General Medical Plan Information

HMO or PPO

What's the difference between HMO (Health Maintenance Organization) plans and PPO (Preferred Provider Organization) plans?

These videos explain each type of medical plan:

HMO plans

PPO plans
 

HSA Plans

You must be enrolled in either the Kaiser Deductible medical plan or the Blue Shield Deductible medical plan to open the HSA account. The HSA is not available with the Kaiser HMO, Blue Shield HMO or Blue Shield PPO medical plans. Employees enrolled in a 125 plan cannot have employee or employer contributions to a HSA plan within the same tax year. Contact the payroll department with any questions.

For Regular Employees - The district deposits $100.00/month into your HSA for single coverage or $150.00/month for double/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.

For Associate Faculty - The district deposits these amounts per year: HSA Single: $600.00 HSA Double: $900.00 HSA Family: $900.00

Starting 12/1/2024 SRJC has transferred the HSA account from Optum Bank to Fidelity. Here's the Fidelity HSA Guide.

Here is a video about HSAs.

 

Enrolling Dependents

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.
Additional SISC benefits for Kaiser Members

 

These benefits are available through SRJC's membership in Self-Insured Schools of California (SISC).

Kaiser Member Services # is 800-464-4000.

Employee Assistance Program (EAP): Employees and everyone in their household can access free resources
for help with personal concerns--emotional well-being, marital, financial, interpersonal addiction and recovery, legal, stress, and more. Up to 6 free visits per topic.

EAP offers 24 hours, 7 day a week access to licensed mental health professionals. The EAP website also includes wellness articles, tips and resources for employees besides just access to providers.

EAP's 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.

 

 

  • Fitness memberships - through One Pass. Here's how to sign up:
    • Log into www.kp.org
    • Go to Health and Wellness tab
    • Go to Fitness deals
    • Learn more about One Pass
    • From there it will take you to the link to establish your account.

 

  • Kaiser Mental Health and Well-being - access mental health professionals, wellness coaches and self-care apps like Calm and Headspace Care which are free to Kaiser members.
     
  • Want a second opinion? All SISC members can consult with Teladoc 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.
     
  • Talkspace: Digital platform that supports behavioral health and emotional wellness needs from a secure, HIPAA-compliant app. Up to 6 counseling sessions per situation. Visit talkspace.com/associatecare and enter SISC as your organization name.

 

 

 

Additional SISC benefits for Blue Shield Members

These benefits are available through SRJC's membership in Self-Insured Schools of California (SISC).

Blue Shield Member Services # is 855-599-2657.

Employee Assistance Program (EAP): Employees and everyone in their household can access free resources
for help with personal concerns--emotional well-being resources, marital, financial, interpersonal addiction and recovery, legal, stress, and more. Up to 6 free visits per topic.

EAP offers 24 hours, 7 day a week access to licensed mental health professionals. The EAP website also includes wellness articles, tips and resources for employees besides just access to providers.

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:

 

  • Want a second opinion? All SISC members can consult with Teladoc 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. 

 

  • Talkspace: Digital platform that supports behavioral health and emotional wellness needs from a secure, HIPAA-compliant app. Up to 6 counseling sessions per situation. Visit talkspace.com/associatecare and enter SISC as your organization name.

 

 

  • MDLIVE - 24/7 access to virtual urgent care services. Physicians can prescribe medication when appropriate. Virtual visits with psychiatrists and therapists for members ages 10 and up. $0 copay.

 

  • Vida Health - Get free one-on-one health coaching, therapy, chronic condition management, health trackers and other tools and resources online or via phone. 

 

 

  • Vaccines - available through your Navitus pharmacy plan. Or through Costco.

 

For Blue Shield PPO members:

 

  • Ambulatory Surgery Center - need to have surgery? Pay less by going to an Ambulatory Surgery Center for certain surgeries. You'd pay more by going to an in-network outpatient hospital.

 

  • Hinge Health - Have back or joint pain? Get free unlimited one-on-one coaching and personalized exercise therapy. Also access to free wearable sensors and monitoring devices. *Medical costs subject to deductible for members on the Blue Shield PPO Deductible/HSA plan. 

 

 

  • Midi Health - Access to expert care for menopause through a specialized virtual clinic. The Midi team can provide personalized care for symptoms like hot flashes, mood changes, poor sleep and more. Not available for members on the Blue Shield PPO Deductible/HSA plan.

 

  • Lantern cancer care benefit - Get help for free from a personal oncology nurse who can partner with you on every step of your cancer journey, including a review of your initial diagnosis and development of a care plan.

 

  • Carrum Health: Blue Shield PPO members receive a free concierge surgery benefit. Consult top-quality surgeons on hip and knee replacements and certain spine surgeries. Benefit covers all related travel and medical bills. *Medical costs subject to deductible for members on the Blue Shield PPO Deductible/HSA plan. 

 

  • Centivo Care - Virtually connect with a primary care physician to manage all your physical and mental healthcare needs. Centivo Care providers diagnose conditions, manage prescriptions, refer to in-network specialists and answer follow up questions using video visits or live chat. 

 

  • WellTheory - Get free nutrition and lifestyle coaching for your autoimmune condition or undiagnosed symptoms like chronic pain, fatigue, digestive or skin issues and more. * not for those on Blue Shield Deductible/HSA.

 

Blue Shield Drug Formularies & Doctor Search

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.

 

Blue Shield Doctor Search

 

Blue Shield PPO: www.blueshieldca.com/networkppo

Blue Shield HMO: www.blueshieldca.com/networkhmo

 

Current Health Insurance News and Information 

IRS 1095-B Medical Coverage Statement for Tax Year 2025

 

It is not necessary to wait for forms 1095-B or 1095-C in order to file your taxes. You do not need to attach any of these forms to your tax return. These forms are typically ready by March 2025.

Some taxpayers may not receive these forms by the time they are ready to file their tax return. While the information on these forms may assist in preparing a return, they are not required. Individual taxpayers should not wait for these forms and should file their returns as they normally would. Taxpayers can prepare and file their returns using other information about their medical insurance.

 

KAISER MEMBERS

The form 1095-B that you can use to file your taxes is from Kaiser. This form doesn't come from SRJC.

Employees can call Kaiser Member Services for their form at 844-477-0450 or access their 1095-B form online in their online member portal once Kaiser completes it.

 

BLUE SHIELD PPO MEMBERS

The form 1095-B that you can use to file your taxes is from SISC PPO. This form doesn't come from SRJC.

 

BLUE SHIELD HMO MEMBERS

The form 1095-B that you can use to file your taxes is from Blue Shield HMO. This form doesn't come from SRJC.

 

IRS 1095-C INFORMATION

The deadline for employers to provide employees who are considered a full-time employee under the ACA guidelines with Form 1095-C is in March 2025. Part-time employees don't receive this form.

 

RETIREE INFORMATION ON 1095-B REPORTING

Anthem CompanionCare and Kaiser Senior Advantage members are excluded from this reporting. For more information on Medicare and the 1095-B reporting, you may visit the Medicare website Medicare and IRS Form 1095-B.