Associate Faculty Medical Benefits Program
The medical eligibility and enrollment period for the Associate Faculty Medical Benefits Program (AMBP) happens twice per year in September (for coverage October 1 through March 31) and March (for coverage April 1 through September 30).
You must re-confirm your enrollment during every eligibility and enrollment period by submitting the Declaration of Eligibility form to Human Resources.
The current eligibility and enrollment period is happening now (March 1 to March 31, 2023) and the medical insurance starts 4/1/2023 and lasts until 9/30/2023. If you resign your position or retire, then your medical insurance ends at the end of the month that you last work. All forms and required documents are due to Human Resources by 5 p.m. on March 31, 2023.
** IMPORTANT: The forms on this page are all fillable and signable electronically. Once you've opened the form, please click "Download" and "Save" to access the signable electronic option.
Eligibility requirements for those CONTINUING their medical insurance in Spring 2023:
Click here for the Declaration of Eligibility form to complete if you are continuing your Associate Faculty medical insurance.
All enrollees who plan to continue their SRJC medical insurance must submit this semester’s Declaration of Eligibility Form to Human Resources by 3/31/2023 or your current medical insurance will end 3/31/2023.
Eligibility requirements for NEW enrollees in Spring 2023:
Click here for the enrollment packet, which includes information about the Associate Faculty Medical Benefits Program 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.
Medical Plan Offerings
The District offers a choice of five medical plans through our membership in Self-Insured Schools of California (SISC). Please click on the links below to view the Benefit Summaries of these five plans:
- Kaiser Permanente HMO
- Kaiser Permanente Account Based Health Plan with a Health Savings Account (HSA). This is a HMO deductible plan.
- Blue Shield of California HMO
- Blue Shield of California PPO
- Blue Shield of California Account Based Health Plan with a Health Savings Account (HSA). This is a PPO deductible plan.
New! Please click below for plan features and member benefits for:
Toward the bottom of this page you can view additional plan benefits for both Kaiser and Blue Shield members.
There are no dental insurance or vision insurance plans offered to Associate Faculty.
Medical Plan Rates
Rates 10/1/2022 through 9/30/2023
Your portion of the monthly medical premium will be deducted from your paycheck.
Enrollment Forms and Instructions
All enrollment forms should be submitted to Christie Colón in Human Resources
- Blue Shield Enrollment Form – use this form to enroll for the first time and follow these instructions:
* 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 Name/Hospital Affiliation
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 on “Primary Care Physician”
Type in your location
Select Specialty, like “Family Practice”, “Internal Medicine”
Then click on the doctor's name and you'll be able to find the PCP and IPA info
- Kaiser Enrollment Form – use this form to enroll for the first time and follow these instructions:
* 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.
Medical Plan Selection form - for new enrollees only.
Declaration of Eligibility form - for new enrollees only.
Declaration of Eligibility form - for continuing enrollees only.
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.
Verification of Teaching Load - If you are working at least 40% load at SRJC, you don’t need to complete this form. You only need your other college to complete this form if you have less than a 40% load at SRJC.
REQUIRED DEPENDENT DOCUMENTS
To enroll a spouse:
• Copy of your 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. If you have legal guardianship or legal court documentation establishing guardianship the child can be covered up to age 18.
Dependents can be enrolled at your time of hire or within 30 days after experiencing a qualifying event.
There are limitations depending on where you live:
· If you live outside of California, the Blue Shield PPO plans are the only plans you’d be eligible to enroll in since they are available in every state.
· Kaiser operates by region, so if you live outside of the San Francisco Bay Area, then you are not eligible to be enrolled in the District’s Kaiser plans. SRJC is part of the Kaiser Bay Area/Northern California region and is not part of the Southern California Kaiser region. SRJC is also not a part of the Kaiser regions in other states.
· Blue Shield HMO is only available in California.
Here’s how the deductible/Health Savings Accounts (HSA) plans work:
The district deposits $600.00/year into your HSA for single coverage or $900.00/year for family coverage and you can also put deposit money of your own into your account. You can use the money in the HSA to pay your Kaiser or Blue Shield medical plan deductible or copayments. Just be sure to keep all your receipts for your medical services and reimburse yourself from the HSA account for any medical expenses you accrue. The Health Savings Account is through Optum Bank - FAQs and Guide.
