Eligible part-time faculty with an accumulation from 0.4000 through 0.49999 load are eligible for 50% District paid benefits and those who averaged 0.5000 or more are eligible for 100% District paid benefits. The eligible part-time faculty will be receiving an Annual Benefits Open Enrollment packets around June 20th.

Only out-of-state faculty are eligible to participate in either the PPO Network or PPO+ Medical Plan option. Kaiser HMO serves strictly to California residents. Members who select the PPO Plan option are required to pay the difference in cost between HMO and PPO rates less District's Kaiser contribution rates.

Current enrollees for PY 07/08 who continued to qualify for PY 08/09 must go through the renewal process - you are only required to submit the Affidavit Statement which must be notarized ANNUALLY; there is no exception! In addition, we do not provide the notary public service in-house.

If you have misplaced or need additional copies of the Open Enrollment information that was sent to you, please see the links below.

Note: You may only submit the forms and enroll in the benefits plan for which you are eligible. If you submit the incorrect form, your enrollment is incomplete. Improper completion of the open enrollment process and/or submitting incorrect paperwork could jeopardize your benefits.


Forms for Eligible Part-Time Faculty (.4000-.4999 load)

• Universal PT Open Enrollment Form (Kaiser only, all loads)

• Open Enrollment Newsletter (.4000 - .4999 load)

• Kaiser Affidavit Statement (.4000 - .4999 load) (50% employee contribution)

• DEPENDENT ELIGIBILITY AUDIT (DEA) PROCESS (instructions for enrolling eligible dependents, including children and spouse) DEA deadline: September 15, 2008

• Universal PT Open Enrollment Form (Kaiser, all loads)

• Open Enrollment Newsletter (.5000 and above load)

• Kaiser Affidavit Statement (.5000 and above load) (100% District contribution)

• DEPENDENT ELIGIBILITY AUDIT (DEA) PROCESS (instructions for enrolling eligible dependents, including children and spouse) DEA deadline: September 15, 2008

• Open Enrollment Newsletter (.4000 - .4999 load)

• PPO+ Affidavit Statement (.4000-.4999 load) (employees pay 50% Kaiser rate contribution plus Kaiser (HMO)/PPO+ rate differential)

• PPO Network Only Affidavit Statement (.4000-.4999 load) (employees pay 50% Kaiser rate contribution plus Kaiser (HMO)/PPO rate differential)

• DEPENDENT ELIGIBILITY AUDIT (DEA) PROCESS (instructions for enrolling eligible dependents, including children and spouse) DEA deadline: September 15, 2008

• Open Enrollment Newsletter (.5000 and above load)

• PPO+ Affidavit Statement (.5000 and above load) (100% Kaiser rate District contribution; employee pays Kaiser (HMO)/PPO+ rate differential)

• PPO Network Only Affidavit Statement (.5000 and above load) (100% Kaiser rate District contribution; employee pays Kaiser (HMO)/PPO rate differential)

• DEPENDENT ELIGIBILITY AUDIT (DEA) PROCESS (instructions for enrolling eligible dependents, including children and spouse) DEA deadline: September 15, 2008

Table of Contents

• COBRA Continuation Rights

• Dependent Coverage Provision(for all health plans) (FSA)

• Disease Management (PPO Network Only and PPO+ Plan)

• Flexible Spending Account (FSA)

• Forms (Medical Claim Forms, Prescription Drug Claim Forms, FSA Reimbursement Claim Forms, Rx Mail Order Prescription Form, etc...)

• How to Order Additional or Replace ID Cards

• Information for Retirees (also Medicare Part D)

• Medical Benefits (effective July 1, 2006)

• Prescription Drugs, Dental, Vision, Behavioral/Counseling Information

• Related Web Sites (List of PPO contracted providers, etc...)

• Request for Continuing Health Coverage Forms

• Supplemental Term Life Insurance (Hartford Life)

• Workers' Compensation

  
  

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Please follow the following instructions.

First, access the web page: www.MyUHC.com. Under the section on the right, "Need a username and password?", you must register on-line by entering the newly assigned ID number (listed on ID card) or your SSN to register and set your own LOGIN and PASSWORD to access personalized health care, benefits information and order ID cards.

Once logged in, go to the "Manage my Account" menu at the top, and then choose, "Request ID cards".

Please Note: Individuals can only place one ID card request per individual per day. If you need to request more cards for the same person, please try again tomorrow. Otherwise, you can print a temporary ID card immediately.

If you are experiencing technical difficulties, while accessing myuhc.com, please contact UHC Technical Support at (877) 844-4999.

If you don't have access to a computer, you can always contact UHC customer care at 1-800-510-4846 to request it.

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• Hartford Group Life Summary Plan Description

• Hartford Group & Supp Life Summary Plan Description

• Group Life(Suppl)and AD&D Application(Personal Health Form)

• Hartford Beneficiary Designation Form (for Group Life and Group Accident Insurance)"

• Hartford Life Portability Application Form

• Hartford Notice of Conversion Form