Medical Benefits
Employees are now able to submit their medical and dental enrollments form using the secure DocuSign process. You will be required to log into DocuSign with your SF State credentials to complete the forms. Most forms will require you to begin by entering your SF State ID. You will also be required to read and accept the submission guidelines for the forms. Please review the DocuSign instructions for additional information . Document upload to MoveIt is no longer required when using DocuSign.
Additional documents will be updated to the new DocuSign process. Documents that do not require submission to the SF State Benefits Office will continue to be available in PDF format for your convenience.
As an employee of the California State University (CSU), you have a comprehensive program of health benefits including medical, dental, vision, flexible benefits programs and more available to you and, in many instances, your family.
Employees that are benefits eligible may enroll in one of several medical plans for themselves and their eligible dependents:
- Monthly plan premium costs shared by the CSU and the employee.
- Employee contribution rates vary depending on the plan selected and the number of dependents enrolled.
- Before enrolling, review the current Health Plan Rates form attached and the information provided below on each plan.
- To find health plans available in your area go to the CalPERS Health Plan Search by Zip Code
- Use the attached list to contact providers for more information.
What's in a Plan (HMO vs PPO vs EPO vs Combination Plans
- HMO - A Health Maintenance Organization (HMO) plan provides health care from specific doctors and hospitals under contract with the plan. You pay co-payments for some services, but you often have no deductible, no claim forms, and a geographically restricted service area.
- PPO - A Preferred Provider Organization (PPO) is similar to a traditional "fee-for-service" plan, but you must use doctors in the PPO provider network or pay higher co-insurance (percentage of charges). You must usually meet an annual deductible before some benefits apply. You're responsible for a certain co-insurance amount and the plan pays the balance up to the allowable amount.
- EPO - The Exclusive Provider Organization (EPO) plan offers the same covered services as an HMO plan, but you must seek services from the plans' PPO network of preferred providers. You're not required to select a primary care physician.
- Combination Plans - A combination plan means at least one family member is enrolled in a Medicare health plan and at least one family member is enrolled in a Basic health plan through the same health carrier. CalPERS requires all family members to have the same health carrier.
Below please find information to help you understand and navigate the rules, guidelines and deadlines governing the CSU Benefits Program.
Employees select a primary care physician who coordinates all care including referral to specialists.
Anthem BlueCross Traditional HMO California
Anthem BlueCross Select HMO California
- Dedicated to delivering quality care and great value.
- Both plans offer programs that help members become involved in their health and wellness.
- For more information, call (855) 839-4524.
- 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 SmartCare California
- Budget-friendly HMO plan 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.
- Integrated health care system.
- No annual deductible; copayment at each physician visit.
- For more information, call (800) 464-4000.
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.
(administered by Anthem BlueCross 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.
Del Norte County EPO (administered by Anthem BlueCross of California)
- Cost-effective health benefits — You have low copays and no deductible. In some cases, you pay nothing out of pocket for care
- 100% coverage for preventive care — you do not have a copay when you see a doctor in your Del Norte EPO plan.
- Access to the doctors you want to use — you have the freedom to select a local doctor you may already know. (If you need inpatient care, Sutter Coast Hospital in Crescent City is the only hospital in this plan.)
- When you travel out of state or even overseas, you have access to special programs if you need care. See Your coverage travels with you on page 4 for more information.
- Enhanced benefits — you can have up to 20 combined visits each year with a network acupuncturist or chiropractor.
- No claim forms — when you visit a network doctor or provider, just pay a copay — if one is required.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) - Medical
The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) and the Omnibus Budget Reconciliation Act of 1989 (OBRA) require employers to continue Medical, Dental, and Vision coverage for all eligible employees and dependents for up to 18, 29 or 36 months following certain events. The purpose of this continuation of coverage is to ensure access to health coverage for employees who would otherwise lose group coverage under specified circumstances called "qualifying events."
Employee Eligibility
An employee covered by a CSU health plan has a right to choose continuation coverage if group health coverage is lost because:
- Of a reduction in work hours; or
- The termination of employment (other than due to gross misconduct).
Spouse or Domestic Partner Eligibility
A spouse or domestic partner of an employee, covered by a CSU health plan, has the right to choose continuation coverage if group health coverage is lost for any of the following reasons:
- The death of the employee;
- Termination of employee's employment or reduction in employee’s work hours;
- Divorce, legal separation, or dissolution of domestic partnership from the employee; or
- Employee becomes entitled to Medicare.
