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Health, Vision, and Dental Insurance 

As a condition of appointment, UCSD requires that all Postdoctoral Scholar appointees have adequate health insurance coverage for the duration of their appointments. On January 1, 2005, the University of California implemented a system-wide health insurance plan for all Postdoctoral Scholars. The UC Postdoctoral Scholar Benefits Plan (PSBP) is a comprehensive program that offers medical, dental, vision, life and AD&D insurance, short-term disability insurance, and voluntary long-term disability insurance and is available to all scholars appointed on or after January 1, 2005.The PSBP is comprised of the following plans, some of which offer a choice between an HMO or PPO options:
  • Medical: Health Net HMO or PPO
  • Dental: Health Net DHMO or Principal POS
  • Health Net Vision PPO
  • Life, AD&D and Short-Term Disability Insurance offered through Standard Insurance (you will be automatically enrolled in these plans)
  • Voluntary Long-Term Disability Insurance offered through Standard Insurance

Medical Plans

An HMO or a PPO medical insurance plan is offered through Health Net of California. 

An overview of the health plan options is available at https://clients.garnett-powers.com/pd/uc/downloads/2018Medical.pdf

HMO Plan

  • One of the main components of an HMO that distinguishes the model from other types of plans is the Primary Care Physician (PCP) who acts as your gatekeeper for all of your care.
  • You can choose a PCP for each family member, or change the PCP assigned to you by calling Health Net Member Services at (800) 522-0088.
  • If you or a family member is in need of treatment from a Specialist or is in need of an In-Patient or Out-Patient procedure, you must obtain a referral from the PCP prior to any type of consultation or treatment (except in the case of an emergency). If the referral is not obtained, no benefits will be paid.
  • There is no Out-of-Network benefit (except in the case of an emergency).
Plan details can be found at http://clients.garnett-powers.com/pd/uc/

PPO Plan

  • When covered under a PPO plan, there is no need to be assigned a Primary Care Physician.
  • There is an In-Network and Out-of-Network component.
  • You have the flexibility to see a doctor without a referral either in-network or out-of-network.
  • The PPO plan offers more flexibility in physician access than the HMO plan. As a result, the out-of-pocket costs tend to be higher.
Plan details can be found at http://clients.garnett-powers.com/pd/uc/

Rates

Garnett-Powers & Associates, Inc.

UC Postdoctoral Scholar Benefit Plan Administrators

2019 Rates

*For proposal preparation, please use the actual premium rates or the fringe benefit rates at https://blink.ucsd.edu/finance/costing-analysis/cbrs/index.html.

If your fellowship award or external funding source provides an institutional allowance, research allowance or funding for the cost of health benefits, the University may deduct (if the allowance is administered by the university) or bill you (if the award is given directly to you) for the cost of the university portion of the benefits premiums.

Notice of such deduction or billing will be provided to you no later than 30 days prior to the deduction or billing. If the allowance is managed by the university, you have the right to request and receive a copy of your budget from your mentor or department financial administrator.

Eligibility

The eligibility requirements for the new Postdoctoral Scholar Benefit Plans are the following:
An appointment in one of the three Postdoctoral Scholar titlecodes (3252, 3253, and 3254).

  • Initial Eligibility requires an appointment at 100% time for at least three months or 50%-99% time for at least 12 months.
  • To retain eligibility, Postdoctoral Scholars- Employee are required to maintain an average regular paid time of at least 17.5 hours per week (43.75%).  
    Note: the paid percent time can differ from the appointment percent time.
  • To retain eligibility, Postdoctoral Scholars- Fellow or Paid Direct, are required to maintain an appointment at a minimum of 43.75% time.

Appointments in other academic or staff titles are not applicable to the PSBP criteria for eligibility.   
Eligibility for family members:
Family member eligibility requirements are the same as the family member eligibility requirements for the UC Faculty/Staff plans.  The major family categories are the following:

  • Spouse
  • Natural or adopted child or children to age 26 (unless eligible to continue coverage because of disability) and unmarried.
  • Stepchild to age 26 if unmarried, lives with the Postdoctoral Scholar, is supported by the Postdoctoral Scholar at more than 50%, and is claimed as a tax dependent by the Postdoctoral Scholar or spouse.
  • Same-sex domestic partner or AB 205 defines an eligible opposite-sex domestic partner as being age 62 or above, eligible for Medicare and both parties are over the age of 18. 
    For additional information (PDF)

Initial Enrollment

Period of Initial Eligibility (PIE)

Postdoctoral Scholars are provided 31 days from their appointment begin date to select and enroll in the UC Postdoctoral Scholar Benefit Plan (PSBP).

