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Benefit Information for the period October 1, 2020 to September 30, 2021
Santa Rosa Junior College offers its regular employees (Faculty, Classified and Management) and their eligible dependents a comprehensive fringe benefit package that includes medical insurance, dental insurance, vision care and life insurance. The highlights of the package include:
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 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 deductible plan.
2020-2021 Rates – For Contract Faculty, Classified and Management. October 1, 2020 to September 30, 2021. For employees working less than full-time, benefits will be pro-rated
Santa Rosa Junior College offers a self-insured dental plan that includes more than 750 participating dentists. The annual dental benefit provided each benefit year is $1,700.00. Claims are administered by: Arrow Benefits Group, 1 Willowbrook Court, Suite 230, P.O. Box 750758, Petaluma, CA 94975, (707) 544-1801. Click here for the Summary Plan Description and click here for the List of Participating Dentists.
The District provides a Vision Service Plan (VSP) benefit to employees. This vision plan provides an annual exam and an allowance to purchase vision products from participating providers. Click here for the VSP benefits summary.
The 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 are doubled if an accidental death & dismemberment event occurs. Voluntary supplemental coverage is available at the employee’s expense.
ELIGIBLE DEPENDENT REQUIREMENTS
Employees who enroll a spouse/domestic partner or children on the plans must provide the following documents showing of dependent eligibility:
- Spouse - a copy of a marriage certificate and a copy of page 1 of your most recent 1040 tax return that shows your married status (block out all income and first five digits of SSN)
- 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 most recent 1040 tax return (block out all income and first five digits of SSN)
- Children up to age 26 - a copy of the birth certificate
All enrollment forms should be submitted to Christie Colón in Human Resources
Blue Shield - Use the Blue Shield Enrollment Form to enroll for the first time.
**Blue Shield - HMO – you must select a doctor when enrolling 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 on “Primary Care Physician”
Type in your location
Select Specialty, like “Family Practice”, “Internal Medicine”, etc.
*** Blue Shield PPO or HSA – you must write HSA or PPO in the top margin on the enrollment form
Kaiser - Use the Kaiser Enrollment Form to enroll for the first time.
* Be sure to check HMO or Deductible plan in Section A on enrollment form
Making changes to your current medical plan (like adding or deleting a dependent)? Please fill out this Membership Change Form and include the proper dependent documentation (see above for dependent eligibility)
Dental - use this Form
Vision for Faculty and 10-month employees - use this Form
Vision for 12-month Classified and Management - use this Form
Life - use the Beneficiary Change Form to make changes to your plan
Additional medical plan information:
- Employee Assistance Program (EAP)
- Blue Shield PPO plan: Ambulatory Surgery Center option
- Health Savings Account with Optum Bank - FAQs and Guide.
- Additional benefits for employees enrolled in a SISC medical plan include the Employee Assistance Program (EAP), expert medical opinions and 24/7 physician access. Advance Medical is now Teledoc. Want a second opinion? Click here for information about how to get an independent medical review from Teledoc.
- Optum Bank - Health Savings Account FAQs and Guide
SISC has also implemented new programs to add value and give members access to the best care:
RETIREE HEALTH BENEFITS
Faculty - Click here for information on Retirement Health Benefits
Classified - Click here for information on Retirement Health Benefits
Benefit Summaries for Retiree Medical Benefits 65 and older:
The renewal rates listed are effective October 1, 2020 and will remain in place through September 30, 2021.
KAISER SENIOR ADVANTAGE
• Single Party Sr Advantage (1) over 65 $339.00
• 2-Party Sr Advantage (2) over 65 $678.00
• 2-Party Sr Advantage/Kaiser HMO (1) over 65+ (1) under 65 $1,053.00
• 3-Party Sr Advantage/Kaiser HMO (1) over 65+ (2) under 65 $1,828.00
• Single Party Companion Care (1) over 65 $402.00
• 2-Party Companion Care (2) over 65 $804.00
• 2-Party Companion Care/Blue Shield PPO (1) over 65+ (1) under 65 $1,277.00
Additional Retiree Benefit: Silver & Fit benefits for both Kaiser Senior Advantage and Companion Care
Retiree Dental Benefits:
- Santa Rosa Junior College offers a self-insured dental plan that includes more than 750 participating dentists. The annual dental benefit provided each benefit year is $1,700.00. Claims are administered by: Arrow Benefits Group, 1 Willowbrook Court, Suite 230, P.O. Box 750758, Petaluma, CA 94975, (707) 544-1801. Click here for the Summary Plan Description and click here for the Listing of Participating Dentists.
Listed below are annual notices provided for informational purposes.
SISC Blue Shield Members:
- Costco Pharmacies – Walk-in flu shots are available at all Costco pharmacy locations (no membership required). Click here for the flyer.
- Network Pharmacies – Walk-in flu shots are available at pharmacies such as Rite Aid and CVS. Members interested in this option may contact Navitus at 1-866-333-2757 to locate participating pharmacies. Click here for the flyer.
SISC Kaiser Permanente Members:
- $0 flu shots are available at many of their facilities. Members may access https://healthy.kaiserpermanente.org/health-wellness/flu for specific locations.
ADJUNCT FACULTY MEDICAL BENEFITS
The current Enrollment Period for the Adjunct Medical Benefits Program is during March 2021 for medical coverage from April 1, 2021 through September 30, 2021. Forms are due to Human Resources by 5 p.m. on March 31, 2021.
Click here 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.
Click here for more information about the AMBP such as eligibility requirements, types of medical plans offered and the required forms to complete if you are enrolling for the first time.
If you're enrolling in one of the SRJC Kaiser plans, please click here and submit this enrollment form to Human Resources, along with the other required forms.
To enroll in Blue Shield, please click here to fill out the enrollment form and return it to Human Resources, along with the other required forms.
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
Income protection coverage for regular employees (Faculty, Classified and Management) is provided through Sun Life Financial and is dependent on your employment status. Should you become disabled, after a 60-day waiting period, the benefit payable to you may be two-thirds of your monthly salary before tax liability. You may be entitled to either a one-year benefit or up to the age of 65.
Employees are eligible for participation in either the State Teachers Retirement System (CalSTRS) or the Public Employees Retirement System (CalPERS) based upon the position classification and/or prior membership. These programs provide a lifetime retirement allowance based upon a retirement system formula which includes five full-time years of service. Adjunct faculty also have the option of participating in Fidelity Investments or the CalSTRS Cash Balance system which do not require any vesting or years of service.
For information on 403(b) and 457 plans, please click here to go to the Payroll department website.
For information on the Flexible Spending plan (FSA) or Health Savings Account (HSA), please click here to go to the Payroll department website.
If you have any questions or need assistance with these documents, please contact Human Resources at 707-527-4954