Frequently Asked Questions (FAQs)

1. Which family members are eligible for plan enrollment?

Eligible family members include:

  • Your spouse or registered domestic partner. Domestic partnership must be registered with the California Secretary of State. Specified same-sex domestic partnerships between persons who are both at least 18 years of age; or specified opposite sex domestic partnerships where one person is over the age of 62. (Former spouses and former domestic partners are not eligible.)
  • Your children, adopted children, or stepchildren under age 26 (regardless of whether or not they are living with you).
  • A child over age 26 who is incapable of self-support because of a mental or physical condition that existed prior to age 26 and continuously since age 26 may be included at your initial enrollment. This enrollment is subject to CalPERS approval.
  • Another person's child under age 26 may be eligible for coverage if a parent-child relationship exists.

Split Enrollments: Members who are married or in a registered domestic partnership and both work, or worked, for agencies in the CalPERS Health Program can enroll separately. If you and your spouse or domestic partner enroll separately, you must enroll all other family members, regardless of the relationship, under only one of you. Dependents cannot be split between parents. If split enrollments are found, they will be retroactively corrected. You will be responsible for all costs incurred from the date the split enrollment began.

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2. I am getting married soon. Can I add my new spouse and/or stepchild(ren) to my coverage or do I have to wait until there is an open enrollment period?

You have 60 days from the date of marriage to add your spouse and/or stepchild(ren) to your health, dental and/or vision insurance.

Insurance will be effective the 1st of the month following the receipt of the Enrollment Worksheet for Benefit Elections and/or Changes in Human Resources. You must provide social security numbers for all dependents along with a copy of your marriage certificate and any birth certificates of added dependents within 2 weeks of enrollment. Failure to do so may result in a termination of benefits for said dependents.

Requests for enrollment outside of the 60 day timeframe will result in a 90-day waiting period from receipt date in Human Resources before an enrollment can occur.

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3. I am expecting a baby soon. Can I add my baby to my coverage?

You have 60 days from the date of birth to add your newborn to your health, dental and/or vision insurance. In order to initiate the enrollment, please submit an Enrollment Worksheet for Benefit Elections and/or Changes to Human Resources. Insurance will be effective the 1st of the month following the date of birth.

Please remember to contact Human Resources immediately when a social security number has been issued for your newborn, as a social security number is required by CalPERS for continued enrollment. Also, submit a copy of the birth certificate when one is issued. Failure to do so may result in a termination of benefits for said dependent(s).

For enrollment requests outside of the 60 day timeframe, please contact the Benefits Unit at 805-756-5436.

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4. Can my grandchild or niece/nephew be covered under my health plan?

Another person's child under age 26 may be eligible for coverage if a parent-child relationship exists. A "parent-child" relationship occurs when an employee assumes a parental role and is considered the primary care "parent." Evidence of this relationship may include assuming responsibilities such as providing shelter, clothing, food, child care or education for the child, as well as assuming parental duties, such as providing permission for school activities, health care services, extracurricular, and recreational activities.

To enroll a dependent under this criteria, please submit an Affidavit of Parent - Child Relationship form along with an Enrollment Worksheet for Benefit Elections and/or Changes to Human Resources within 60 days from the date of custody. If approved, insurance will be effective the 1st of the month following the receipt of the appropriate paperwork. A birth certificate is also required within two weeks of submitting the enrollment forms, however should not delay your submission of enrollment paperwork.

Enrollment paperwork received outside of the 60 day election window, will result in a 90 day waiting period.

***If the dependent is disabled prior to 26 and continuously since 26, special enrollment rules may apply, please contact Human Resources directly at 1-805-756-5436 to discuss enrollment options.***

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5. Can I enroll a Domestic Partner or Domestic Partner Children in my benefits?

Domestic Partners and Domestic Partner children are eligible for enrollment in the various benefits plans. Please submit an Enrollment Worksheet for Benefit Elections and/or Changes within 60 days from the date of the Domestic Partnership Registration with the State of California to enroll a Domestic Partner/Domestic Partner children in medical, dental, and/or vision plan.

Insurance will be effective the 1st of the month following the receipt of the Enrollment Worksheet for Benefit Elections and/or Changes in Human Resources. You must provide a copy of your "Declaration of Domestic Partnership", along with any birth certificates of added dependents within 2 weeks of enrollment. Failure to do so may result in a termination of benefits for said dependents.