In order to enroll in the UC PSBP, the Postdoctoral Scholar must visit http://clients.garnett-powers.com/pd/uc/ click on Enrollment/Change Form and follow the instructions. 

Depending on how the postdoc answers the pre-enrollment questions, they will be directed to one of two ways to enroll in the insurance (via AYSO or paper form).  If postdoc is directed to enroll by completing the enrollment/change form on the Garnett-Powers website, please submit completed form to Jennie Salomon in OPRSA, opsa@ucsd.edu or Campus Mailcode 0043.

Questions concerning general eligibility conditions should be directed to the departmental HR/personnel representative, or the OPRSA Postdoctoral Scholar Specialist, Jennie Salomon at opsa@ucsd.edu or (858) 534-3553. Emergency enrollment, questions regarding the details of each plan, activation of short term disability benefits, should be directed to:

Garnett Powers and Associates
23361 Madero, Suite 240 
Mission Viejo, CA 92691
Monday - Friday, 8 am - 5 pm 
Toll free at 1-800-254-1758
psbp@garnett-powers.com

Insurance Enrollment Process

  • Visit the Garnett-Powers & Associates website http://clients.garnett-powers.com/pd/uc/ and complete enrollment as instructed.
  • Paper enrollment forms must be sent to Jennie Salomon in OPRSA, opsa@ucsd.edu or Campus Mail Code 0043 for entry of elections into PPS.
  • The campus will send the enrollment information to UCOP each month.  UCOP will then create an FTP file to be accessed once each month by the insurance carriers.  It is important to note that if the information is not entered into PPS prior to the information being retrieved by UCOP, the Postdoctoral Scholar will not be active in the carriers’ systems until the following month. 
  • The insurance carriers will access and load the enrollment data into their systems and send Evidence of Coverage booklets and identification cards to the Postdoctoral Scholars’ home address.
  • The coverage will begin on the Appointment/Fellowship start date listed on the Enrollment form. However, it may take up to 6 weeks before your enrollment shows in the insurance carriers system. If you need to access services before you are showing up with the insurance carrier, please contact Garnett-Powers Customer Service at (800) 254-1758.

 

Open Enrollment and Qualifying Events

Want to change plans? Forgot to add a family member?

  • Open Enrollment provides the opportunity to change plans or add a family member.
  • Open Enrollment occurs every year around October or November
  • Effective date of Open Enrollment elections will be January 1

Adding a dependent due to a "Qualifying Event"

If postdoctoral scholar is wishing to add a dependent due to a "qualifying event" such as marriage, newborn, loss of previous insurance coverage, postdoctoral scholar has 31 days from the date event occurred to add dependent.

Postdoctoral scholar will complete enrollment/change form found at http://clients.garnett-powers.com/pd/uc/, print it, sign it and send to Jennie Salomon in OPRSA, opsa@ucsd.edu or mailcode 0043 along with documentation reflecting the date of "qualifying event".

Examples of documentation:

  • Marriage – copy of marriage certificate
  • Loss of previous insurance coverage – letter showing previous coverage and date that coverage ended
  • U.S Entry – copy of documentation showing U.S. entry date
  • Newborn – no need to attach documentation as birth date of newborn will provide adequate documentation.

If request to add dependent is not completed with 31 days of the “qualifying event”, the next opportunity will be during Open Enrollment. Open Enrollment occurs in October or November with effective date of action January 1.

Termination of Coverage and COBRA

Termination of Coverage

If a Postdoctoral Scholar wishes to terminate PSBP coverage prior to his/her appointment end date, or when a dependent loses eligibility, the Postdoctoral Scholar must complete the cancellation section of the Enrollment/Change Form and submit it to his/her department staff for processing. The department staff will then do the following:

  • Submit Enrollment/Change form (noting early cancellation) to Jennie Salomon in OPRSA, opsa@ucsd.edu or mailcode 0043.
  • Enter the appointment termination in PPS and send a PAN to Jennie Salomon "sdorameb"
  • Instruct the postdoc to contact Garnett-Powers to receive COBRA information.
  • Complete Unemployment Form.
    • It is imperative that any termination or change in status be reported immediately to OPRSA as there are financial consequences to the department.

