Annual Health Coverage Statements Required Under the Affordable Care insurance enrollment Act (ACA)
The Affordable Care Act (ACA) requires large employers to file annual reports with the Internal Revenue Service (IRS) and furnish a statement to full-time employees with information about the health coverage offered to the employee and their dependent children, using IRS Form 1095-C. Health coverage providers are also required to file annual reports with the IRS and furnish a statement to individuals with information about those who had minimum essential coverage for at least one day during the preceding calendar year, using IRS Form 1095-B.
By March 2, 2017, for the 2016 statements, and by January 31 annually thereafter, the State of California, via the State Controller’s Office, will issue a Form 1095-C to its full-time employees with information about the health coverage offered, if any, to the employee and their dependent children. The state’s health coverage providers will also issue a Form 1095-B to employees who were enrolled in state-sponsored health coverage for at least one day during the preceding calendar year.
- 2017 Health Plan Summary .pdf
- CalPERS Blue Shield Access + HMO 
Phone: (800) 334-5847
- CalPERS Anthem Blue Cross Traditional HMO  | CalPERS Anthem Blue Cross Select HMO California 
Phone: (855) 839-4524
- CalPERS Kaiser Permanente HMO 
Phone: (800) 464-4000
- CalPers UnitedHealthcare Alliance HMO 
Phone (877) 359-3714
- PERSCare/PERSChoice/PERSSelect PPO 
Phone: (877) 737-7776
- OptumRx 
Phone (855) 505-8110
- Benefits Information Worksheet.pdf 
- Benefits Provider Contacts 
- 2017 Health Plan Medical Premium Rates.pdf
- FlexCash Enrollment Form .pdf
- FlexCash Plan & Tax Advantage Premium Plan .pdf
- 2017 HCRA/DCRA Open Enrollment Form .pdf
- ASI FSA Debit Card Application .pdf 
- ASI FSA Debit Card FAQ .pdf 
- ASI FSA Claim form.pdf 
- Declaration of Health Coverage .pdf
- 2017 Voluntary Insurance Rates 
- CalPERS 2016 and 2017 Health Plan Chooser 
- 2017 HCRA/DCRA Form 
- 2017 Health Plan Medical Premium Rates 
- 2017 Voluntary Insurance Rates .pdf
- 2017 Dental Plan Summary .pdf
- 2017 Dental Plan Summary .pdf
- CSU offers two dental plans (monthly dental premiums are 100% paid by CSU):
(1) Delta Dental PPO  - traditional fee-for service plan that covers mosts dental providers
(800) 765-6003 (Group #4018);
(2) DeltaCare USA HMO  (formerly PMI) - offers a limited network of dentists
(800) 422-4234 (Group #2034)
Assembly Bill 26 (AB 26) was signed by Governor Davis and the CSU Board of Trustees adopted those provisions. Effective January 1, 2000, the CSU is extending health, dental and vision coverages to eligible employees who have the following registered domestic partnerships:
- Specified same-sex domestic partnerships between persons who are both at least 18 years old.
- Specified opposite sex domestic partnerships when one or both persons are over 62 years old.
Eligible employees must first register the domestic partnership with the Secretary of State:
Secretary of State
P. O. Box 944225
Sacramento, CA 94244-2250
Once registered, employees must submit the following completed documents to the Human Resources Office:
- Declaration of Domestic Partnership, available from the Secretary of State; and
- Statement of Financial Liability for Domestic Partner Health Benefits, available on the forms rack outside the Human Resources Office; and
- Statement of Financial Liability for Domestic Partner Dental and Vision Benefits, available on the forms rack outside the Human Resources Office.
Once the necessary documentation is received, the insurance enrollment forms will be completed. Children of registered domestic partnerships may also be enrolled in the insurance plans. The effective date of coverage will be on a prospective basis.
Health Care FAQs
How do I sign up for insurance or change my existing coverage?
Fill out the Benefits Information Worksheet and return to the Benefits Office MSR340. If you are a new employee or have recently become benefits-eligible, you have 60 days from your date of hire to sign up. You may change your existing coverage only during Open Enrollment (in fall each year) or if you have a qualifying life event.
How do I find out what medical or dental insurance I have?
Login to your MyCSUSTAN account. Under the Employee Page tab, locate the Benefits section and choose Benefits Summary. The following page will list all of your services, with detailed explainations found by clicking a benefits option in the list.
Do I get insurance cards for medical?
Yes. You should receive your cards within two months of enrolling. If you haven't received them after this time, please contact your provider - Anthem Blue Cross, Blue Shield, Kaiser, or United Healthcare.
Do I get insurance cards for dental?
No. When you visit a participating Delta Dental dentist, you will just need to give them your social security number for identification. Visit the Delta Dental website  for more information.
Do I get insurance cards for vision?
No. When you visit an optometrist, you will just need to give them your social security number for identification.
Do I need a form to visit the doctor, dentist or optometrist?
To see your doctor, simply bring your insurance card to your appointment. For dentist or optometrist visits, provide your social security number when checking in. If you have dependents utilizting these services, they will need to use your (covered employee's) social security number.
What pharmacy can I go to?
If you are covered under Anthem Blue Cross, Blue Shield, or United Healthcare you may use any pharmacy to order and pick up prescriptions. These networks also allow you to have prescriptions mailed to your home using OptumRx . If you are a Kaiser member, you must go to a Kaiser pharmacy.
Can I mail order prescriptions?
Yes. Refer to your prescription provider's website for information.
What is FlexCash and how do I get it?
Employees who are eligible for medical/dental insurance can elect to waive CSU coverage in exchange for a cash payment ($128/monthly if you waive medical only, $12/monthly if you waive dental only and $140/monthly if you waive both medical and dental), if they have other non-CSU coverage. If they elect not to keep the CSU medical and/or dental coverage, you will be required to certify on the FlexCash Enrollment Authorization form that you have alternative non-CSU medical and/or dental coverage and provide proof of other non-CSU coverage. You are not eligible to participate if you are covered as the dependent of another CSU employee. The Flex Cash payment is treated as taxable income and is subject to payroll taxes. For detailed information, refer to the CSU FlexCash pamphlet.
Who is my vision care provider?
All benefits-eligible CSU employees have Vision Services Plan .
Do you have discount tickets for the various amusement parts and activities?
Visit the Tickets at Work  website to see what tickets are available. They can be ordered online.