.edu for eligibility and qualifying events.

More Information:

·       2018 COBRA Rates

 

Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) protects the enrollment and policies for employees and family members who are eligible to enroll in a CalPERS-sponsored health plan.

HIPAA also protects the confidentiality between you and your health care provider. In accordance with HIPAA, should you need an SFSU benefits coordinator to assist you with your health care claims, an Authorization to Use and/or Disclose Personal Health Plan Information Form is required.

 

Medicaid and the State Children's Health Insurance Program (SCHIP/CHIP)* Offer Free or Low-Cost Health Coverage to Children and Families

If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid* or CHIP* programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.

If you or your dependents are already enrolled in Medicaid* or CHIP* and you live in a State listed below, you can contact your State Medicaid* or CHIP* office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid* or CHIP,* and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid* or CHIP* office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you and/or your dependents enroll in State Medicaid* or CHIP*, but subsequently lose eligibility, you and your dependents can be re-enrolled in the employer’s health plan. If you (or your dependent(s)) are already enrolled in your employer’s health plan, but become eligible for State Medicaid* or CHIP*, you have the right to dis-enroll yourself and/or your dependent(s) from the employer’s health plan**. These special enrollment/disenrollment requests must be submitted to the Benefits Office within 60 days after you or your dependent(s) is terminated from, or determined to be eligible for such assistance.

If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States (State Office Locations) is current as of November 3, 2010. You should contact your State for further information on eligibility.

Medicaid and the State Children’s Health Insurance Program (SCHIP/CHIP)* Offer Free or Low-Cost Health Coverage to Children and Families.

Additional Information:

·       CSU Privacy Notice

·       Authorization to Use and/or Disclose Personal Health Plan Information Form