Effective 4/1/2013; Health (medical, dental, and vision) coverage will end on the last day of the month for Postdocs who separate or end their appointment as of April 1, 2013, or later. For example, any postdoc separating from April 1 to April 30, 2013 shall see his/her coverage end on April 30, 2013.

Disability, life, AD&D and workers compensation will terminate the same day as his/her appointment.

COBRA

COBRA (PDF) stands for The Consolidated Omnibus Budget Reconciliation Act, which was passed by the U.S. Congress in 1985 and provides certain continuation coverage rights to individuals and their eligible family members when they lose group medical, dental or vision coverage because the individual appointment is terminated from UCSD, dies, divorces, or is legally separated, or because a child ceases to be eligible.

Notification at Time of Enrollment
At the time of enrollment, Postdoctoral Scholars are required to review the “General Notice of COBRA Continuation Coverage Rights” and indicate that they have reviewed it on the Enrollment/Change Form.

Notification to Separating Postdoctoral Scholar
In order for GPA to inform the Postdoctoral Scholar of his/her COBRA eligibility, the dept staff should ensure that the termination is entered in PPS as soon as possible and that the postdoc is instructed to contact GPA for COBRA application.  

Notification to Family Members When Change in Status Occurs
When a child reaches the age of 26, the carrier will notify the Postdoctoral Scholar and the dependent of the impending loss of coverage. GPA will provide the COBRA notification to the Postdoctoral Scholar and dependent.  PPS will automatically cancel the dependent enrollment at the appropriate time.

In all other circumstances when a family member loses eligibility, it is the responsibility of the Postdoctoral Scholar to complete the Enrollment/Change Form to de-enroll that family member.  The form should be submitted to Jennie Salomon in OPRSA, opsa@ucsd.edu or mailcode 0043.

Emergency & After-Hours Care

HMO & PPO Life threatening emergencies:

  • Go to the nearest hospital and contact Health Net Member Services within 48 hours at the number listed on your Health Net ID card.

HMO Non-emergency after hours care:

  • Once you are enrolled, contact your Primary Care Physician (PCP) to find out where to go should you need to seek care after hours. Many PCPs are associated with an Urgent Care Center.

PPO Non-emergency after hours care for in-network:

  • Once you are enrolled, you may wish to contact Health Net Member Services at the number on your ID card for closest contracted in-network Urgent Care Center.

Seeking Care Outside of the US

  • The subscriber and their dependents will be covered under either their HMO plan or their PPO plan for medical emergencies only while traveling. These plans do not cover postdocs and/or their dependents if they reside outside of the USA. If the covered person establishes primary residency outside the United States, they are not eligible to be enrolled in the plans.

  • If you are traveling with small children, please be aware that they are covered for medical emergencies only. If your child becomes ill with something that is not deemed a medical emergency by your insurance carrier, it will not be covered. Unlike adults, small children can often have an illness that needs to be treated but is not deemed a medical emergency. You might think about purchasing some type of travel insurance. Garnett-Powers does not offer travel insurance; you will have to obtain this coverage on your own.

  • If you have an emergency and you are away from home you will need to contact Health Net using the number located on your Health Net ID card. Inform Health Net of your situation and that you need to seek the care of a physician. You do need to be aware that sometimes a hospital might ask you to pay in full for services rendered; then you can submit the claim directly to Health Net.  Please contact Garnett-Powers to request a medical claim form 800-254-1758.

  • If you are enrolled in the HMO plan and you experience an emergency condition you need to call your primary physician group prior to or within 48 hours of first seeking care, or as soon as possible thereafter. If you are enrolled in the PPO plan, please notify Health Net within 48 hours of first seeking care, or as soon as possible thereafter. The phone number of your primary physician group and/or Health Net are listed on your Health Net ID card.

Dental Plans

Dental Insurance plans go through two different providers:

  • HMO Plans are through Health Net of California
  • POS Plans are throgh Principal Financial Group

Plan details can be found at: http://clients.garnett-powers.com/pd/uc/

Vision Plans

PPO Plan (EyeMed) go through Health Net of California.

There is an In-Network and Out-of-Network component.

Frequency:

  • Examination - Once every 12 months
  • Lenses or Contact Lenses – Once every 12 months
  • Frames – Once every 24 months
Plan details can be found at: http://clients.garnett-powers.com/pd/uc/.