Health Plans
Eligibility
Cost
Who's an Eligible Dependent and What Proof is Required
Kaiser Permanente Health Maintenance Organization (HMO)
Health Net Health Maintenance Organization (HMO)
Health Net Preferred Provider Organization (PPO)
Eligibility
For Regular–Salaried employees, other than Research Scholars, SDSU Research Foundation offers health insurance through two different carriers: Kaiser Permanente or Health Net. Under both plans, coverage is effective the first of the month following a Regular–Salaried hire date.
For health plan options for employees outside the San Diego area, contact a Human Resources Representative before enrolling in a health plan.
You may have an annual opportunity to change health plans during Open Enrollment, usually held in November. Changes made during Open Enrollment are effective the first of the following January.
Cost
| Kaiser HMO | Health Net HMO | Health Net PPO | Delta Dental | |
|---|---|---|---|---|
| Employee Only | $0.00 | $0.00 | $120.00 | $0.00 |
| Employee + 1 dependent | $40.00 | $40.00 | $314.00 | $5.00 |
| Employee + 2 or more dependents | $65.00 | $65.00 | $448.00 | $10.00 |
If your dependent is a domestic partner, or the child of a domestic partner there may be additional costs.
Who's an Eligible Dependent and What Proof is Required
Eligible employees who enroll in the health or dental insurance plans may elect to enroll their eligible dependents. Although the eligibility standards for dependents may vary slightly among the specific plan “agreements,” generally, the following classes of dependents are eligible for health and dental benefits:
- The employee's spouse
- The employee's same sex or opposite sex domestic partner
- Children or domestic partner's children through age 25
- Grandchild(ren) of eligible and enrolled dependents
- Children over age 25 and incapable of self-sustaining employment by reason of mental retardation or physical handicap incurred prior to age 26 and chiefly dependent upon you, your spouse, or domestic partner for support.
Dependents who are on active duty in any of the armed forces are not considered eligible dependents. Additionally, if both the employee and spouse are employed by SDSU Research Foundation, each will be covered separately as employees. For such employees who wish to enroll their eligible dependent child(ren), the child(ren) may be covered under either employee, but not both. A person who is eligible for coverage as an employee, is not considered an eligible dependent.
View a list of documents you may use to prove dependent eligibility.
Kaiser Permanente Health Maintenance Organization (HMO)
Kaiser Web Site Just for SDSURF Employees
Kaiser Benefits Summary for Southern California Employees (PDF Format, 18KB)*
Kaiser Benefits Summary for Northern California Employees (PDF Format, 55KB)*
Kaiser Chiropractic Summary (PDF Format, 59KB)*
Cost
Vision Coverage under Kaiser
Locations and Service Hours
Cost
SDSU Research Foundation pays 100% of the cost for employee health insurance with Kaiser. If you wish to enroll your eligible dependents the monthly cost to you is:
- One dependent: $40.00
- 2 or more dependents: $65.00
If your dependent is a domestic partner, or the child of a domestic partner there may be additional costs.
Vision Coverage Under Kaiser
- Eye Exam: $15 copay, not applied toward allowance
- Contact Lens Exam: $15 copay, not applied toward allowance
- Contact Lens Fitting: One time fee for initial fitting with Kaiser as long as you stay with same type of lenses. Fitting fee varies by lens type and condition. Fitting is applied towards allowance.
- Optical Hardware: Covered lenses, frames, and/or cosmetic lenses.
- Amount of Allowance: $175 per allowance period. Note: Your price is reduced by the $175 allowance. If the price of the service received exceeds the allowance, you pay the difference.
- Allowance period: Every 24 months from point of sale
Kaiser Locations and Service Hours
Kaiser ChooseHealthy: a comprehensive health web site offering a directory of complementary health care providers, information about complementary health care services, and discounts on health and wellness products.
As a ChooseHealthy™ premium member, you also receive a free subscription to FitnessCoach®. Here you can purchase phone-based coaching sessions to help improve your health, and have access to exercise, nutrition, and healthy living tools.
Kaiser Live Healthy: Explore total health resources for you and your family, including fitness, nutrition, mind and body health, weight maintenance, and more.
