Faculty Benefits

Eligible Faculty Members and Retirees:

General Information and Requirements:
Change forms must be completed and returned to the Human Resources Department within 30 days of the event (marriage/domestic partnership; birth/adoption/legal guardianship). Please contact the Benefits Assistant in the Human Resources Department for change forms and required documentation.

Please note: Dependent children are eligible to the age of 26. The Patient Protection and Affordable Care Act (PPACA) requires health plans and issuers that offer dependent coverage to make the coverage available until the adult child reaches the age of 26. This coverage must be extended regardless of the adult child’s marital or student status or financial dependence on the employee.

Medical Benefits Documents:
acrobat .pdf bullet Children's Health Insurance Program (CHIP)
acrobat .pdf bullet Medical Plan Comparison
acrobat .pdf bullet Open Enrollment Notice
acrobat .pdf bullet Patient Protection Disclosure (Kaiser Only)

Anthem BlueCross PPO  Anthem BlueCross Logo

Under the Prudent Buyer Plan, you can choose your own physician or a Prudent Buyer Physician each time you receive care. A non-Prudent Buyer Physician will be paid a percent of eligible charges according to customary and reasonable rates. A Prudent Buyer Physician will be paid based on Blue Cross pre-negotiated fees. Therefore, your out-of-pocket cost will be lower when you use a Prudent Buyer Provider.


Phone: 800-288-2539
 External Website www.anthem.com/ca
pdfimage Anthem Enrollment Form
pdfimage Anthem Claim Form
acrobat .pdf bullet Mandatory Anthem Plan Changes 2018

Coverage, California Residents:
pdfimage Summary of Benefits and Coverage
pdfimage Plan Summary
acrobat .pdf bullet Evidence of Coverage
Coverage, Non-California Residents:
pdfimage Summary of Benefits and Coverage
pdfimage Plan Summary
acrobat .pdf bullet Evidence of Coverage
acrobat .pdf bullet States Amendment
Anthem Faculty Grandfathered Status Disclosure:
pdfimage Anthem Faculty Grandfathered Status Disclosure


Medical Eye Services (MES):
Phone: 800-877-6372
 External Website www.mesvision.com
acrobat .pdf bullet MES Summary of Benefits
acrobat .pdf bullet MES Evidence of Coverage 
acrobat .pdf bullet Medical Eye Services Out of Network Claim Form
acrobat .pdf bullet MES Out-of-Pocket Copay

Kaiser Kaiser Logo

Kaiser Foundation Plan is a Federally Qualified Health Maintenance Organization (HMO) which arranges for medical and hospital care to be provided at their Kaiser Permanente facilities or with the contracted affiliated physicians or hospitals in Western Ventura County. Members may use any one of their medical offices and hospitals when care is required. This plan includes annual vision exam, and $150 towards frames, lenses, or contact lenses once every 24 months.

Medical & Vision:

Phone: 800-464-4000
 External Website www.kaiserpermanente.org
acrobat .pdf bullet Kaiser Enrollment Form
acrobat .pdf bullet Summary of Benefits
acrobat .pdf bullet Evidence of Coverage
acrobat .pdf bullet Mandatory Kaiser Plan Changes 2018

acrobat .pdf bullet Delta Care PPO and Delta Care HMO - Plan Comparisons
acrobat .pdf bullet Delta Dental Cost Estimator

Delta Dental PPO Plus Premier Plan DeltaDental Logo

Phone: 866-499-3001
 External Website www.deltadentalins.com 
acrobat .pdf bullet Delta Dental PPO Enrollment Form
acrobat .pdf bullet Delta Dental - Summary of Benefits
acrobat .pdf bullet Delta Dental - Evidence of Coverage
acrobat .pdf bullet Delta Dental Claim Form

Delta Dental Delta Care HMO  DeltaDental Logo

Phone: 800-422-4234
acrobat .pdf bullet Delta Care - Summary of Benefits
acrobat .pdf bullet Delta Care - Evidence of Coverage
acrobat .pdf bullet Delta Care - Provider Directory
acrobat .pdf bullet Delta Care USA Enrollment Form

Note: If you make a change from the Delta Dental PPO Plan to the Delta Dental DHMO (Delta Care) and then switch back to the Delta Dental PPO Plan at then next Open Enrollment or Qualifying Event, your incentive level will revert back to 70%. Please review the Delta Care Network of Providers. It is unlikely that your current Delta Dental PPO Dentist is in the Delta Care HMO Network.

American Fidelity American Fidelity Logo

District's Cafeteria/125 Plan Administrator:

 External Websitehttps://americanfidelity.com

acrobat .pdf bullet Section 125 Flexible Benefit Plan Expense Reimbursement Voucher
acrobat .pdf bullet Cancer Diagnostic Benefits Statement
acrobat .pdf bullet American Fidelity Brochure

Benefits - Disability, Life Insurance, Cancer/Intensive Care:
Phone: 800-662-1113
Fax: 800-818-3453 (Disability Only)

Customer Service:
Phone: 800-323-3748
Fax: 800-522-6343

Flex Account Administration - Medical Expense/Dependent Care Accounts:
Fax: 800-543-3539

Annuity Services:

Social Security Administration Social Security Logo

Phone: 800-772-1213
 External Website
acrobat .pdf bullet
Understanding the Benefits

403(b) & 457(b) Plan Information

3rd Party Administrator:
c/o MidAmerica
402 South Kentucky Avenue, Suite 500
Lakeland, FL 33801

Phone: 800-248-8858
Fax: 877-513-2272
Email: info@envoyplanservices.com
 External Website
 External Website www.EnvoyPlanServices.com
acrobat .pdf bullet Envoy 457 403b Comparison Chart
acrobat .pdf bullet Voluntary Retirement Savings Plans
acrobat .pdf bullet SRA Salary Reduction Agreement 457(b) (TSA) Plan
acrobat .pdf bullet SRA Salary Reduction Agreement 403(b) (TSA) Plan

California State Teachers' Retirement System Calstrs

Phone: 800-228-5453

 External Website www.calstrs.com