Frequently Asked Questions

Health Related Benefits Eligibility and Enrollment

Q1: Am I eligible for medical, dental, and/or vision benefits?

A: Eligibility requirements differ depending on your classification:

Faculty, Teaching Associates and Staff. Requires an appointment with a time base of at least .50 (equivalent to 7.5 weighted teaching units) for at least six months and one day.
Lecturers and Coaches. Requires an appointment with a time base of at least .40 (equivalent to 6 weighted teaching units) for at least one semester.

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Q2: How do I know what benefits I’m enrolled in?

A: To view your medical, dental, vision, flex cash, flexible spending (HCRA and DCRA), Life and AD&mp;D, and long-term disability benefits please follow these steps:

Go to PeopleSoft and log-in
Click on “Self Service”
Click on “Benefits Summary”

If you have any questions about your benefits please call a Benefits representative at 619-594-1144.

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Q3: What type of benefits am I eligible for?

A: Please see, Benefit Summaries for each employee category.

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Q4: I am eligible for benefits. When can I enroll?

A: You have 60 calendar days from your employment / eligibility date to enroll yourself and your eligible dependents in a variety of benefits.

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Q5: What if my time base drops below the minimum requirement?

A: If at any time your appointment falls below the minimum time base requirement, benefits will automatically be cancelled. When you meet the eligibility requirements at a future date, you will need to re-enroll into benefits within 60 days of being eligible in order to have benefits. You will not be automatically re-enrolled.

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Q6: If I don’t enroll into benefits within 60 calendar days from my employment / eligibility date, can I still enroll into benefits?

A: If you miss your eligibility period, you will have other opportunities to enroll in benefits:

During open enrollment, which is usually held from mid-September to mid-October, with an effective date of January 1st of the following year;
Within 60 days of a qualifying event (i.e. birth of a child, marriage, divorce, when you lose coverage from another source, etc.); or
Request a late enrollment with a minimum 90-day waiting period before benefits take effect.

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Q7: If I enroll into benefits, when does it become effective?

A: Benefits are effective on the 1st of the month following the date the Benefits office receives your completed enrollment form. For example, if the Benefits office receives your enrollment form on September 2nd, your benefits will become effective on October 1st. Expect an administrative delay of up to 4 weeks before your benefits are reflected in the plan carrier’s system.

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Q8: Who is considered an eligible family member?

A: Eligible family members or dependents include your spouse or registered domestic partner, and your children under age 23 and who have never been married. Parents are not considered eligible dependents.

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Q9: How do I enroll my spouse or registered domestic partner?

A: To enroll your spouse, a copy of the marriage certificate and spouse’s social security number are required. If you do not have a marriage certificate, the Benefits office can provide you an affidavit that needs to be notarized. To enroll your registered Domestic Partner and their dependents, a Declaration of Domestic Partnership and your domestic partner’s social security number are required.

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Q10: If I have benefits and leave university employment can I maintain my benefits?

A: If you are an employee of San Diego State University covered by a health, dental and/or vision plan(s), you have the right to choose COBRA continuation coverage if you lose your group coverage because of a reduction in your hours of employment or termination of your employment (for reasons other than gross misconduct on your part). If you choose to continue coverage through COBRA, you will be responsible for paying 102% of the premiums.

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Health Benefits

Q11: What is an HMO?

A: An HMO (Health Maintenance Organization) plan offers members a range of health benefits, including preventative care. Upon request, the HMO can provide you a list of doctors from which you select a primary care provider. Your Primary Care Provider coordinates all your care, including referrals to specialists. There is no annual deductible and only a minimal co-pay (expressed as a flat dollar amount) for certain services. This type of plan typically has lower premium costs and lower co-pay costs.

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Q12: What is a PPO?

A: A PPO (Preferred Provider Organization) is an indemnity plan and is similar to a traditional “fee-for-service” plan, but you must use doctors in the PPO provider network or pay a higher co-insurance rate, which is a percentage of the charges. A PPO allows you to select a primary care provider and specialists without a referral. You must meet the annual deductible before some benefits apply. You are responsible for a certain co-insurance amount (expressed as a percentage of the fee), and the plan pays the balance up to the allowable amount. This type of plan provides you the flexibility to see any doctor.

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Q13: How do I choose a health plan?

A: While CalPERS provides a variety of health plans, only you can decide which is best for you and your family. Although cost is a key factor in choosing a health plan, you’ll want to consider other factors, such as the available doctors and hospitals in your area, restrictions on your choice of providers, the location of care facilities, and how your plan works with other plans like Medicare, etc. The best plan for you will be the one that works for your specific situation. Also, the type of plan that is available to you will depend on your home or work address that we have on file.

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Q14: What tools are available to help me choose the health plan that works best for my situation?

A: You can refer to the CalPERS Health Benefit Summary which gives a side-by-side comparison of benefits, covered services and co-payment information for all CalPERS Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans.

You can also use the CalPERS Health Plan Chooser, which is an online tool found on the benefits portal. This tool will help you review plan costs, doctors, quality ratings, features and services information.