Requests for enrollment outside of the 60 day timeframe will result in a 90-day waiting period from receipt date in Human Resources before an enrollment can occur.

If your Domestic Partner is not claimed as a dependent for your tax filing purposes, any additional premium paid by the University as a result of the Domestic Partner enrollment is considered imputed income for Federal tax purposes and will cause an increase to your tax liability.

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6. Can my dependent parents be covered?

No. Even if totally dependent on the employee, parents are not eligible for coverage under the health, dental, vision insurance plans. However, parents are eligible for the voluntary plans below:

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7. I live with my boyfriend/girlfriend and we share living expenses. Can I add them to my benefits? Aren't we considered "Domestic Partners?"

Domestic Partners are either same-sex gender couples, or opposite gender couples where at least one member is over the age of 62. Only legal spouses or domestic partners that have registered their partnership with the Secretary of State of California may add their dependents to their benefits. Proof of domestic partnership registration is required along with the dependent's social security number.

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8. What supporting documentation and information are required to enroll my family members?

  • Spouse: Marriage Certificate
  • Domestic Partnership: Declaration of Domestic Partnership
  • Dependents: Birth Certificate
  • Recognized Child: Birth Certificate and Affidavit of Parent-Child Relationship

CalPERS requires social security numbers for all of the above.

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9. How long may my dependent children remain covered under my benefit plans?

Eligible dependent children (natural, adopted, step, domestic partner's children, children in a parent-child relationship status) are eligible for coverage up until the age of 26.

Disabled Children Over Age 26: A child over age 26 who is incapable of self-support because of a mental or physical condition that existed prior to age 26 and continuously since age 26 may be included at your initial enrollment. This enrollment is subject to CalPERS approval.

Prior to enrollment of a disabled child over the age of 26, you must submit a Member Questionnaire for the CalPERS Disabled Dependent Benefit form, and your doctor must complete and submit a Medical Report for the CalPERS Disabled Dependent Benefit form for CalPERS approval. You must update these forms periodically upon request.

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10. What core benefits am I eligible for?

Class Appointment Type + Appointment Length (at Least) + Units or
Hours
= Eligible for:
Faculty
(Tenure Track)
12 Month + 6 Months + 1 Day + 7.5 Units = Health, Dental, Vision
Academic Year + 6 Months + 1 Day + 7.5 Units = Health, Dental, Vision
Lecturer/
Coach
12 Month
+ 6 Months + 1 Day
+ 7.5 Units = Health, Dental, Vision
Academic Year + 2 Quarters*
+ 6.0 Units
= Health, Dental, Vision
Teaching Associate 12 Month
Academic Year
+ 6 Months + 1 Day
(days of instruction)
+ 7.5 Units = Health, Dental, Vision
Staff/MPP Regular + Permanent + 20 hours/week = Health, Dental, Vision
Temporary + 6 Months + 1 Day + 20 hours/week = Health, Dental, Vision
Emergency Hire + 3 Months or less + 130+/month = Health Only (ACA)
Intermittent + Any length + 130+/month = Health Only (ACA)
ALL Employees ANY
+ ANY + 130+/month = Health Only (ACA)
ANY
+ ANY + 11.25 units = Health Only (ACA)

*Initial appointment must be for two consecutive quarters or greater, quarter by quarter contracts do not meet requirement. Once requirement is met, appointments thereafter can be quarter by quarter as long as the units meet or exceed six units per quarter. Breaks in employment will require a re-qualification. (Note: Summer is not considered a break in employment)

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11. When can I enroll in benefits?

Newly benefits eligible employees have 60 days from the date of benefit eligibility to enroll in health, dental, FlexCash, voluntary group term life insurance (without completing the medical questionnaire), dependent and health care reimbursement plans.

Benefit eligible employees can also enroll in benefits during the annual open enrollment period held in September/ October for a January 1st effective date.

There are also "permitting events" that may allow you to enroll outside of 60 day election window or the open enrollment period. Please call Human Resources at 805.756.5436 for further information.

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12. How do I choose a health or dental plan?

For detailed information regarding Health & Dental Plans, please see Medical Insurance and Dental Insurance.

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13. When is coverage effective?

Health/Dental/Vision: Effective dates of new enrollments, additions, deletions, and plan changes are normally effective the 1st of the following month from the event date or the date Human Resources receives the enrollment form.