Dependent Child Eligibility
A dependent child of a covered employee has the right to continuation coverage if group health coverage is lost for any of the following reasons:
- The death of the parent (employee);
- The termination of the parent's employment or reduction in the parent's work hours with the CSU;
- The parents' divorce, legal separation, or dissolution of domestic partnership;
- The parent (employee) becomes entitled to Medicare; or
- The dependent ceases to be a "dependent child" under the CSU health plan.
If an employee does not choose continuation coverage, the employee's coverage will end. However, the employee's spouse or domestic partner and/or eligible dependents may elect continuation coverage, independent of the employee's rejection.
COBRA coverage is effective from the date of the qualifying event. The CSU must notify eligible employees of their right to choose continuation coverage within fourteen (14) days of the qualifying event. An employee’s COBRA rights will be forfeited if the CSU does not receive notification of the employee’s wish to continue coverage within sixty (60) days of the qualifying event or date of the notification.
Following the sixty (60) day election period, an employee or eligible dependents have forty-five (45) days from the date of enrollment to pay for the continued coverage. The first payment will include the cost of coverage beginning with the first date coverage would have otherwise ended. After the initial payment, the required monthly premium is due before each month of coverage. Coverage will be cancelled if payment is not received within the thirty day grace period following each payment due date.
COBRA premium rates are paid for by the participant. The CSU does not pay any portion of the COBRA premium. Rates are calculated at 102%.
CalPERS Health Plans - COBRA Group Continuation Coverage For 2023
Medical Rates for January 1, 2023 to December 31, 2023
| Plan Code | Plan Name | 2023 Monthly COBRA Premium | ||
|---|---|---|---|---|
| Emp. | EE + 1 | EE 2 + | ||
| 181 | Anthem Blue Cross Select HMO | $921.93 | $1,843.85 | $2,397.01 |
| 180 | Anthem Blue Cross Traditional HMO | $1,138.98 | $2,277.97 | $2,961.36 |
| 172 | Anthem Blue Cross EPO (Del Norte County) | $1,105.57 | $2,211.14 | $2,874.47 |
| 141 | Blue Shield Access+ | $859.46 | $1,718.92 | $2,234.61 |
| 191 | Blue Shield Access+ EPO (Restricted to certain counties) | $859.46 | $1,718.92 | $2,234.61 |
| 471 | Blue Shield TRIO (Restricted to certain counties) | $775.92 | $1,551.85 | $2,017.41 |
| 184 | Health Net Salud y Mas | $644.53 | $1,289.06 | $1,675.77 |
| 185 | Health Net SmartCare | $1,013.26 | $2,026.52 | $2,634.47 |
| 056 | Kaiser (CA) | $869.73 | $1,739.47 | $2,261.31 |
| varies | Kaiser Permanente Out-of-State | $1,178.54 | $2,357.08 | $3,064.20 |
| 434 | PERS Platinum (PERS Care and PERS Choice) | $1,105.57 | $2,211.14 | $2,874.47 |
| 437 | PERS Gold (PERS Select) | $781.43 | $1,562.86 | $2,031.73 |
| 207 | PORAC** | $790.50 |
$1,555.50 | $2,040.00 |
| 189 | Sharp (San Diego County) | $780.26 | $1,560.52 | $2,028.68 |
| 187 | UnitedHealthcare Alliance HMO | $858.55 | $1,717.11 | $2,232.24 |
| 319 | UnitedHealthcare Harmony HMO | $736.73 | $1,473.45 | $1,915.49 |
| 176 | Western Health Advantage (Bay Area, Sacramento, and other Northern regions) | $775.37 | $1,550.75 | $2,015.97 |
*These premiums cover all regions of Kaiser out-of-state.
**Restricted to employees in Unit 8, State University Police Association (SUPA)
Contact Information & Additional Resources
| Benefits, Leave Programs & Retirement Services Support Line | Main | 415.405.4004 | benefits@sfsu.edu |
| Terance Williams (A-I) | Benefits Analyst | (415) 338-1556 | terancewilliams@sfsu.edu |
| Mel Cabrera-Brohmi (J - R) | Benefits Analyst | 415.405.4371 | melca9@sfsu.edu |
| Lola Thomas (S - Z) | Sr. Benefits Lead Analyst, and Fee Waiver Coordinator | 415.338.2683 | ythomas@sfsu.edu |
| Mary Saw | Retirement Specialist | 415.405.0578 | msaw@sfsu.edu |
| Braulio Alcaraz | Leave of Absence Coordinator | 415.338.2508 | braulioalcaraz1@sfsu.edu |
| Martha Paul | Associate Director, Leave Programs, Benefits, and Retirement Services | 415.338.1878 | mcpaul@sfsu.edu |