You are here: Human Resources / Benefits
Medical Insurance: The Basics (How to Enroll)
Who is Eligible?
- Residents (title codes 2708, 2724) and Clinical Fellows (title codes 2726, 2732) are the only groups of trainee-employees eligible for enrollment in the health insurance plans offered through the Human Resources office. All registered candidates from the above title codes in the Schools of Medicine, Nursing, Pharmacy, and Dentistry are eligible for these plans. Contrarily, this group is not eligible for the Faculty/Staff benefit plans.
- Eligible dependents – including Domestic Partners – are also eligible for coverage. They must be listed on the initial enrollment form or added on an amended enrollment form within 31 days of birth, arrival in the U.S., new marriage, etc.
- Residents need to be actively ‘opted-out’ of core insurance in the payroll system when they enroll in the Human Resources Insurance Plans, otherwise the department pays duplicate premiums through two systems for redundant coverage.
What is the Coverage?
- Residents are eligible for complete health coverage: medical, dental, vision,life and accidental death and dismemberment, as well as long-term disability insurance. Dependants are eligible for medical, dental, and vision coverage. The plans are designed for trainees and purchased just for this group. The plan designs are different than the Faculty/Staff plans – even though both groups offer Blue Cross and Health Net as a medical plan option.
- The component plans are not available individually; we cannot offer just medical, or just dental, or just vision, etc. Coverage comes as a package deal and choice of a medical plan automatically enrolls the trainee and their dependents with the other insurance carriers.
When Does Coverage Begin?
- The Resident Plan Year coincides with the academic year, July 1st - June 30th. This is different from the Faculty & Staff insurance plans, which begin January 1st.
- Residents and their dependents must actively enroll within the initial 30 days after appointment to an above title code at UCSF, or within 31 days after a marriage, birth, etc. This is the PIE = Period of Initial Eligibility for the member and dependents.
- If they miss the PIE, they cannot enroll themselves or a new dependent until an Open Enrollment period. For Human Resources plans the Open Enrollment is held during the months of June and July with an effective date of July 1st (even if they enroll on July 31st, it is retroactive to July 1st.
What Are Some Qualifying Events?
- Some qualifying events may allow residents eligible to enroll outside of the Open Enrollment period: one example would be loss of coverage from a spouse’s plan. Then the PIE clock starts and they have 31 days to enroll with proper supporting documentation.
How Does a Trainee Enroll?
- Residents should review the information on the plans and make a decision between the medical carriers: Health Net HMO or Blue Cross PPO. A Resident pays $0 monthly premium for Health Net HMO. Those choosing Blue Cross PPO pay a premium contribution of $30 for self, $60 for self plus child(ren) or self plus spouse/domestic partner and $90 for family coverage. Enrollment with Delta Dental, Vision Service Plan, LTD and life insurance is automatic once enrolled in health insurance.
- The Resident completes the UCSF Residents Insurance Enrollment Form, the Reliance Beneficiary Form, the COBRA Acknowledgement Form, and the Declaration of Domestic Partnership Form if appropriate and and returns the forms to the departmental representative. The departmental representative checks for completeness, adds accounting information, has the form signed where necessary, makes a copy for the department file and a copy for the member, and sends the original, signed copy to the Human Resources office for enrollment.
- The Finance Unit of the Human Resources office makes monthly payments to all the carriers for our group plans. We then recharge these costs to the Home Departments, Divisions, and/or Hospitals. Recharges are always set-up by the Home Department at the time of enrollment. That process is described in detail in the following pages. If Blue Cross is selected, the premium contribution will be collected from the Residents through the payroll system or by the Home Department.
- UCSF rules do not allow duplicate UCSF coverage. This means that you cannot be covered in a UCSF sponsored health plan as a resident AND as an eligible family member under another resident UCSF plan. Generally this also means that you cannot be covered under a UCSF faculty/staff plan when you have your own UCSF coverage. Children can only be covered under one parent with a UCSF health plan. If duplicate enrollment occurs, UCSF will cancel the later enrollment. UCSF and the plans reserve the right to collect reimbursement for any duplicate premium payments and for any benefits provided due to the duplicate enrollment.
What Then?
- Throughout membership, the enrollees as health care consumers should address all requests for service and their claim questions exclusively to the Customer Service Representatives for the various carriers. We provide the Residents with a contact list of phone numbers on this website. When all else has failed, an enrollee may be referred to the Human Resources office for assistance with a claim problem.
- Upon termination or loss of eligibility, Residents are eligible for COBRA or conversion for most of the plans. Example COBRA information is available on this website and must be distributed by their department to them in advance of separation.
- Upon termination a coordinator is responsible for submitting an enrollment/termination form to the central insurance desk. This is required so the University may inform the health plans to discontinue enrollment.
- The Human Resources office and the departmental representative will thereafter communicate through the monthly fiscal recharge process, which is also detailed later in this documentation. However, please do not hesitate to contact us if you have questions, concerns or unusual situations, phone: 476-8093, fax: 476-4449.
When is Open Enrollment?
- Open enrollment is held every June and July with an effective date of July 1.
A newly enrolled candidate plus dependents are covered from the date of enrollment. The Human Resources office communicates with the carriers to enroll them and details of the coverage are available on the Human Resources web site. Members and dependents are fully insured until someone in the department actively terminates them and provides them with COBRA information. Coverage under the Residents plans ends on the date of termination. Again, this is different than the other Campus plans where coverage continues for 30 days.