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Q15: What is the difference between a formulary, generic, brand-name and non-formulary drug?

A: A formulary is a list of preferred generic and/or brand-name drugs that your health plan will cover. Formulary drugs have been reviewed for clinical effectiveness, safety, and cost-effectiveness. A generic drug is produced and sold under the chemical name and approved by the Food and Drug Administration (FDA) to be therapeutically equivalent to the brand-name drug. A brand-name drug is produced and sold under the original manufacturer’s brand name. A non-formulary drug is medication that has a preferred alternative listed in the drug formulary.

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Q16: I require maintenance medications for treatment of my long-term/chronic condition. How does the mail service program work?

A: Through the mail service program, you can get up to a 90-day supply of generic medication for only $10 through Blue Shield or $5 through Kaiser Permanente. A 90-day supply of formulary brand name drugs is available for $25 through Blue Shield or $15 through Kaiser Permanente. A 90-day supply of non-formulary drugs is available for $75 through Blue Shield. Kaiser Permanente does not have a mail service program for non-formulary drugs.

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Q17: When will I receive an ID card?

A: You will receive an ID card within 10-15 days following enrollment. If you do not receive your ID card within 15 days, please contact your health plan.

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Q18: Do I have chiropractic or acupuncture care?

A: Alternative care, such as chiropractic and acupuncture care, is either covered directly through your health plan or through a discount program. Kaiser covers acupuncture ($15 co-pay) when it is medically necessary and performed by a plan physician. Otherwise, it offers a discount of up to 25% off. Kaiser contracts their chiropractic care through American Specialty Health and covers 20 visits per calendar year ($10 co-pay). Otherwise, it offers a discount of up to 25% off. Please see American Specialty Health or call 800-678-9133.

Blue Shield Access+ HMO and Blue Shield NetValue HMO do not cover acupuncture or chiropractic care. However, both plans offer an alternate care discount of 25% or more through an alternative care discount program. For a list of discount programs, see Alternative Care Discounts or call 877-335-2746 to see what services are covered, or to find a participating provider.

PERS Select and PERS Choice offer a combined benefit for acupuncture/chiropractic of 15 visits per calendar year (20% co-insurance in network; 40% co-insurance out of network). PERS Care offers a combined benefit for acupuncture/chiropractic of 20 visits per calendar year (10% co-insurance in network; 40% co-insurance out of network). For a list of providers see, Anthem Blue Cross or call 877-737-7776.

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Dental Benefits

Q19: What does DeltaCare dental plan feature?

A: DeltaCare USA is a prepaid dental maintenance organization (DMO), which means that all covered dental care for you and your dependents is prepaid and must be performed by DeltaCare USA panel dentists. DeltaCare USA provides you and your family with quality dental benefits at an affordable cost. The DeltaCare USA program is designed to encourage regular visits to the dentist by having no co-payments (fees you pay to the contract dentist) on most diagnostic and preventive benefits. When you enroll, you select a contract dentist to provide services. If you require treatment from a specialist, your contract dentist will handle the referral for you. DeltaCare offers convenience with no claim forms to complete. It also offers cost savings with no deductibles, out-of-pocket costs that are clearly defined, and no annual or lifetime dollar maximum.

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Q20: What does Delta Dental PPO plan feature?

A: Delta Dental PPO is an indemnity plan, which provides a certain amount of coverage regardless of who provides the service. It allows you to select the dentist of your choice. Both you and Delta have a shared responsibility of paying the dentist for services received. If you receive services from a dentist in the network, Delta Dental will pay a percentage of the Usual, Customary and Reasonable fee. If you choose a non-Delta dentist, you must pay entirely for services obtained and submit a claim form with appropriate documentation to Delta Dental PPO for reimbursement. The calendar year deductible is $50 per person, not to exceed $150 per family. The calendar year maximum is $1,500 per person for the Basic plan or $2,000 per person for Enhanced coverage, depending on your collective bargaining agreement.

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Q21: When will I receive an ID card?

A: If you have enrolled into the DeltaCare DMO plan, you will receive an ID card within 10-15 days following enrollment. If you do not receive your ID card within 15 days, please contact your dental plan. If you have enrolled into the Delta Dental PPO plan, you will not receive an ID card.

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Vision Benefits

Q22: Who administers the vision benefits and how do I find providers participating in the network?

A: Vision Service Plan (VSP) administers our vision benefits. VSP is dedicated solely to providing eye care wellness benefits through an exclusive network of independent eye doctors, which consists of approximately 17,000 providers. For a list of providers, see Vision Service Plan (VSP) or call 800-877-7195.

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Q23: What if I want to seek services from a non-VSP provider?

A: Dollar for dollar you get the best value from your VSP benefit when you visit a VSP Select Network provider. If you decide to see a non-VSP provider, the $10 exam co-pay still applies and you will receive a lesser benefit and typically pay more out-of-pocket. You must pay the provider directly for services and materials received from a non-VSP provider and submit a claim form with a copy of the itemized receipt to VSP for reimbursement up to the allowable amounts.

