Open enrollment is a period annually in which employees are allowed to make changes to their medical, dental and vision plan coverage. Employees may enroll in benefits, change plans, remove dependents, or add eligible family members to their coverage. This is also a time to review and enroll in the CSU voluntary benefit plans.
Faculty and staff may also sign up for the Health Care Reimbursement Account (HCRA) and/or Dependent Care Reimbursement Account (DCRA) at this time. If you are currently enrolled in the HCRA and/or DCRA, and want to continue your coverage, you must re-enroll during the Open Enrollment period.
If your current medical and dental coverage meets your needs, and you are not enrolled in HCRA or DCRA, you do not need to take any action to continue your current coverage.
1. When is Open Enrollment?
All Open Enrollment Forms must be submitted to Human Resources between Monday, September 15th and Friday, October 10th, 2014.
2. What if I miss the deadline?
If you miss the deadline, you will need to wait until next year to change your coverage. However, if you have a qualifying life change (such as a birth, marriage, divorce or loss of coverage) that allows you to make a change mid-year, please contact Benefits administration. If you do not re-enroll in HCRA or DCRA, your coverage will end on December 31, 2014.
3. Am I eligible for University-provided Health Benefits?
You must be employed half time or more in a benefits eligible appointment that exceeds six months and one day. Temporary faculty (AY Classification) must have 6.0 units or more for at least one semester, including the current semester.
4. What's next?
Below you will find information on how plans have changed, how you can compare plan rates (between plans, and between 2014 and 2015). For each section (Medical, Dental, Vision, Flex ), read the information provided and visit the CalPERS Open Enrollment pages for additional tools and resources that will assist you in your decision making process.
Where can I find information on the Medical Plans?
View the CalPERS Open Enrollment page and visit the "Our Health Plans Online". "Health Program Publications", and the “Health Plan Chooser”.
CalPERS Open Enrollment website
You should also view individual video presentations designed to assist you in understanding each medical plan.
CalPERS Provider Video Presentations
I. How have Medical Plans changed for 2015?
The Medical Plans choices remain the same with the following updates:
Removal of Sharp Medical Group from Blue Shield's NetValue Plan.United Healthcare has expanded its service area to also encompass San Joaquin and Aolano Counties.Blue Shield will no longer require the use of Centers of Excellence for knee/hip replacement.
- Employees enrolled in Sharp through Blue Shield's NetValue Plan will receive a letter from the carrier.
Blue Shield has eliminated the $250 outpatient hospital copay for upper endoscopies, colonoscopies, cataract surgery, and knee injections.
Inclusion of Acupuncture and Chiropractic benefits for all HMO plans.
- Plans that don't currently offer Acupuncture or Chiropractic services will provide twenty (20) annual visits (combined) for these services, regardless of medical necessity, at the standard office visit copay level ($ 15.00) .
Adoption of High Performance Generic Step Therapy (HPGST) for HMO, EPO, and PPO plans.
- High Performance Generic Step Therapy encourages the use of a preferred drug prior to the utilization of a non-preferred drug. The preferred drug is FDA recommended and represents the most cost-effective drug for a given condition. Per CalPERS, an established evidence-based protocol must be met before a non-preferred speciality drug will be covered. It is important to note that the targeted brands in HPGST have generic alternatives within therapeutic classes and the dispensing of a generic alternative requires a new prescription from the prescriber.
Implementation of Affordable Care Act (ACA) maximum out-of-pocket (MOOP) requirements. For 2015, the ACA limits maximum out-of-pocket (MOOP) amounts for health plans to $6,600/$13,200 for individuals/families for both medical and pharmacy benefits combined.
CalPERS has made a correction to the out of pocket Maximum Calendar Year Co-pay and recently included supplemental information to the 2015 Health Benefit Summary booklet
Refer to page 17 of the CalPERS Health Plan Benefit Comparison – Basic Plans section. For the PPO Basic Plans, the amounts reflected in the Maximum Calendar Year Co-pay for an individual ($4,600) and family ($9,200) are incorrect. The accurate amounts are the same as 2014 which are $3,000 for an individual and $6,000 for a family for PERS Select and PERS Choice, and $2,000 for an individual and $4,000 for a family for PERSCare.