FlexCash: Human Resources must have the enrollment form to the State Controller's Office by the 10th of the month for the effective date to be the first of the following month. Human Resources requires the form to be submitted by the 1st of the month for it to be effective the following month.

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14. Can I still enroll in benefits if I missed the 60-day enrollment deadline?

Medical and Dental Insurance: There are two options. Based on the qualifying event, you may be granted a late enrollment extension. A 90-day waiting period would apply starting from the date Benefits receives the enrollment request. The effective date would be the first of the month following the completion of the 90-day waiting period. You will also be able to enroll in benefits during the annual Open Enrollment period for a January 1st effective date.

HCRA/DCRA: You may enroll 60 days following your benefit eligibility date, during the Open Enrollment period (effective date: 1st of January) or within 60 days of a permitting event (such as a child birth, adoption, etc.). Call Human Resources at 805-756-5436 for further information.

Standard Voluntary Life/LTD/ADD: You may enroll in this at any time, however if you enroll within 60 days of your benefits eligibility date, you will not be required to complete the medical questionnaire for coverage up to the Guarantee Issue amount for life insurance which is $150,000 for employees, $50,000 for Spouses/Domestic Partners and $20,000 for Dependent Children.

TSA's: You may enroll in the Tax Shelter Annuities (TSA) at any time.

For other plan information, please visit Voluntary Benefit Plans

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15. Can I opt-out of insurance if I am covered by another insurance program?

Yes, there is no mandatory enrollment for CSU medical and/or dental coverage. However, you may be eligible for FlexCash (cash in lieu of health/dental coverage) if your alternate coverage is a non-CalPERS medical and/or non-State dental plan. Please see Benefits web page for eligibility requirements.

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16. What if I am already enrolled in a non-CSU health and/or dental plan?

If you have other non-CalPERS coverage, FlexCash is an optional benefit plan that allows you to waive your CSU medical and/or dental insurance coverage in exchange for cash. You will receive $128.00 for health and $12.00 for dental.

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. FlexCash will not be considered compensation for retirement purposes. The additional cash income will be reported as income on Form W-2 for the year you receive it.

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17. What is FlexCash and how do I get it?

If an employee is enrolled in a non-CalPERS medical plan and/or a non-State dental plan, they are eligible to receive cash in lieu of CSU coverage, which is referred to as FlexCash. Employees eligible for the FlexCash plan may receive an additional $128.00 per month for health and/or $12.00 per month for dental. Choosing FlexCash for both Health and Dental will result in an additional $140.00 per month on your pay check. FlexCash payment is treated as taxable income and is subject to payroll taxes.

In order to enroll in FlexCash please complete/submit an Enrollment Worksheet for Benefit Elections and/or Changes, along with proof of other coverage to Human Resources within 60 days of the event date (Hire Date; Gain of alternate Health/Dental Coverage).

Please Note: Proof of other coverage is required for enrollment. You are ineligible for FlexCash if you are covered as a dependent of another CSU employee.

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18. I often have questions about my benefit plan coverage. What is the best resource for locating answers to my questions?

The best way to learn about your plan coverage is to review the plan's Evidence of Coverage (EOC) booklet. The EOC will outline in great detail coverages and exclusions to your current insurance plan. In conjuction with your review of the EOC, Human Resources also recommends confirming your interpretation with the insurance carrier, to validate your understanding.

EOCs can be found here:

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19. I intend to enroll in one of the HMO Health Plans. How do I select a primary care physician (PCP)/medical group?

When you enroll in one of the HMO plans, the plan will select a Primary Care Physician (PCP) for you and each of your dependents. However you and your covered depedents have the option of selecting a different PCP/medical group.

To change your PCP/medical group prior to your coverage effective date, please call one of the following numbers (dependent on your selected health plan):

Health Plan Phone Number Online Directory of Eligible PCPs
Blue Shield Access+HMO 1-800-334-5847 Blue Shield PCPs
(Under 'Select a Plan,' choose CalPERS as your medical plan and either 'CalPERS Access+HMO' or 'CalPERS NetValue HMO')
Anthem HMO Traditional 1-855-839-4524 Anthem PCPs
(Select the 'Traditional HMO' hyperlink)

Once you select the doctor, we recommend call the doctor directly to confirm that they still accept Access+ HMO. You may change your PCP/Medical Group once per month. Changes to either PCP/Medical Group will be effective the 1st of the following month when the request was received.

