The medical eligibility and enrollment period for the Associate Faculty Medical Benefits Program happens twice per year:
- in September (for coverage October 1 through March 31)
- in March (for coverage April 1 through September 30)
Associate Faculty must re-confirm their enrollment during every eligibility and enrollment period by submitting the Declaration of Eligibility form to Human Resources
When you resign from your position or retire, your medical insurance ends at the end of the month that you last work.
Associate Faculty are not eligible for dental insurance or vision insurance through SRJC.
- Eligibility Requirement
You may be eligible for medical insurance for yourself, your spouse or registered domestic partner and dependent children. This program is part of the benefit package negotiated between the District and the All Faculty Association and may be subject to change and/or cancellation. There are two eligibility/enrollment periods per year during the months of March and September.
Initial Eligibility Requirements
All of the requirements below must be met in order to be eligible to enroll:
- Must have a current cumulative load of 40% or greater from all California Community College Districts, with at least 20% load from SRJC.
- Must not have any portion of your medical benefits premium paid by any other employer, or by any employer of your spouse or domestic partner, including businesses owned by yourself, spouse or domestic partner, or by another California Community College District.
- Must not receive reimbursement for retirement medical benefits or stipends, from any source.
- Must not receive a payment in lieu of medical benefits from another employer, nor from any employer of your spouse or domestic partner.
Continuing Eligibility Requirements
For those already enrolled who want to continue their SRJC medical insurance:
- Must meet eligibility requirements #1 through #4 as described above in the initial requirements. If you do not meet the 40% eligibility requirement #1 above, you must have at least 20% at SRJC AND have a cumulative load at SRJC of 80% for the current semester and past two terms of instruction. For Spring 2025 the cumulative load will include Spring 2025, Fall 2024 and Summer 2024 term.
- You must re-confirm your enrollment during every enrollment period by submitting the Declaration of Eligibility form to Human Resources.
- Medical Plan Benefits Summaries and Rates
The District offers a choice of five medical plans through our membership in Self-Insured Schools of California (SISC).
SRJC pays the entire monthly premium for single, double and family coverage for the Kaiser HMO, Kaiser Deductible HSA and Blue Shield Deductible HSA. The Associate Faculty member will pay the portion of the Blue Shield HMO or Blue Shield PPO premium above the Kaiser HMO rate.
Monthly Premium Rates
These rates are for Associate Faculty employees during the plan year which starts every October 1. If you owe a premium portion, your premium payment will be deducted from your paycheck. During a coverage period when you don't receive a paycheck (like summer for instance), you are responsible for making the premium payment directly to the Accounting Department by calling Debbie Weatherly at 707-527-4505. Failure to pay the Associate Faculty portion of the premium will result in cancellation of your medical plan and it will be effective at the end of the month that you last paid.
The Benefit Summaries of the five medical plans are below:
- Kaiser Permanente HMO
- Kaiser Permanente Deductible 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 PPO Deductible plan with a Health Savings Account (HSA). This is a PPO deductible plan.
Please see the General Benefits Information for information on the differences between HMO and PPO; how the HSA plan works; additional plan benefits through SISC, enrolling dependents, etc.
Limitations based 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.
WHAT'S NEW FOR 2024-2025?
The monthly premiums for all medical plans change on October 1, 2024, and will be in effect for the entire plan year through September 30, 2025.
Blue Shield PPO: Your office visit copy will decrease from $30 to $20
- Forms
To continue your coverage complete this form:
Declaration of Eligibility Form to continue your current coverage
New enrollees must complete these forms:
Declaration of Eligibility Form for new enrollees
Blue Shield enrollment form
For Blue Shield HMO only – you must select a doctor when enrolling in this plan and include the doctor's IPA & PCP information on the enrollment form:
- IPA is the Medical Network/Group Name (like Providence Medical Network for instance)
- PCP is the Primary Care Physician #
Here’s how to search on Blue Shield's website for the IPA and PCP 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”, etc.
Next to the doctor's name you'll see the medical network they belong to - you'll need to enter that in the "IPA" field on the enrollment form (example: Providence Medical Network)
Click on the doctor's name and you'll find the Primary Care Physician ID (PCP) that you'll need to enter on the enrollment form.
Kaiser enrollment form. * Be sure to check "HMO" or "Deductible plan" in Section A on enrollment form
Verification of Teaching Load Form - 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 work between 20% load and 40% load at SRJC.** IMPORTANT: The forms on this page are all fillable and signable electronically. Once you've opened the form, please download and save the file before filling it out to access the signable electronic option.
- Dependent Eligibility
Dependents can be enrolled at your time of hire within 31 days; or within 31 days after experiencing a qualifying event; or during Open Enrollment.
The following documents must be provided for proof of dependent eligibility:
- Spouse - a copy of your marriage certificate AND a copy of page 1 of your 1040 tax return from last year that shows your married status (block out all income)
- Domestic Partner - a certified copy of the State of California Certificate of Registration of Domestic Partnership AND a copy of page 1 of each person's 1040 tax return from last year (block out all income)
- Children up to age 26 - a copy of their birth certificate. OR, if child is adopted: legal adoption documentation. OR, if you have legal guardianship or legal court documentation establishing guardianship the child can be covered up to age 18.
If you are getting married/registering your domestic partnership and adding your new spouse/domestic partner and any children, here's what we'll need:- Spouse - a copy of your marriage certificate.
- Domestic Partner - a certified copy of the State of California Certificate of Registration of Domestic Partnership and a copy of page 1 of each person's 1040 tax return from last year (block out all income)
- Children up to age 26 - a copy of their birth certificate. OR, if child is adopted: legal adoption documentation. OR, if you have legal guardianship or legal court documentation establishing guardianship the child can be covered up to age 18.