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Enrollment

The deadline for enrolling in benefits is 60 calendar days from date of hire or eligibility. For enrollment in medical, dental and the Health Care and Dependent Care Reimbursement Plans, employees must complete the Benefits Enrollment Worksheet. Enrollment in vision and life/AD&D insurance is automatic for all eligible employees. Currently, there is no exclusion for pre-existing conditions. An open enrollment period for medical, dental and various voluntary plans plans is usually scheduled in October of each year.
 
For a list of appropriate forms and supporting documentation necessary to enroll in benefits, see the Benefits Enrollment Process form.
 
See Dependent Benefits Enrollment and Deletions for information on enrolling dependents.
 

Health Insurance Portability and Accountability Act (HIPAA)

HIPAA allows for "special enrollment" and "late enrollment" periods.

Special Enrollment – Permitting Events

Allows the employee to enroll, make changes or cancel enrollment outside the open enrollment period due to qualified permitting events. Employees have 60 calendar days from the date of the event to enroll.  Examples of permitting events include:

  • Loss or gain of other coverage.
  • Non-enrolled employees acquiring a dependent or enrolled employee's non-enrolled spouse can enroll for self and all eligible dependents.
  • Court-ordered coverage.
  • Marital Status change (i.e. Marriage, Divorce, Dissolution of Domestic Partnership or Certification of Domestic Partnership)

Late Enrollment

Upon request, the employee and eligible dependents can enroll after a 90-day waiting period. The 90-day waiting period commences upon receipt of the employee's completed and signed Benefits Enrollment Worksheet along with supporting documentation.
 

Continuation of Benefit Plans

If the employee or eligible dependents can no longer participate in a benefit plan due to a loss in eligibility, medical, dental and/or vision plan coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) may be continued for a specified amount of time.
 

Direct Pay

If an employee is on a Leave of Absence without Pay or are otherwise in an approved non-pay status, the employee may elect to continue medical, dental, vision, life/AD&D, and various voluntary coverages by paying the full premiums via the Direct Pay method.  
 

Dependent Benefits Enrollments and Deletions

Family Member Additions

Married employees who are both employed by the CSU can enroll in their own right.  However, only one parent must enroll all dependent children. Children cannot be split between parents.  
 

Newborn or Adopted Child of the Employee Enrollment

Coverage starts at birth or when the employee receives physical custody of the adopted child. The premium, however, is changed to include the new child effective the first of the month following the birth or physical custody. To continue enrollment, the employee must provide proof of birth or adoption paperwork and complete a Benefits Enrollment Worksheet. Employees must provide the dependent's Social Security number upon receipt from the Social Security Administration.
 

Economically Dependent Child Enrollment

Enrollment of an economically dependent child(ren) who resides with the employee requires the completion of an economically dependent affidavit. If coverage is approved, within 60 days following the date the child(ren) became a family member, coverage will become effective on a prospective basis. Enrollments submitted later than 60 days after the permitting event (date dependent became a family member) are considered late enrollments. The effective date of the coverage for new dependent(s) is the first of the month following a 90 day wait from the date the enrollment request is received. Employees must complete a Benefits Enrollment Worksheet and provide the Social Security number of the economically dependent child(ren).
 

New Spouse Enrollment

Enrollment of new spouse and/or stepchild(ren) within 60 days following marriage, the coverage will become effective on a prospective basis. The spouse's Social Security number is required, as well as a copy of the marriage certificate. Enrollments submitted later than 60 days after the permitting event (date of the marriage) are considered late enrollments, and the effective date of the coverage for new dependent(s) will be the first of the month following a 90 day wait from the date the enrollment request was received.
 

Domestic Partner Enrollment

Eligibility and Enrollment Rules –CalPERS' will use the same enrollment statutes and regulations for domestic partnerships as are currently used for spouses.  The enrollee must provide a copy of the registered Declaration of Domestic Partnership provided by the Secretary of State and Domestic Partner's Social Security number.
 

Tax Implications

Providing health benefits to a domestic partner and/or child(ren) of a domestic partner is a taxable benefit for the enrolled individual(s). Employees should consult their tax counselors regarding withholding requirements for these additional benefits.
 

Family Member Deletions

Mandatory notification is required for the following events:
  • Death of a dependent (copy of the death certificate required)
  • Enrolled child attains age 26 (if incapable of self-support because of a mental or physical disability that existed prior to age 26, a member questionnaire for the CalPERS Disabled Dependent Benefit; and a medical report for the CalPERS Disabled Dependent benefits must be completed and approved by CalPERS in order for the dependent to continue coverage beyond age 26)
  • Family member enrolled as an employee, or as a dependent of another CSU or CalPERS agency. (Proof of other coverage and date obtained required)
  • Divorce of spouse (copy of the final divorce decree required)
  • Termination of domestic partnership (copy of the notice of termination of domestic partnership completed and filed with the State of California required)

The effective date of all mandatory transactions is the first of the month following the event. 

 

 

 


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