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20. Will I receive health/dental/vision insurance cards?

Health Plan
Yes, you should receive health insurance card(s) approximately 10-15 business days after your benefits are recorded by the carrier. This card will also serve as your "prescription card". You may print a temporary card by visiting your providers website.

Delta Dental PPO
You will not receive insurance cards for your Delta Dental PPO. Eligibility for you, and eligible dependents, will be confirmed by your dental office using your social security number and birthdate. You may also need to provide your dentist with your Delta Dental PPO group number which you can obtain from Human Resources by calling 805-756-5436.

Deltacare USA HMO
You will receive an identification card and an Evidence of Coverage (EOC) booklet describing your benefits. You can make an appointment once you have received confirmation of your enrollment. You may change contract dentists by notifying Delta Care USA by calling 800-422-4234. DeltaCare USA must receive the DeltaCare USA enrollment materials and/or contract dentist change request by the 21st day of the month for coverage to be effective the 1st day of the following month.

Vision Plan (VSP)
You will not receive insurance cards for your vision plan. Eligibility for you, and eligible dependents will be confirmed by your VSP provider using you social security number and birthdate.

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21. Since Delta does not issue identification cards, what information should be given to the provider to confirm benefit eligibility?

Delta Dental PPO uses an employee's social security number as the identification number for eligibility for the employee and their dependents. A dental office may also request the Group Number. If the Group Number is needed, please contact Human Resources at 805-756-5436.

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22. What is the name of our vision plan and what plan information is required for services?

Vision Service Provider (VSP). No identification cards are issued for the plan. Employee's Social Security Number is used to confirm eligibility for employee and dependents. By registering at www.vsp.com, employees may check benefit eligibility, look up providers, print forms and more.

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23. How do I find out what my group numbers for medical, dental, and vision are?

  • Health: You can locate your group number on your insurance card.
  • Dental: Call Human Resources at 805-756-5436
  • Vision: 12292796

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24. What can I do if I have not received or lost my medical ID card?

Newly enrolled employees who have not received their medical cards within 10-15 business days may not have a current mailing address on file. Please verify your current mailing address via your MyCalPoly portal.

Otherwise, you may contact your provider to request a new card or register online to print a temporary card:

Health Plan Website Phone Number
Blue Shield Access+ www.blueshieldca.com 1-800-334-5847
Anthem Traditional Blue Cross HMO http://www.anthem.com/ca/calpershmo/ 1-855-839-4524
Anthem Blue Cross PPO http://www.anthem.com/ca/calpers/ 1-877-737-7776

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25. What can I do if I tried to make an appointment and the doctor's office said I and/or my dependents were not eligible?

Contact Human Resources at 805-756-5436 to confirm that your enrollment was received by your provider. If possible it is best to wait to make an appointment with your dentist until you see the employer deduction on your pay stub. This will avoid any unnecessary reimbursement for services rendered. If you are unable to wait, please contact Human Resources and we will expedite your enrollment.

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26. How can I find out what benefits my family and I are enrolled in and if HR has my correct address as well as emergency contact information?

Benefits Information

  1. Sign into your Cal Poly Portal
  2. Select the Personal Info Tab
  3. Go to "My Benefits" section
  4. Select the link "Benefits Summary" (this will take a few moments to load)
  5. When your benefits summary is loaded, you may select each benefit to show the dependents

Personal Information

  1. Sign into your Cal Poly Portal
  2. Select the Personal Info Tab
  3. Go to 'My Info' section
  4. Review Emergency Contact Information

If you find a discrepancy, please contact Human Resources at 805-756-5436.

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27. Am I able to change health/dental plans?

Employees are able to switch health and dental plans during the annual open enrollment period (normally during the months of September/October). Employees will be notified through campus announcements when open enrollment begins and ends. All changes made during open enrollment are effective January 1st of the following year.

If you have a permitting event (e.g. moving out of the service network for your plan), this may allow a change outside of the open enrollment period. Please contact Human Resources at 805.756.5483 to confirm if you would qualify for this.

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28. Can I add or delete my dependents at any time?

