New for 2023 – Postdoctoral Scholar Employees (Title Codes 3252, 3255, 3256) are eligible to participate in the Health FSA (HFSA) and Dependent Care FSA (DCFSA) plans.  The HFSA is a pre-tax benefit account that is used to pay for eligible medical, dental, and vision care expenses that are not covered by your health plan or elsewhere. A Dependent Care FSA (DCFSA) is a pre-tax benefit account used to pay for eligible dependent care services, such as preschool, summer day camp, before or after-school programs, and child or adult daycare.  For more information on FSA plans and how to use them, check out the FAQs. 

Flexible Spending Account

UC POSTDOCTORAL SCHOLARS FLEXIBLE SPENDING ACCOUNTS FAQs

View the WEX FSA Video Presentation

Dependent Care Flexible Spending Account Summary

Health Care Flexible Spending Account Summary

Welcome!

Gallagher Benefit Services is pleased to offer the UC Postdoctoral Scholar Benefit Plan.

• Medical: Health Net HMO or PPO
• Dental: Health Net DHMO or Principal Point of Service
• Vision: Health Net PPO
• Life: The Standard Insurance (Eligible Postdocs will be automatically enrolled)
• AD&D: The Standard Insurance (Eligible Postdocs will be automatically enrolled)
• Short-Term Disability: The Standard Insurance (Eligible Postdocs will be automatically enrolled)
• Health FSA and Dependent Care FSA – New for 2023

    In addition, Eligible Postdocs will have access to the following services:

• Wellness Programs
• The Standard Travel Assist Program
• Child and Home Care Providers
• Mental Health Benefits
  
  

  ---

  Important Information

  ELIGIBILITY:

  As a new postdoc appointed in any of the postdoc title codes of 3252, 3253, 3254, 3255 or 3256, you have 31 days from your date of appointment to enroll yourself and your eligible dependents.

  Family member eligibility requirements are the same as the family member eligibility requirements for the University of California Faculty and Staff plans. The major family member eligibility categories are the following:

  • Spouse
  • Natural or adopted child or children to age 26 for medical plans (unless eligible to continue coverage because of disability). Adult age children are not eligible to enroll if they are eligible for their own employer-sponsored plan.
  • Same-sex or Opposite-sex domestic partner, as long as the relationship meets established criteria.

  Note: When two family members are employed through the UC, duplicate coverage is not allowed.

  Your eligible family members must be enrolled with the same coverage start date as you, which is the date of appointment. However, you may enroll eligible family members at a later time due to a qualifying event as listed in the section below.  

  Failure to enroll yourself, or enroll your dependents, within this time frame could result in a significant delay in access to coverage, or the inability to enroll yourself and/or your dependents until the next Open Enrollment period.

  UC's Definition of a Domestic Partnership

  • Each Other's Sole Domestic Partner in a Long-Term, Committed Relationship and Intended to Remain so Indefinitely
  • Neither Party Legally Married or a Partner in Another Domestic Relationship
  • Not Related to Each Other by Blood
  • Both Parties 18 Years Old and Capable of Consenting to the Relationship
  • Parties Financially Interdependent
  • Parties Share a Common Residence

  INFORMATION FOR J-1 AND J-2 VISA HOLDERS

  All Postdoctoral Scholars in job codes 3252 (Postdoctoral Scholar - employee), 3253 (Postdoctoral Scholar - fellow), and 3254 (Postdoctoral Scholar - direct paid) and their dependents are automatically covered for medical evacuation and repatriation benefits necessary to satisfy the J Visa Program.

ELECTING COBRA AND CONTINUING YOUR MEDICAL, DENTAL AND/OR VISION COVERAGE

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), offers continued coverage when you, your spouse or domestic partner, or your dependents lose group medical, dental, vision, or Health FSA coverage because you experience a qualifying event, such as termination of employment (other than gross misconduct), reduction in work hours (below eligible benefit status), death, divorce/legal separation, or when a child ceases to be an eligible dependent.

Please keep in mind that even if your appointment were to terminate at any time during the month, your PSBP coverage continues until the end of the month and your COBRA elected coverage would begin on the first of the month following your termination.

COBRA continuation coverage is identical to the UC-sponsored coverage you and/or your dependents had immediately prior to qualifying for COBRA coverage.

You may continue coverage under COBRA for up to 18 months if you terminate employment or experience a reduction in hours that affects your benefits eligibility.

If your dependent(s) lose coverage because you divorce, legally separate, get an annulment, end a domestic partnership or die or because the dependent loses eligibility (for example, turns age 26), your dependent generally may continue coverage for up to 36 months.

It is important for you to notify UCPath in the event of:

• Divorce/legal separation/annulment
• Termination of domestic partnership
• Loss of dependent status (e.g., child turns age 26)

To be eligible for COBRA continuation coverage, you must provide notice within 60 days of the event, either by completing the Notice to UC of a Qualifying EventPDF form (UBEN 109) or by providing written notice.

As of July 1, 2023, WEX Health is UC’s COBRA administrator. If you lose coverage because of a qualifying event, WEX Health will send you a COBRA election packet. You must send enrollment forms and premiums directly to WEX Health and WEX Health will then report eligibility and premiums to the individual health plans. To learn how much you will pay per month for any coverage you elect through COBRA, please click below:

2023 MONTHLY COBRA PREMIUMS 

If you have any questions about your COBRA election or status, please contact WEX by phone, online chat, or email.

