Regular Employees include Classified Staff, Management, and Contract Faculty

The plan year is October 1 through September 30

Open Enrollment for regular employees takes place annually for medical and vision insurance from August 1 to August 31. Any changes you make go into effect October 1.

Open Enrollment for Dental Insurance is once every three years. The next Dental Open Enrollment is in 2027.

All benefits forms must be submitted to Christie Colón  at ccolon@santarosa.edu

• Employee Medical Insurance

  The District offers a choice of five medical plans through our membership in Self-Insured Schools of California (SISC). The medical plans meet the Affordable Care Act (ACA) requirements for affordable coverage that provides minimum value for full-time employees. Please click on the links below to view the Benefit Summaries of these five plans:

  • 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.

   

  Premium rates as of 10/1/2024 – Rates for Contract Faculty, Classified and Management employees for the current plan year. 

  For Contract Faculty, Classified and Management employees working less than 1.0 FTE, benefits will be pro-rated.

  For those working less than 1.0 FTE but above .75 FTE, you may be eligible for the Affordable Care Act rate which offers affordable minimum essential coverage that provides minimum value. SRJC has determined the Kaiser HMO plan meets this coverage, so SRJC will pay the portion of the Kaiser HMO self-only premium in excess of 8.39% of the federal poverty level. During the current plan year, the ACA rate for employee-only Kaiser HMO coverage is $105.29/month.

   

  Please see the General Benefits Information for information on the differences between HMO and PPO; how the HSA plan works; additional plan benefits from SISC, etc.

   

  There are plan 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.
  • Blue Shield HMO is only available in California.
  • Kaiser operates by region, so if you live outside of the San Francisco Bay Area, you may not be eligible to enroll in the District’s Kaiser plans. We are part of the Kaiser Bay Area/Northern California region and not the Southern California Kaiser region, nor are we a part of the Kaiser regions in other states.

   

  You can search for Blue Shield doctors at the websites below:

  Blue Shield PPO: www.blueshieldca.com/networkppo

  Blue Shield HMO: www.blueshieldca.com/networkhmo

   

  Blue Shield Drug Formularies

  Here are the steps for a non‐member to access formulary info for the Blue Shield plans:

  • Call Navitus at 866‐333‐2757
  • Identify yourself as a part of Self‐Insured Schools of California but note that you are not yet active Navitus members
  • Give Navitus the RX plan offered by SRJC (For Blue Shield PPO & HMO it's 200D/10‐35 and for Blue Shield PPO Deductible/HSA it's 9X35HSA1700)
  • Ask for the Navitus Book of Business Formulary, and that you would like information on XYZ drug. The medical carrier is (Anthem NVANT). This will help the agent provide the information when the member information/eligibility hasn’t been loaded yet.

   

• Employee Dental Insurance

  The District offers a self-insured dental plan that includes more than 750 participating dentists. The plan is administered by Redwood Health Services. The annual dental benefit is $1,700.00. The plan year is from October 1 to September 30.

  The District pays the entire monthly premium for employees working 1.0 FTE and their eligible dependents. For employees working less than full-time, benefits will be pro-rated.

  This dental plan is an incentive plan, which means that there’s an incentive for you to go to the dentist. For instance, for Preventative and  Diagnostic Services (like teeth cleanings) all new subscribers start out at 80% coverage; if you go to the dentist during your 1st plan year (now through 9/30/2025), then you will move up to 90% coverage on 10/1/2025. Then if you go to the dentist from 10/1/2025 through 9/30/2026, you will move up to 100% coverage on 10/1/2026. Once you hit 100% you stay there. You have 3 covered teeth cleanings per year per person. 

  • Dental Plan Summary
  • List of Participating Dentists 
  • Monthly Premium Rates

   

  Redwood Health Services will process and pay claims. You can check the status of claims or print a temporary card by logging in to: https://services.hi-techhealth.com/rhs/pages/member_signon.shtml

  If you have any questions, don't hesitate to get in touch with Redwood Health Services per below:

  Redwood Health Services|
  3510 Unocal Place, #108
  Santa Rosa, CA 95403|
  Phone: 800-548-7677 x2
  Email: rhscustomerservice@rhs.org
   

• Employee Vision Insurance

  The District provides a Vision Service Plan (VSP) benefit to employees, which provides an annual exam and an allowance to purchase vision products from participating providers. Santa Rosa Junior College is part of the VSP Signature provider network.

  The plan year starts over every October 1.

  • VSP benefits summary
  • Exclusive offers for VSP members from VSP and leading industry brands
  • VSP claim reimbursement
  • VSP grievance process 

   

• Employee Life Insurance

  District-paid basic life insurance benefits are provided by Standard Insurance Company. The benefit amount is $50,000.00 for the employee and $5,000.00 for eligible dependents. These benefit amounts may be doubled if an accidental death & dismemberment event occurs. Voluntary supplemental life insurance is available at the employee’s expense.

  More information on supplemental life insurance.

  Make changes to your life insurance beneficiaries.

  Life insurance enrollment forms and supplemental purchase forms are available from HR by emailing ccolon@santarosa.edu.

   

• Forms

  All enrollment forms should be submitted to Christie Colón in Human Resources.

  Don't forget to provide the dependent eligibility documentation if you're adding a dependent. 

  These forms are fillable and signable. Once you've opened the form, please click "Download" to download the signable version.

   

  MEMBERSHIP CHANGE FORM

  Making changes to your current medical plan (like adding or deleting a dependent)? Please fill out the Membership Change form.

   

  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 form

  Blue Shield HMO – 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
  • 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:

  Search Blue Shield HMO Doctors 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.
  • 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

  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

   

  WAIVE MEDICAL INSURANCE

  If you work more than 90% and want to waive your health insurance, please fill out these three forms. WABE stands for Waiver of Anchor Bronze Enrollment: 

  • WABE option enrollment form 
  • WABE option SRJC form
  • SRJC waiver

   

  DENTAL INSURANCE FORM 

   

  VISION INSURANCE FORM

   

  LIFE INSURANCE FORM

  Life insurance beneficiary change form

  Life insurance enrollment forms and supplemental purchase forms are only available directly from Human Resources and are not posted here.

   

  Waiver of dental and vision insurance for Classified staff at less than 50%

   

• 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.