Research Scholars Benefits Program
For employees with an initial hire date on or after May 1, 2007, SDSU Research Foundation offers employer paid employee-only health, dental, and vision insurance, as well as the Employee Assistance Program (EAP) to appointed Research Scholars in the employee class of Scholar/Exempt (SE). Scholars may also participate in the health care and dependent care flexible spending accounts (FSAs). This benefits program is specifically designed for those individuals who have completed a bachelor’s, master’s or doctoral degree, and who are receiving practical training in a particular scientific area. Please be aware that this program affects Research Scholars (SE) only and does not apply to other categories of SDSU Research Foundation employees, nor does it apply to those with non-employee awards, fellowships, or training grants.
Benefits through SDSU Research Foundation
The employer paid employee-only health plan available to Research Scholars is characterized as the least expensive plan available to SDSU Research Foundation employees which, in 2012, is Kaiser Permanente. Additionally, dental insurance is available for those employees who choose to enroll, and vision insurance is automatically provided to those individuals who enroll in the health plan.
Coverage is effective the first day of the month following the appointment into the SE employee class. Research Scholars will have an annual opportunity to add and drop eligible dependents during Open Enrollment, usually held in November. Changes made during Open Enrollment are effective the following January 1.
There is no cost to the employee for health, dental, vision, or EAP coverage. However, if the employee wishes to enroll eligible family members, the monthly cost of each benefit for the period January 1, 2012 through December 31, 2012, will be:
2011 Costs
| Kaiser | Delta Dental | |
|---|---|---|
| EE + 1 Dependent | $375.32 | TBD |
| EE + 2 or More Dependents | $686.96 | TBD |
If dependent coverage is elected, the cost of the coverage will be deducted from the Scholar’s paycheck on a pre-tax basis. For dental rates, contact Human Resources at Benefits@foundation.sdsu.edu.
More detailed information regarding the flexible spending accounts (FSAs), the contribution limits, and the Employee Assistance Program, is available through HR’s website or by contacting SDSURF Human Resources.
Kaiser Permanente Health Maintenance Organization (HMO)
To obtain medical care, you must utilize Kaiser facilities and physicians. There are no deductibles or claim forms. When you see a physician, there is a $15 co-payment. Prescriptions are $10 or $35. 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. You will pay $15 for each chiropractic office visit.
United Concordia
You will have two Dental plan options, both are offered through United Concordia. The first option is Concordia Plus (DHMO). If you enroll in Concordia Plus, 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 Concordia Plus dentist will arrange for a referral for you. The Concordia Plus plan is the richest plan option offered, with many services covered at 100%. There is no annual maximum benefit amount. The Concordia Plus option is only available to individuals who reside within California. There may be exceptions for certain states.
The second Dental option is Concordia Advantage Plus (PPO). With Concordia Advantage Plus, 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 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%. Under the Concordia Advantage Plus plan option, the annual maximum in-network is $1,750, out-of-network is $1,500.
Under Concordia Plus and Concordia Advantage Plus, adult and child orthodontia is covered and may be subject to certain lifetime limits.
Whichever plan you select, Concordia Plus or Concordia Advantage Plus, it will be your dental plan option for the year. You may change your enrollment annually during Open Enrollment.
How do you enroll in the plan?
Enrollment is available within the first 31 days of the SE appointment, or during the annual Open Enrollment period held during the month of November. Typically, you will be scheduled for a new employee orientation in which you may return your enrollment forms.
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 unmarried dependent child, or a domestic partner’s unmarried dependent child, living with you in a regular parent-child relationship and fully dependent upon you or your spouse or domestic partner for support, who is either under age 25 or over age 25 and incapable of self-sustaining employment by reason of mental retardation or physical handicap incurred prior to age 25.
Dependents who are on active duty in any of the armed forces are not considered eligible dependents.
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
- 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)
- Through a court order
- You cease to be eligible for SCHIP or Medicaid coverage
- You become newly eligible for a state premium subsidy under Medicaid or SCHIP
(A 60 day reporting window is permissible for the last two mid-year status changes only.)
When does coverage start and end?
The effective date of coverage will be the first day of the month following the appointment date into the SE employee class. If Human Resources is not notified within 31 days of the start of the first year of the training, individuals may enroll during the next Open Enrollment period.
Coverage will end the last day of the month of the SE or any other Regular-Salaried appointment. Coverage may also end the last day of the month in which an unpaid leave of absence begins. At the end of your appointment, or at the beginning of your unpaid leave of absence, you may be eligible to continue coverage through COBRA. For more information regarding COBRA, go to SDSU Research Foundation’s website, www.foundation.sdsu.edu.
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.
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