Dependents may be added/deleted due to the following circumstances:

Addition of Dependent

  • New Born/Adopted Child/Parent Child Relationship
  • New Spouse/Step Children (due to marriage)
  • Change in Custody
  • Loss of Other Coverage
  • Open Enrollment
  • Certified Disabled Dependent
  • Domestic Partner/Domestic Partner Child

Deletion of Dependent

  • Dependent gains other coverage
  • Divorce
  • 26th birth month
  • Change in Custody
  • Dissolution of Domestic Partnership (DP child only)
  • During the Open Enrollment Period
  • Dependent moves out of household
  • No longer disabled

Employees must submit a Benefit Elections and/or Changes worksheet along with supporting documentation to Human Resources within 60 days of the Permitting Event (see list above). If you do not see your Permitting Event above or your are outside of the 60 day election window, please contact Human Resources at 805-756-5436.

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29. Qualifying Life Events - What do I need to know?

Since there are timelines to add/delete dependents, when you have a "life event" such as marriage, registration of domestic partnership, birth or adoption of a child, divorce, termination of domestic partnership, or death of a family member you should contact Human Resources immediately at 805-756-7472 for necessary document completion.

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30. I am resigning or my appointment expires at the end of the month. How long will my coverage be in effect?

Coverage is usually effective through the end of the following month in which you resign or the appointment ends. If you work a few days into a pay period, the State Controller's Office will deduct any required premiums as long as there is enough net pay to cover that premium.

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31. Can I continue my health benefits if I resign or when my appointment expires?

Yes. COBRA Continuation Coverage provides you the option of continuing your medical, dental and/or vision plans for up to 18 months (or longer in some cases). You would be responsible for paying the entire premium amount to the carriers, plus a 2% administrative fee. The provisions of COBRA also apply to dependents who lose coverage. Please contact Human Resources for further information.

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32. Can I elect to continue benefits if a family member or I become ineligible for coverage?

Yes. Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to continue benefits coverage for yourself and your dependents. If you are losing benefits due to separation from the CSU, or your time base changes making you ineligible for benefits, you can continue benefits through COBRA up to 18 months. If your loss of benefits is due to divorce, death, or your dependent turns 26, you may continue benefits through COBRA up to 36 months. The premium for COBRA is 102 percent of the total (which includes the employers portion also) monthly premium rate.

You must submit a COBRA Election Form within sixty (60) calendar days following notification of eligibility. The Benefits Unit will notify you automatically if you are eligible. Coverage must be continuous and you will be required to pay premiums from the date your benefit coverage ended.

It is important to have your address updated in your Cal Poly portal, as all COBRA notifications will be sent to this address.

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33. When are health care premiums deducted from my pay warrant?

Your premium for health benefits are paid in advance of the pay period for which you receive the benefit. For example, health plan coverage for the month of August will be deducted from your July pay warrant.

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34. How much will my health, dental and or/vision insurance cost me?

Health
The amount you pay is based on the amount the employer contributes, the health plan you select, and the number of dependents on your health plan. The amount can change each calendar year. Please see the health premium rate chart for current rates, which can be accessed on the Benefits webpage.

Also, please remember that the out-of-pocket expenses for utilizing services will be dependent on the plan selected. Please refer to the Summary of Covered Services for further details.

Dental/Vision
Dental and vision premiums are covered fully by the CSU. However, you will be responsible for a co-payment and/or co-insurance dependent on the insurance plan selected. Co-payments are based on the services provided. For detailed information, please visit our Dental and Vision insurance pages.

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35. Can I fill a prescription prior to receiving my health insurance card?

"If you or any covered dependent need to fill a prescription prior to receiving your health insurance card, you will need to pay for the prescription in full (save your sales receipt) at a participating pharmacy. Once you receive your insurance card, you may submit a claim for reimbursement and your sales receipt to your health plan.

You may be able to print a temporary insurance from your providers website:

You may also call Human Resources at 805.756.5436 for information on the status of your enrollment.

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36. When is the annual Open Enrollment period?

Open Enrollment period is normally mid September through mid October. However, dates can change and Human Resources will notify all employee's via email, Cal Poly Report and flyers to departments. During this period you have the opportunity to enroll, change health plans and/or add eligible family members not currently enrolled. The effective date of changes will be the following January 1.

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37. How do I register or terminate my domestic partnership with the Secretary of State?

To register or terminate domestic partnership, please visit http://www.sos.ca.gov/dpregistry/

If your question is not listed above, please submit it to humanresources@calpoly.edu or call 805-756-5436.



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