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Q24: How often can I have an eye exam?

A: You are eligible for one eye exam every calendar year. For example, if you have an eye exam in February 2009, you will be eligible for another eye exam on January 1, 2010, or thereafter.

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Flex Cash Benefit

Q25: What is the FlexCash benefit?

A: FlexCash is an optional benefit plan that allows you to waive CSU medical and/or dental insurance coverage in exchange for cash, provided you have other non-CSU coverage. If you waive medical and/or dental insurance coverage, you will receive additional cash in your paycheck each month. The cash payment is $140 per month for medical and dental, $128 per month for medical only, and $12 per month for dental only.

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Q26: How do I enroll into the FlexCash program?

A: You must complete and sign the FlexCash Enrollment Authorization form to enroll and provide proof that you are enrolled in a non-CSU medical and/or dental plan without any lapses in coverage. If you do not enroll in FlexCash within 60 days of becoming eligible, you may enroll during open enrollment or when you experience a qualifying event.

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Flexible Spending Accounts (FSA)

Q27: What is a Flexible Spending Account?

A: A Flexible Spending Account (FSA) is a tax-free account that allows you to pay for essential health care expenses that are not covered, or are partially covered, by your medical, dental and vision insurance plans; or pay for child/dependent care expenses. The two programs we offer are the Health Care Reimbursement Account (HCRA) and the Dependent Care Reimbursement Account (DCRA). By contributing a portion of your payroll dollars into your FSA on a pre-tax basis, you can save from 25% to 40% on the cost of eligible expenses you are already experiencing.

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Q28: How much can I contribute to each account for the entire Plan Year?

A: When you enroll in an FSA, you decide how much to contribute to each account for the entire Plan Year. The money is deducted from your paycheck pre-tax (before Federal & State income taxes and FICA taxes are deducted) in equal amounts, over the course of the plan year. The IRS limit is $5,000 per individual per year for the HCRA plan. However, the IRS limit is $5,000 per household per year for the DCRA plan.

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Q29: How do I request reimbursement from my Flexible Spending Account?

A: After you incur expenses that qualify for reimbursement, you submit claims (reimbursement requests) and supporting documents to ASIFlex to request tax-free withdrawals from your FSA to reimburse yourself for these expenses. See, Flex Claim Forms to download a claim form. You must file all your claims for expenses by June 30 after the end of the Plan year.

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Q30: Do I need to re-enroll into the Flexible Spending Account each year?

A: Enrollment into the health care and/or dependent care reimbursement account plan(s) is for the current plan year only. If you wish to continue enrollment for the next plan year, you must re-enroll annually during open enrollment (even if you don’t want your deduction amount to change). For a Flexible Spending Account form, see CSU Center for Human Resources, Benefits or contact the the Benefits office at 619-594-1144.

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Q31: What happens if I put more money in my Flexible Spending Account than I need?

A: Reimbursement accounts just reimburse expenses you incur in the calendar year for which you are enrolled. If you put more money in your account than you need, you will forfeit the leftover amount. In other words, you have to use it or you will lose it.

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Fee Waiver & Reduction Program

Q32: What is the Fee Waiver Program?;

A: The Employee Fee Waiver Program allows eligible employees to participate in general-fund courses at reduced rates at any of the CSU campuses. Eligible faculty or staff members may transfer their fee waiver benefit to a qualified dependent (dependent child, spouse or domestic partner). Fees are waived for a maximum of two courses or 6 units per term. Additional fees that are reduced or waived are dependent upon the employee’s bargaining unit.

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Q33: How often do I have to submit a fee waiver form?

A: Once an employee or qualified dependent has been accepted to one of the California State Universities, they will need complete SDSU’s Employee or Dependent Fee Waiver form each semester. Benefits staff will review and approve the form and forward it to the appropriate campus. It is up to the employee to ensure they meet the receiving campus’ deadline for submitting forms.

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Q34: Are there course limitations?

A: Yes. Only courses in regular academic programs may be taken under the fee waiver program. Fee waivers cannot be applied to Open University or courses offered through Extended Studies. Auditing a course is not permitted.

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Q35: What is the difference between Work Related and Career Development?

A: Work Related courses are taken for the purpose of improving the level of skills needed to perform existing duties and responsibilities, or acquiring additional skills needed to perform newly assigned duties. Since Work Related fee waiver participants are considered “Academic Visitors” they are not required to provide transcripts or declare a major. Employees pursuing the Career Development option are considered students of the university (on a degree track) and must satisfy all entrance requirements.

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Q36: Is the Fee Waiver Benefit Taxable?

A: It is always taxable for domestic partners.

It is taxable only for Post Baccalaureate classes for spouses and dependent children.

It is never taxable for employees using the benefit on their own behalf.

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Q37: Where are the forms available?

A: See, Forms to get all the forms necessary for the Fee Waiver program.

Note: Documents in Portable Document Format (PDF) require Adobe Acrobat Reader 5.0 or higher to view. Download Adobe Acrobat Reader.

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Benefits