Human Resources

Employee Benefits FAQs

• I Just Got Married. What Do I Need To Do?

  You must complete the required form to add your spouse and any other new eligible dependents to your health insurance within 60 days of the date of your marriage. You will have 60 days to provide official documentation for your new dependents. (A list of acceptable documents is in your Employee Summary Booklet.) Contact your department Payroll/Personnel Assistant for assistance.
  
  If you do not add your new spouse or registered domestic partnership within 60 days of your marriage, you will not be able to add them until the next Health Insurance Open Enrollment.
  
  If you do not provide the official documents within 60 days of the event, your spouse and any other new dependents will be removed from your health insurance and cannot be added again until the next Health Insurance Open Enrollment.
  
  Note: This is also a good time to check and make any changes to your beneficiaries for your life insurance, Deferred Compensation (if applicable) and PERS. You may also want to change your Power of Attorney for PERS.

• I Just Got Divorced. What Do I Need To Do?

  You have 30 days from the date of your divorce to supply a copy of your divorce decree to your Departmental Payroll/Personnel Assistant and to complete the form to delete your spouse and any step-children (unless you adopted them) from your Health Insurance.
  
  Note: This is also a good time to check and make any changes to your beneficiaries for your life insurance, Deferred Compensation (if applicable) and PERS. You may also want to change your Power of Attorney for PERS.

• I Just Had A Baby. What Do I Need To Do?

  You must complete the required form to add your new baby to your health insurance within 60 days of the date of birth. You will have 60 days to provide official documentation for your new dependent. (A list of acceptable documents is in your Employee Summary Booklet.) Contact your department Payroll/Personnel Assistant for assistance.
  
  If you do not add your new dependent within 60 days of the date of birth, you will not be able to add your dependent until the next Health Insurance Open Enrollment.
  
  If you do not provide the official documents within 60 days of the event, your new dependent will be removed from your health insurance and cannot be added again until the next Health Insurance Open Enrollment.

• I Am Adopting A Baby/Child. What Do I Need To Do?

  You must supply Human Resources with a copy of the initial adoption paperwork to be able to add your new baby/child to your health insurance. A copy the official adoption paperwork must be sent to Human Resources when the adoption is final. Contact your department Payroll/Personnel Assistant for assistance. Adoptions must be reported within 60 days of the event.

  Note: This is also a good time to check and make any changes to your beneficiaries for your life insurance, Deferred Compensation (if applicable) and PERS. You may also want to change your Power of Attorney for PERS.

• I Have An Anthem Blue Cross PPO Plan. Do I Need A Referral To Go To A Specialist?

  No. You do not need a referral to go to a specialist. Members will need to go to a PPO contracted specialist to obtain the maximum benefit.

• I Have A Dependent Full-Time Student Over 19. How Long Will My Dependent Be Eligible To Be Covered On My Health Insurance?

  The age limit for eligible, dependent children is up to age 26 regardless of student or marital status for all plans.

• I Have A Dependent Attending School Out Of State. Will My Dependent Still Be Covered Under My Health Insurance?

  Yes. The Anthem Blue Cross PPO plan provides coverage outside of California. The Anthem website, http://www.anthem.com/ca/colb/, has a "Find A Provider" link by which out-of-state students may locate Anthem contracted doctors/facilities in their area. They should confirm that the doctor/facility is still contracted when calling to schedule an appointment.

  The Anthem Blue Cross HMO plan provides Guest Membership Access for out-of-state students. The dependent should be enrolled in the HMO plan with a local California PCP and the subscriber will need to call Anthem Guest Membership at (800) 827-6422 to request Guest Membership Access.

  There are a few states in which Guest Membership is not available and in this case, the dependent will have emergency and urgent care only. Out-of-state HMO provider information may be obtained by calling the Anthem Guest Membership Team at (800) 810-2583.

• I Have A Full-Time Student Over 19. When Do I Need To Send Student Verification?

  With the onset of Healthcare Reform, it is no longer necessary to provide student verification. As stated above, the age limit for dependent children is up to age 26 regardless of student or marital status for all plans.

• I Have A Flexible Spending Account. I Haven't Used All Of My Election Amount For This Plan Year. Will I Lose It?

  You have until March 15th of the following plan year to incur expenses for Health and Dependent Care. You have until April 15th to submit expenses. If you have not used your funds by March 15th of the following plan year, you will forfeit your remaining funds.

• What Is The Difference Between The Delta Preferred Option (DPO) And The Non Delta Preferred Option (NDPO)?

  When treating with a DPO provider, you pay no deductible and the plan pays a plan year maximum of $2,000.
  When treating with a NDPO provider, the plan pays a percentage up to a plan year maximum of $1,000.
  Delta will only pay the LOWER plan maximum, $1,000, if you treat with a DPO and a NDPO in the same plan year.
  
  Examples:
  If your DPO dentist's contract expires during the benefit year and the dentist does not renew, the plan maximum is the lower rate for any work after the non-renewal date.
  
  Exception:
  If you have received a pre-treatment authorization from Delta while your dentist was contracted, the DPO plan maximum will apply for the authorized treatment.
  
  If your NDPO dentist contracts to be a DPO dentist during the benefit year after you have received treatment besides cleanings, the plan maximum is still the lower NDPO rate for the remainder of the benefit year.

• I Went To A Contracted (Network) Hospital Under My Anthem Blue Cross Plan For Emergency Care But I Don't Know If The ER Doctor Was Contracted. Will My Visit Be Covered At The Contracted Rate?

  Since the member has no control over the physicians provided by the network hospital, these physicians are paid based on the network status of the facility.

• I Want To Waive The Health And Dental Insurance. Can I Keep The Basic Life Insurance?

  Basic Life Insurance no longer has to be waived with the health and dental insurance.

• My Registered Domestic Partner Is Covered Under My Health Insurance. Are My Domestic Partner's Children Eligible Too?

  Children of registered Domestic Partners are now covered under the City's health, dental and vision plans. The age limit for eligible, dependent children is up to age 26 regardless of student or marital status for all plans and does not extend to spouses or children of such dependents. This is due to health care reform.