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2017 Annual Benefit Open Enrollment

Open Enrollment Period – October 21, 2016 through November 10, 2016.

NO ENROLLMENT FORMS WILL BE ACCEPTED AFTER NOVEMBER 10TH.

OPEN ENROLLMENT IS NOW CLOSED!

  • Coverage Effective Date for All Changes – January 1, 2017
  • Enrolling a spouse/registered domestic partner requires a copy of the marriage certificate/official documentation with the completed enrollment form. Enrolling a dependent child requires a copy of the birth certificate or proof of legal Guardianship and social security number.
  • No election form needed if not changing coverage.

    ELIGIBILITY -Full-time regular status Research Foundation employees working 30 hours or more per week. Dependent child coverage extends to their 26th birthday.

    VOLUNTARY WAIVER OF MEDICAL COVERAGE – Required to sign “Waiver of Health Coverage 2017” and provide proof of non-Research Foundation health plan coverage in order to avoid incurring a tax penalty.

    The Research Foundation has established the following monthly employer contribution amounts. Employees are responsible for premium amounts over and above the employer contributions:

    PARTY TYPE

    2016 EMPLOYER CONTRIBUTION

    2017 EMPLOYER CONTRIBUTION

    One Party (Employee only) $705.00 $707.00
    Two Party (Employee + 1) $1343.00 $1349.00
    Family (Employee + 2 or more) $1727.00 $1727.00

    Links to 2017 benefits summary and carrier information:

    For additional information:

    No election form needed if not changing coverage.

    Eligibility: Full-time regular status Research Foundation employees working 30 hours or more per week. Dependent child coverage extends to their 26th birthday

    The links below reflect the 2017 dental plan overview and enrollment form.

    No election form needed if not changing coverage.

    Eligibility: Full-time regular status Research Foundation employees working 30 hours or more per week. Dependent child coverage extends to their 26th birthday

    The links below reflect the 2017 vision plan overview and enrollment form.

    For additional information, contact VSP Member Services at (800) 877-7195 or www.vsp.com

    Health and/or Dependent Care – ASIFlex

    REMINDER: PARTICIPATION IN THE FSA REQUIRES THAT AN ANNUAL ELECTION FORM BE SUBMITTED EACH YEAR DURING THE OPEN ENROLLMENT PERIOD.

    Eligibility: Part-time regular and full-time regular status Research Foundation employees in a benefitted category. Enrollment is only available during the annual Open Enrollment period and will be effective on January 1st. Once enrolled, you cannot stop participation without a qualifying event.

    The following FSA options are available to you. You may participate in ALL options that apply to you:

    OPTION 1. Pre-tax Election for Group Health Insurance Premiums - if you participate in our group medical, dental or vision insurance programs, your monthly out-of-pocket premiums, if any, will be processed through the FSA Plan as a pre-tax deduction.

    OPTION 2. Flex Spending Account (Health Care) - you may enroll for pre-tax payroll deductions and elect up to $2,550/year to cover certain un-reimbursed out-of-pocket healthcare expenses.

    OPTION 3. Flex Spending Account (Dependent Care) - you may enroll for pre-tax payroll deductions and elect up to $5,000/year ($2,500/year if married, filing separate), to cover dependent care expenses for children under the age of 13.

    Reminder: Participation in the FSA requires that an annual election form be submitted each year during the open enrollment period.

    For additional information, contact ASI Flex Member Services (800) 659-3035 or visit their website at asiflex.com.

    Individuals enrolling a spouse/domestic partner must provide a copy of their marriage certificate/official documentation with the completed enrollment form. If enrolling a dependent child, a copy of the birth certificate or proof of legal Guardianship is required.

    All fees, rates and employer contributions are subject to change at any time during the plan year.

    ANTHEM BLUE CROSS HMO
    MONTHLY CARRIER PREMIUM
    RFND MAX MONTHLY CONTRIBUTION
    EMPLOYEE OUT-OF-POCKET PER MONTH
    Employee only $642.47 $707.00 $0.00
    Employee + 1 Dependent $1349.21 $1349.00 $0.21
    Employee + 2 or more Dependents $1927.44 $1727.00 $200.44

     

    KAISER HMO
    MONTHLY CARRIER PREMIUM
    RFND MAX MONTHLY CONTRIBUTION
    EMPLOYEE OUT-OF-POCKET PER MONTH
    Employee only $519.05 $707.00 $0.00
    Employee + 1 Dependent $1090.00 $1349.00 $0.00
    Employee + 2 or more Dependents $1427.38 $1727.00 $0.00

     

    ANTHEM BLUE CROSS PPO
    MONTHLY CARRIER PREMIUM
    RFND MAX MONTHLY CONTRIBUTION
    EMPLOYEE OUT-OF-POCKET PER MONTH
    Employee only $753.13 $707.00 $46.13
    Employee + 1 Dependent $1493.38 $1349.00 $144.38
    Employee + 2 or more Dependents $2096.85 $1727.00 $369.85

     

    DELTA (DENTAL)
    CODE
    TOTAL MONTHLY CARRIER PREMIUM
    EMPLOYEE MONTHLY
    Employee only Single $47.98 $0.00
    Employee + 1 Dependent Two Party $87.20 $19.60
    Employee + 2 or more Dependents Family $141.22 $46.62

     

    VSP (VISION)
    CODE
    TOTAL MONTHLY CARRIER PREMIUM
    EMPLOYEE MONTHLY
    Employee only Single $6.53 $0.00
    Employee + 1 Dependent Two Party $9.48 $1.48
    Employee + 2 or more Dependents Family $16.99 $5.22

    For questions regarding 2017 Open Enrollment. Confidential HR Fax number (562) 985-1726.

    Stephanie Moreno
    Director of HR
    stephanie.moreno@csulb.edu
    (562)985-7949

    Rhonda Jensen
    Human Resources Assistant
    rhonda.jensen@csulb.edu
    (562)985-7950