Adjunct Medical Insurance

ADJUNCT MEDICAL INSURANCE

The medical enrollment periods for Adjunct employees happens twice per year in September and March.

The next enrollment period is during the month of March and the medical insurance would start 4/1/22 and last until 9/30/22.

You would need to re-confirm your enrollment during every enrollment period.

 

The information below will be updated in March 2022.

 

 

The next Eligibility and Enrollment Period for the Adjunct Medical Benefits Program (AMBP) is during March 2022 for medical coverage from April 1, 2022 through September 30, 2022. Forms are due to Human Resources by 5 p.m. on March 31, 2022.

 

CONTINUING ENROLLEES

Click here for the required form to complete if you are continuing your adjunct medical insurance. You must submit this semester’s Declaration of Eligibility Form to Human Resources by 3/31/2021 or your current medical insurance will end 3/31/2021.

 

NEW ENROLLEES

Click here for more information about the AMBP such as eligibility requirements, types of medical plans that are offered and the required forms to complete if you are enrolling for the first time.

 

RATES

Adjunct Faculty Rate Chart for 2021-22

Your portion of the monthly medical premium will come out of your paycheck.

 

ENROLLMENT FORM INSTRUCTIONS
All enrollment forms should be submitted to Christie Colón in Human Resources

 

* Blue Shield PPO or HSA – you must write HSA or PPO in the top margin on the enrollment form

                      

**Blue Shield HMO – you must select a doctor when enrolling in this plan and include the doctor's IPA & PCP numbers on the enrollment form:

                         IPA is the Group #

                          PCP is the Primary Care Physician #

                          Here’s how to search on Blue Shield's website for that information and to select a Blue Shield HMO doctor in your area:

                                   Click here

                                  Click on “Primary Care Physician”

                                  Type in your location

                                  Select Specialty, like “Family Practice”, “Internal Medicine”, etc.

 

                         * Be sure to check HMO or Deductible plan in Section A on enrollment form

 

  • Membership Change Form - making changes to your current medical plan (like adding or deleting a dependent)? Please fill out the Membership Change form and include the required dependent documentation.

 

  • Premium Payment Voucher – use this form to pay for your medical insurance during a month that you don’t have a paycheck, like during the summer.

 

 

REQUIRED DEPENDENT DOCUMENTS

         To enroll a spouse:

                • Copy of Marriage Certificate

                • Copy of page 1 of your most recent 1040 Federal Tax Return that shows Married filing status

          To enroll a domestic partner:

                • Copy of the State of California Certificate of Registration of Domestic Partnership

                • Copy of page 1 of both partner’s most recent 1040 Federal Tax Returns

          To enroll a child:

               • Copy of birth certificates for children up to age 26

               • OR, if child is adopted or you are the legal guardian: legal adoption documentation or legal court documentation establishing guardianship