Introduction Medical Plans Health Care Providers Contact Information Urgent Care Information Health Benefits FAQs Dental Plans Vision Plans Life Insurance, Accidental Death & Dismemberment Insurance Disability Plans
Current Benefit Rates
Employee Assistance Program Flex Spending - American Fidelity Liability Coverage VOYA Voluntary Group Term Life Insurance Program Workers' Compensation
COBRA Coverage for COBRA Participants What Is a Qualifying Event? Can I Have More Than One Qualifying Event? Do I Have to Notify the District of Any Qualifying Events? What Is Continuation Coverage? How Do I Elect Continuation Coverage? How Long Can I Continue Coverage? Do I Have to Pay for My Continuation Coverage? Are there any Special Provisions Regarding Continuation Coverage? Can the District Terminate My Continuation Coverage Before the Maximum Coverage Period Ends? Who Can I Contact If I Have Questions About Continuation Coverage? May I Obtain Conversion Coverage When My Continuation Coverage Terminates? Do Special Provisions Apply to the Disabled?
Forms
Retiree Coverage Retiree FAQ Retiree Useful Links
Leave of Absence Safety In the Workplace Useful Website Links VEBA Resources
Insurance Staff

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Health Benefits FAQs

HEALTH BENEFITS | COBRA | RETIREE | WORKER'S COMPENSATION

 

Health Benefits:

Q: I am a new employee.  When do I have to return the Health Benefits enrollment paperwork?

A: 30 days from the date of hire.

 

Q: I am a new employee.  When will my Health Benefits become effective?

A: The first day of the month following the completion of a 30-day waiting period.

 

Q: Do I have to enroll in medical, dental, and vision?

A: No, you can enroll in any combination of the three health benefits.  Please be aware that whatever you as the employee are enrolled in, all dependents must be enrolled in the same.  Example, if you are enrolled in medical only, your dependents will be medical only as well.   

 

Q: What qualifies a child as a dependent?

A: Natural children, legally adopted, or stepchildren.

 

Q: Who does not qualify as an eligible dependent?

A: Ex-Spouse/Partner, former stepchildren, parents, nieces/nephews, siblings, aunts/uncles, and grandparents.

 

Q: What is a qualifying event that would allow me to add or drop coverage for a child or spouse outside of Open Enrollment?

A: Marriage, filing a domestic partnership, having a baby, divorce, loss of other coverage, eligibility for coverage for employee or dependents under spouse’s coverage.

 

Q: What is the time frame I have to add or delete a dependent (child/spouse)?

A: Within 30 days from the date of birth, marriage, divorce or eligibility for/loss of other coverage.

 

Q: When does coverage begin or end when adding or deleting a dependent (child/spouse)?

A: First of the month following the event date.

 

Q: What is required to add/delete a dependent (child/spouse)?

A:  Medical/Vision Change form, Cigna Dental Change form, and the acceptable documentation or divorce decree

 

Q: At what age do my dependent children drop off my coverage?

A: 26

 

Q: Do my dependent children need to be financially dependent on me for support, claimed as dependents on my tax return, residents of my household, enrolled as students, or unmarried?

A: No

 

Q: Is it my responsibility to notify the Insurance Department when a dependent (child/spouse) becomes eligible or ineligible?

A: Yes

 

Q: Will I be responsible for the District portion of insurance premiums paid if ineligible dependents have not been deleted from my plan?

A: Yes

 

Q: How do I change my address/name with the Insurance carriers?

A: Change forms are required.

 

Q: Where do I find change forms?

A: Insurance Website - Forms.

 

Q: If I do not make changes within the appropriate time frame, when will the next opportunity be?

A: During Open Enrollment.

 

Q: When is Open Enrollment?

A: Usually occurs the end of October/ beginning of November with the changes taking effect January 1.

 

Q: Where can I see what health benefit plans I am enrolled in?

A: From any district computer you can visit MyCUSD to view your plan selections and dependents.

 

Q: How do I check my paystub to make sure the correct deductions are being taken?

A: Please visit the Payroll Department website at  https://capousd-ca.schoolloop.com/payroll

 

Q: I don't have a VSP insurance card, how can I use services?

A: VSP is a paperless service, to find a provider please call them at 800-877-7195 or visit www.vsp.com

 

Q: I don't have a Cigna Dental PPO insurance card, how can I use services?

A: Cigna PPO is a paperless service, to find a provider please call them at 800-244-6224 or visit www.cigna.com

 

Q: I'm trying to pick up a prescription with United Health Care and it says I'm not covered, what do I do?

A: United HealthCare uses Express Scripts for prescription coverage.  If you do not have an Express Scripts ID card please call them at 800-918-8011 to order one.  

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COBRA:

Q: If I lose District- sponsored Health Benefits will I be offered any type of coverage?

A: You will be offered COBRA (Consolidated Ominbus Budget Reconciliation Act) which is a group health care coverage continuation plan at a full premium.

 

Q: Where would I find the COBRA rates?

A: Insurance Website - COBRA.

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Retiree:

Q: At what age may I retiree from the District?

A: CUEA: 55 years old

    CSEA: 50 years old; however the retiree will pay the full cost of coverage until reaching age 53

 

Q: How many consecutive years of service with the District do I need to be eligible for retiree medical benefits?

A: 10

 

Q: What % does the District pay for Medical retiree benefits?

A: Based on 10 – 20+ years of service, the % is 50% - 100%. Please refer to insurance website for

     rates.

 

Q: I am thinking of retiring.  If I complete the school year when do my Health Benefits with the District end?

A: September 30.

 

Q: Is there an option to keep dental coverage?

A: Yes –with the full cost being the responsibility of the retiree.

 

Q: Is there an option for Vision?

A: No

 

Q: Until what age may I keep my retiree Medical Benefits with the District?

A: 65  

 

Q: Is there option to keep Dependents on my retiree coverage?

A: Yes, the retiree pays the full cost of coverage.

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Worker’s Compensation:

Q: If I get hurt on the job what do I need to do?

A: Report the injury immediately to your immediate supervisor.

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Non-Discrimination Statement

The Capistrano Unified School District prohibits discrimination, harassment, intimidation, and bullying in all district activities, programs, and employment based upon actual or perceived gender, gender identity, gender expression, race, ethnicity, color, religion, ancestry, nationality, national origin, ethnic group identification, sex, sexual orientation, marital or parental status, pregnancy, age, physical or mental disability or on the basis of a person’s association with a person or group with one or more of these actual or perceived characteristics. Reference: AR 1312.3, BP 1312.3 and BP 5183.

Rich Montgomery, Executive Director, Human Resource Services/Compliance
33122 Valle Road, San Juan Capistrano, CA 92675
(949) 234-9200

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