Pre/Post Doctoral Benefits
SDSU Research Foundation offers health, dental, and vision insurance to appointed Pre or Postdoctoral Fellows, Trainees, and Scholars. This program is specifically designed for those individuals who, by nature of their award, are prohibited from becoming employees of SDSU Research Foundation. Please be aware that this program affects Pre or Postdoctoral Fellows, Scholars, or Trainees and does not apply to SDSU Research Foundation employees.
Benefits through SDSU Research Foundation
The current health plans available:
- Kaiser Permanente Health Maintenance Organization (HMO)
- Health Net Health Maintenance Organization (HMO)
- Health Net Preferred Provider Organization (PPO)
Enrollment eligibility is based upon the geographic area in which the individual resides. For individuals outside California, the health plan available will be Health Net’s Preferred Provider Organization (PPO). Additionally, dental insurance is available for those who choose to enroll, and vision insurance is automatically provided to those individuals who enroll in either health plan. The additional cost of VSP Vision is only applicable to those who enroll in either Health Net plan.
If you enroll in either plan, coverage is effective the date the award begins, or the first of the month following the award begin date. You will have an annual opportunity to change health plans during Open Enrollment, usually held in November. Changes made during Open Enrollment are effective the following January 1.
The monthly cost paid from your award is contingent upon availability of funds. Before you make any benefit decisions, please note that funds are limited. To determine how much funds are left to use towards your benefit needs, please contact SDSURF Human Resources. If funds are exhausted, or are otherwise unavailable, the cost may be paid monthly by personal check.
The 2011 Monthly Costs
| Health Net HMO | Health Net PPO | Vision Service Plan (VSP) |
Kaiser | Delta Dental | |
|---|---|---|---|---|---|
| Single-party Coverage | $500.64 | $736.14 | $6.20 | $368.02 | $34.68 |
| Two-party Coverage | $1076.32 | $1582.60 | $9.08 | $736.04 | $68.02 |
| Family Coverage | $1476.82 | $2171.46 | $16.00 | $1041.46 | $116.40 |
Kaiser Permanente Health Maintenance Organization (HMO)
To obtain medical care, you will utilize Kaiser facilities and physicians. There are no deductibles or claim forms. When you see a physician, or purchase prescriptions, there is a co-payment. Vision exams and glasses are also covered under the plan within certain time and dollar limits. Chiropractic coverage is included and is offered by a separate provider, American Specialty Health Plans (ASHP). To use the chiropractic benefit, services must be provided by an ASHP-network chiropractor. At the time of your first visit your chiropractic needs will be evaluated and further treatment, if deemed medically necessary by American Specialty Health Plans, will be approved. You may receive up to a maximum of 20 visits during a calendar year, if approved.
Health Net HMO or PPO
If you live in a Health Net service area, you may enroll in Health Net HMO or Health Net PPO. If you live inside or outside California, your enrollment choice is Health Net’s PPO plan. Office visits will require a copayment or coinsurance depending on the plan you are enrolled in. Prescriptions purchased at participating pharmacies are subject to a formulary and a different co-payment for generic vs. brand name medications vs. non-formulary medications. Vision is covered through VSP (Vision Service Plan) and exams including glasses OR contacts are covered within certain time and dollar limits. Chiropractic coverage is included and is offered by a separate provider, American Specialty Health Plan’s Network (ASHP). To use the chiropractic benefit, an ASHP-network provider must provide services. At the time of your first visit your chiropractic needs will be evaluated and further treatment, if deemed medically necessary by ASHP, will be approved.
Delta Dental
You will have two Dental plan options. Both are offered through Delta Dental. The first option is DeltaCare USA. If you enroll in DeltaCare USA, there are no deductibles or claim forms. Each enrolled family member will select a personal dentist from a list of providers. You are required to use the dentist you select, however, if you need to see a specialist, the DeltaCare USA dentist will arrange for a referral for you. The DeltaCare USA plan is the richest plan option offered, with many services covered at 100%. There is no annual maximum benefit amount. The DeltaCare USA option is only available to individuals who reside within California.
The second Dental option is Delta's PPO. With the PPO, you are able to use any dentist for treatment, or at the point of service, you may seek services from a network dentist with whom a reduced fee schedule has been negotiated. Using a PPO network dentist is likely to lower your out-of-pocket costs. Preventive services (cleanings, exams, x-rays), are covered at 100%. Other services are generally covered at 80% with some services covered at 50%. In network there is no annual deductible, and the annual maximum is $1,750 per person. Out of network the annual deductible is $25 per person, $75 for family and the annual maximum is $1500 per person.
Under DeltaCare USA and Delta's PPO (PDF Format, 6,156KB)* adult and child orthodontia is covered and may be subject to certain lifetime limits
Changing dental plan options is easy, and can be done monthly, by contacting Delta's toll-free member services number 1-866-444-0187. If you call between the 1st to the 15th of the month the change will be effective the first of the following month. If you call between the 16th to the last day of the month the change will be effective the first of the next following month. (example: you call Delta May 18th - your change will be effective July 1).
How do I enroll in the plan?
Enrollment is available within the first 31 days of the award only, or during the annual Open Enrollment period held throughout the month of November. Contact your account administrator and ask them to forward a copy of the award to SDSU Research Foundation Human Resources. Human Resources will provide you with all the necessary forms for enrollment and payment.
What family members can be covered?
Although the eligibility standards for dependents may vary slightly among the specific plan "agreements," generally, the following classes of dependents are eligible for health, dental, and vision benefits:
- Your spouse.
- Your same sex or opposite sex domestic partner.
- Your child, or a domestic partner's child, who is either under age 26 or over age 26 and incapable of self-sustaining employment by reason of mental retardation or physical handicap incurred prior to age 26.
Dependents who are on active duty in any of the armed forces are not considered eligible dependents.
To enroll dependents, proof of eligibility is required. To review which documents are appropriate for which dependents please review the proof of eligibility documents list.
What about adding and dropping coverage for my dependents?
You can add or drop coverage for yourself or your dependents once a year during Open Enrollment, or within 31 days of a change in family status. A family status change occurs if:
- You get married, legally separated, or divorced
- You register your domestic partnership
- You experience a birth or adoption of a child, or a change in a child's custody
- Your spouse, your domestic partner, or dependent dies, or
- There is a loss of dependent status
- You, or your spouse, or your domestic partner, has a change in employment status that effects benefits coverage (new employment, end of employment, change from full-time to part time employment (or vice versa), or an unpaid leave of absence)
- Coverage is required by a court order
When does coverage start and end?
The effective date of coverage will be the start date of the award in most cases, if SDSU Research Foundation's Office of Human Resources is provided with a copy of the award within 31 days of the start of the award. If Human Resources is not notified within 31 days of the start of the first year of the award, individuals may enroll during the Open Enrollment period. Participants in this program are required to keep SDSU Research Foundation Human Resources informed in a timely manner of any appointment award status changes, including address changes.
Coverage will end the last day of the award. At the end of your award, you will be eligible to continue coverage through COBRA. Review the COBRA link at SDSURF Human Resources website for more details on costs, timeframes, and deadlines.
Questions about coverage?
If you wish to enroll or have questions about this program or the coverage, contact SDSU Research Foundation Human Resources at benefits@foundation.sdsu.edu, or call an SDSU Research Foundation Benefits Specialist at 619-594-4139.
* Note: Documents in Portable Document Format (PDF) require Adobe Acrobat Reader 5.0 or higher to view. Download Adobe Acrobat Reader.