ADDITIONAL PLAN BENEFITS
for Wellbeing and Holistic Health
For ALL employees:
- Employee Assistance Program (EAP): employees and everyone in their household can access free resources for help with personal concerns--emotional, marital, financial, interpersonal addiction and recovery, legal, stress, and more.
For all SISC members:
- Fitness memberships for Kaiser and Blue Shield members.
- Want a second opinion? All SISC members can consult with a Teledoc physician to obtain an expert medical opinion and an optimal treatment plan at no cost. Teladoc will collect all relevant medical records, retest pathology, engage leading experts, complete and review an expert report with the member, and answer any questions they may have.
- Learn to Live: Employees and everyone in their household can access free emotional well-being tools and resources online and via app. Members receive personalized, one-on-one coaching, live and on-demand webinars, and digital tools to effectively manage stress, depression, anxiety, substance use and sleep issues.
For all Blue Shield members:
- Click here for access to your Blue Shield plan from your phone, tablet or computer.
- MDLIVE - 24/7 virtual access to providers and therapists.
- Vida Health - Sign up for the app or go online and you will be matched with a coach or therapist who will personalize a plan for you related to nutrition, weight loss, mental health or overall wellbeing. Free for PPO and HMO members. HSA members need to meet their deductible.
- Solera4MeDiabetes Prevention Program: Free 16-week program to help Blue Shield members diagnosed with
prediabetes reduce their risk of developing diabetes.:
For Blue Shield PPO members:
- New for Blue Shield PPO members as of 4/1/22: Maven Maternity Care Benefit - free access to virtual care for pregnancy and postpartum support. Plus free 6-month diaper subscription if you meet certain criteria.
- Ambulatory Surgery Center - need to have surgery? Pay less by going to an Ambulatory Surgery Center versus paying more by going to an in-network outpatient hospital for certain surgeries.
- Hinge Health: Blue Shield PPO members have free* access to personalized, digital physical therapy using the latest technology. Members are empowered with tools to address back and joint pain whenever and wherever it works best for them. *Program fee subject to deductible for members on an HDHP/HSA plan.
- City of Hope - enhanced Cancer Benefit through the Oncology Center of Excellence Program.
- Carrum Health: Blue Shield PPO members receive a concierge surgery benefit that waives all cost-sharing* for expenses are covered in full for the patient and one companion. *Medical costs subject to deductible for members on an HDHP/HSA plan. * As of 1/1/2023 this benefit has been expanded to include Stanford Valley Care Hospital in Pleasanton, CA.
- Eden Health - customized virtual primary care through Eden Health's smart phone application. Not available for members on an HDHP/HSA plan.
For all Kaiser members:
- Click here for your Kaiser My Health Manager - your one-stop resource for managing your care online.
- Click here for Kaiser Permanente SISC Plan Features including information about:
- Calm app: use mediation and mindfulness to help lower stress, reduce anxiety and improve sleep quality.
- myStrength: All SISC Kaiser Permanente members have free access to myStrength, an app with a personalized myStrength includes interactive activities, in-the-moment coping tools, community support and more.
- ClassPass: All SISC Kaiser Permanente members have free access to ClassPass, which makes it easier for members to exercise from the comfort of home. Through ClassPass, members have access to online video workouts at no cost, and discounts on in-person gym classes. Program now available through December 2023.
- Omada: All SISC Kaiser Permanente members have free access to a free, year-long diabetes prevention program designed to help at-risk patients prevent type 2 diabetes.
Kaiser member access to wellness strategy or mental health support is located here.
More wellbeing services like FREE in-person classes, online classes and resources here.
You can also get a wellness coach with phone appointments here.
Here are some of the self-care apps free to Kaiser members:
- Calm – app for sleep and meditation designed to help lower stress, anxiety and more.
- Ginger – emotional support coach
- myStrength – build a personalized plan to strengthen your emotional health
IF YOU HAVE ANY QUESTIONS OR NEED ASSISTANCE WITH THESE DOCUMENTS, PLEASE CONTACT HUMAN RESOURCES AT 707-527-4304.