Health Net Health Maintenance Organization (HMO)
Health Net HMO Benefits Summary (PDF Format, 30KB)*
Health Net HMO Pharmacy Benefits Summary (PDF Format, 107KB)*
Cost
Health Net HMO Chiropractic Summary (PDF Format, 110KB)*
Health Net HMO Behavioral Health Summary (PDF Format, 84KB)*
Vision Services Plan
Decision Power
It's Your Life Wellsite
Well Rewards Member Discounts
Cost
SDSU Research Foundation pays 100% of the cost for employee health insurance with Health Net HMO. If you wish to enroll your eligible dependents the monthly cost to you is:
- One dependent: $40.00
- 2 or more dependents: $65.00
If your dependent is a domestic partner, or the child of a domestic partner there may be additional costs.
Chiropractic Benefits
Chiropractic care is provided by chiropractors in the American Specialty Health Plans (ASHP). When you go to an ASHP participating provider, Health Net will arrange and provide coverage if the proper procedures are adhered to. There is no need for a referral. Simply make an appointment with any chiropractor in the ASHP network and you may change chiropractors at any time. Your benefits are as follows:
- $15.00 Copayment per visit
- Limited to 20 visits, per member per calendar year
To make an appointment call any of the more than 1,900 network providers throughout California. These Chiropractors are under contract with ASHP to provide exams and treatment. After the initial visit, authorizations needed for any additional treatments will be requested by your provider and handled through ASHP at no hassle to you!
Vision Services Plan
Vision is covered through VSP (Vision Service Plan) and exams are covered every 12 months with a $10 copay. Glasses OR contacts are covered within certain time and dollar limits. To locate a VSP Choice provider register with VSP to view the online directory.
Vision Services Plan Summary
Health Net Preferred Provider Organization (PPO)
Health Net PPO Benefits Summary (PDF Format, 45KB)*
Understanding Your Heath Net Pharmacy Benefits (PDF Format, 75KB)*
Cost
Vision Services Plan
Decision Power
It's Your Life Wellsite
Well Rewards Member Discounts
Cost
Employees electing the PPO plan will pay the difference between the cost of the Health Net HMO and the PPO. In 2010, the monthly cost to you is:
- Employee only: $120.00
- One dependent: $314.00
- 2 or more dependents: $448.00
If your dependent is a domestic partner, or the child of a domestic partner there may be additional costs.
Vision Services Plan
Vision is covered through VSP (Vision Service Plan) and exams are covered every 12 months with a $10 copay. Glasses OR contacts are covered within certain time and dollar limits. To locate a VSP Choice provider register with VSP to view the online directory.
Vision Services Plan Summary
Additional Benefits Available to All Health Net Members:
Decision PowerSM
This decision-support program brings together under one roof the information, resources and personal support that fit you, your health and your life. Whether you're focused on staying fit, dealing with back pain or facing a serious diagnosis, Decision Power can help you work with your doctor and make informed decisions.
It's Your LifeSM Wellsite
It's Your Life brings together trusted sources of health and medical information to make it easier to stay healthy, balance the demands of work and family, and manage emotional or financial challenges. Delivered in partnership with WebMDŽ and conveniently located within Health Net's member website, It's Your Life brings powerful and easy-to-use programs right to your fingertips, including:
- Free programs on pregnancy support, weight management, smoking cessation, preventive care and nutrition.
- Online Health Risk Questionnaire can help you better understand your health and recognize possible health risks, such as heart disease and diabetes.
- Self-help programs for overall health, insomnia, stress and more.
- Mental health support for depression, alcohol abuse, eating disorders or other emotional health concerns.
- Health and fitness calculators to learn your heart rate, Body Mass Index and how many calories you burn during your favorite activities.
- Discounts on acupuncture, chiropractic, massage therapy plus on health-related items such as fitness club memberships, vitamins, eyewear, fitness apparel, weight management programs and much more.
Well Rewards Member Discounts
Health Net members enjoy discounts at Reebok, Rockport, Greg Norman, Sports4Kids.com, My Gym Children's Fitness Center, Jenny Craig, Weight Watchers, Newport Audiology Centers, Beltone Hearing Centers, AccentCare In-Home Care Services, Healthyroads, Safe Beginnings, and Yoga Journal. After you receive your Health Net ID card, log on to www.healthnet.com It's Your Life - Wellsite>Member Discounts to learn more about these discounts and how to access them.
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