Employees must elect medical coverage; dependent coverage is optional. Eligible dependents are: spouse, domestic partner, children to age 26.
If you choose to decline enrollment for your dependent(s) because of other health insurance coverage, you may in the future be able to enroll your dependent(s) in a health plan, provided that you request enrollment within 31 days after your other coverage ends. In addition, if you have a new dependent as a result of a qualifying event, such as marriage, Declaration of Domestic Partnership, birth, adoption, or placement for adoption, you may be able to enroll your dependent, provided you request enrollment within 31 days following the date of the qualifying event.
- CA Health Insurance Marketplace Notice (permanent employees and associate faculty)
- CA Health Insurance Marketplace Notice (temporary hourly employees & student workers)
Health Plan Options
Kaiser HMO Plan
Group ID: 116461-10
Kaiser Membership Services: (800) 464-4000
List of locations and other benefits: www.kp.org
$10 Office Visit co-pay
$10 Prescription co-pay
- 2022/23 Kaiser Plan Summary
- Detailed Explanation of Coverage
- Kaiser Behavioral Health Benefit, Counseling Services: (877) 496-0450 OR
- MHN Behavioral Health Option: (888) 327-0020
- 2022/23 Kaiser Chiropractic Benefit Summary
- Kaiser Evidence of Coverage
* Chiropractic services provided by: American Specialty Health (ASH). ASH Provider Directory or (800) 678-9133
PPO (Consortium Health Plan)
Group ID: 0230599
Questions about eligibility, benefits or if you need help finding an in-network provider:
San Diego & Imperial County School Fringe Benefits Consortium
Claims Dept: 888-233-7915
FBC Claims
The Consortium Health Plan offers two levels of coverage based on doctor of choice:
PPO Provider Network:
Plan Pays 80%, Employee Pays 20%
$25 Office visit co-pay, deductible waived
Annual Deductible: $300 Individual / $900 Family
Annual Out-of-Pocket Maximum: $3,000 per individual OR $6,000 per family (excludes
prescription co-pays)
Non-member Provider Coverage:
Plan Pays: 60% UCR*, Employee Pays: 40%
Annual Deductible: $550 Individual / $1,650 Family
*Amounts in excess of UCR (usual/customary/reasonable) charges are members responsibility
and do not apply to annual deductible or out-of-pocket maximums.
Annual Out-of-Pocket Maximum: $6,000 per individual OR $12,000 per family (excludes
prescription co-pays
Prescriptions: (30-day supply)
$10 Prescription co-pay (generic meds)
$25 Prescription co-pay (preferred meds)
$40 Prescription co-pay (non-preferred meds)
Mail Order Prescriptions: Express Scripts (two co-pays/90-day supply)
800-334-8134
Pharmacy HelpDesk: 800-922-1557
RxBenefits Member Services
- PPO Preferred Prescription Formulary
- PPO Plan Summary
- Detailed Explanation of Coverage
PPO Provider Network: GWH-Cigna: www.cigna.com (go to"Find a Doctor", select "Plans Offered through Work or School"). You DO NOT need a user name & password to access the directory. - Counseling services provided by Cigna, www.cigna.com
- PPO Evidence of Coverage
- HIPAA Privacy Notices
This summary of benefits is informational only and is not a complete description of all applicable conditions. Coverage and plan offerings are subject to change in subsequent years pursuant to District policy.