II. Are Medical Plan Premiums changing for 2015?
Yes; some medical plan premiums will be affected - some are increasing and some are decreasing. This would be a good time to review your medical plan coverage and compare it to other options. View the Health Care Premium Comparison Chart to look at the different premium rates for 2015.
How have Dental Plans changed for 2015?
There are no changes.
Delta Dental (PPO) and DeltaCare USA continue to be employer-paid.
Where can I find information on the Dental Plans?
Dental Comparison Summaries:
DeltaCare USA Basic & Delta Dental Basic Plans: For eligible employees in the following categories: Unit 8, excluded E99, and Annuitants
DeltaCare USA Basic & Delta Dental Level I Enhanced Plans: For eligible employees in the following categories: Unit 10 and Unit 11 (Teaching Associates)
DeltaCare USA Enhanced & Delta Dental Level II Enhanced Plans: For eligible employees in the following categories: Units 1, 2, 3, 4, 5, 6, 7, 9 and C99, M98, M80 and FERP Annuitants
More information is available on the Delta Dental Website
I. How has the Vision Plan changed for 2015?
There are no changes.
VSP will continue to be employer-paid.
II. Where can I find information on the Vision Plan?
- More information on the Vision Plan is available online through the Benefits Portal.
Can I be compensated if I waive CSUN coverage?
- If you are covered by a non-CSU health insurance plan, you may enroll in FlexCash. This benefit allows you to waive your CSU health plan and receive a cash payment of $128 (medical only); $12 (dental only); $140 (both medical and dental).
Further information can be found in the Flexcash Plan Brochure.
Are you missing an opportunity to put more money in your pocket?
With a Dependent Care Reimbursement Account (DCRA and/or Health Care Reimbursement Account (HCRA) you set aside a portion of your pay on a pre-tax basis to reimburse yourself for eligible expenses. If you are currently enrolled in the (DCRA) and/or (HCRA), and wish to continue participation in the plan(s), you are required to re-enroll annually during open enrollment.
For 2015, the maximum annual contribution for HCRA is $2,500 and remains at $5,000 for DCRA.
Administrative fee remains $1.00 per month for each plan.
Flexible Spending Account Debit Card for HCRA Enrollees - The optional “FSA Benny Card” issued by ASIFlex, allows enrollees to pay for out-of-pocket medical expenses (i.e., health, dental, vision, etc.) as payment at Health Care Providers and at certain retail locations. For more information about the “FSA Benny Card, use these links:
If you wish to appeal a rejected HCRA and/or DCRA claim reimbursement, it must be filed within 60 days from the date the rejection was communicated by ASIFlex.
Start with the Benefits Open Enrollment Worksheet. As you work through the Open Enrollment Worksheet, you will be provided links to additional forms which may need to be completed and submitted to Human Resources along with your supporting documentation. You can also access these additional forms directly below.
1. Making a change to my Medical Plan:
In addition to completing the Benefits Open Enrollment Worksheet, access the Health Benefit Enrollment (HBD 12) Form.
Complete sections 1-4B, 6, 7, 9, 17, and 19 – 21 (You may ignore any codes in these sections).
Print and sign the form.
Print and complete the Declaration of Health Coverage (HBD 12-A) Form.
If you are switching medical plans, please make sure to list all dependents that you would like covered, whether or not they are included on your current plan.
2. Making a change to my Dental Plan:
Access the Dental Plan Enrollment Form. Complete Sections A, B, and D, and print. (You may ignore any codes in these sections).
If you are switching dental plans, please make sure to list any and all dependents that you would like covered, whether or not they are included on your current plan.
3. Making a change to my Vision Plan:
4. Making a change in Flexcash:
5. Making a change or enrolling/re-enrolling in a Dependent or Health Care Reimbursement Account:
CSU offers a variety of voluntary benefits beyond health and wellness that are important parts of managing your life. You pay for the premiums for these plans through payroll deductions. All of the following voluntary benefit plans, with the exception of the MetLaw Legal plan, allow employees to enroll throughout the year.
Additional information regarding these voluntary benefit plans can be found on the CSU Systemwide Benefits Portal at: www.calstate.edu/hr/benefitsportal/. Please contact the vendor directly to enroll.
MetLaw Legal Plan - This is your annual opportunity to enroll in the MetLaw Legal Plan for a low monthly premium of $19.70. The MetLaw Legal Plan offered by Hyatt Legal Plans, Inc., provides representation for many personal legal services for employees and their eligible dependents.