WEX COBRA Participant Services
Phone: 844-561-1338
Online Chat: www.wexinc.com
Email: cobraadmin@wexhealth.com

Web:  https://cobra.discoverybenefits.com

Monday-Friday | 6:00am-9:00pm CST

All eligible Postdocs (Title Code 3252, 3253, 3254, 3255 or 3256) and their dependents are automatically covered for medical evacuation and repatriation benefits necessary to satisfy the J Visa Program.

It is not necessary to purchase supplemental insurance to satisfy the J-1 and J-2 Visa requirements regarding Medical Evacuation or Repatriation. The Standard Insurance Company offers both J1 and J2 visa holders the required insurance coverage as shown below:

U.S. Department of State Requirement$ amount (USD)

Medical Insurance Plans

Vision Insurance Plan

Dental Insurance Plans

HMO SUMMARY OF BENEFITS 

HMO SUMMARY OF BENEFITS (2024)

HN OF CA PROVIDER SEARCH 

HMO EVIDENCE OF COVERAGE 

PPO SUMMARY OF BENEFITS 

PPO SUMMARY OF BENEFITS (2024)

PPO CA EVIDENCE OF INSURANCE 

PPO OOS EVIDENCE  OF INS 

PPO OOS FHN FAQ/FIND PROVIDER 

TRANSGENDER HEALTH BEN

FIND A PROVIDER 

BENEFIT SUMMARY 

BENEFIT SUMMARY (2024)

CERTIFICATE OF INSURANCE 

CERTIFICATE OF INSURANCE (2024)

OUT-OF-NETWORK CLAIM FORM 

ID CARD 

FIND A PROVIDER 

DHMO BENEFIT SUMMARY 

DHMO CERTIFICATE OF INSURANCE 

DHMO COST CALCULATOR 

DPOS SUMMARY OF BENEFITS 

POS DENT OON EXAMPLE 

DPOS BENEFIT BOOKLET 

DPOS BENEFIT POLICY 

DPOS PERIODONTAL VOUCHER 

DPOS DENTAL VOUCHER FLYER 

FIND A PROVIDER 

Life/AD&D Insurance Plan

Travel Assist

Prescriptions

BENEFIT SUMMARY 

CERT AND SUMMARY PLAN DESC 

LIFE BENEFICIARY FORM 

MEDICAL STATEMENT FORM 

BASIC TRAVEL ASSISTANCE EMPLOYEE FLYER 

BASIC TRAVEL ASSISTANCE PROGRAM DESCRIPTION 

EXTENDED TRAVEL ASSISTANCE EMPLOYEE FLYER 

EXTENDED TRAVEL ASSISTANCE PROGRAM DESCRIPTION 

EXTENDED TRAVEL ASSIST WALLET CARD 

TRAVEL ASSISTANCE MOBILE APP 

ASSIST AMERICA SERVICES INTRODUCTION 

HMO PHARMACY BENEFITS 

HMO RX BENEFITS & MAIL ORDER 

PPO PHARMACY BENEFITS 

MAIL ORDER RX MAINT CHOICE 

UNDERSTANDING RX BENEFITS 

Additional Services Available

Short Term Disability

Long Term Disability

YOUR BEHAVIORAL HEALTH BENEFITS

BEHAVIORAL HEALTH PROVIDERS HMO

BEHAVIORAL HEALTH PROVIDERS PPO

HMO CHIROPRACTIC BENEFIT 

HEALTH & WELLNESS 

HEALTHY DISCOUNTS 

HEALTHY DISCOUNTS (SPANISH)

PERDER PESO 

SMART START FOR PREGNANCY 

THE BEST START FOR YOUR BABY 

TEXT4BABY 

NOTIFICATION OF PREGNANCY 

AVISO DE EMBARAZO 

QUIT SMOKING 

YEARS AHEAD 

SITTERCITY AND ADULT CARE 

MINUTECLINIC GUIDE 

HEALTHNET.COM REGISTRATION 

HEALTH COACHING 

MY STRENGTH 

WELLNESS REWARDS 

PREVENTIVE SCREENING 

COVID-19 PANDEMIC RELIEF TIMELINE 

COVID-19 RELIEF FAQS 

COVID-19 FAQ 

WHERE DO I ACCESS CARE?

BENEFITS SUMMARY 

CERTIFICATE OF INSURANCE

CLAIM FORM 

MEDICAL HISTORY STATEMENT (EOI) Form

EFT Form

BENEFITS SUMMARY 

CERTIFICATE OF INSURANCE 

EMPLOYEE ASSISTANCE PROGRAM (EAP) 

LTD FORM 

If you pregnant or thinking of starting a family:

HEALTHY PREGNANCY PROGRAM 
TEXT4BABY 

If you wish to make the healthy decision to quit smoking:

DECISION TO QUIT 

Want to lose weight? - Receive healthy eating counseling from a health coach:

LOSE WEIGHT 

The United States has no single nationwide system of health insurance. Health insurance is purchased in the private marketplace or provided by the government to certain groups. As a result, the U.S. government recently created a new legislation called The Patient Protection and Affordable Care Act (ACA) which was signed into law on March 23, 2010. The ACA impacts only U.S. Citizens and Resident Aliens (“Green Card Holders”). This new law requires that all U.S. Citizens and Resident Aliens obtain health insurance coverage. In addition, the new law required changes to the level of coverage offered by each insurance carrier. Some of the changes include: coverage for pre-existing conditions and free preventive care. Therefore, if you are a U.S. citizen or Resident Alien, please ensure that you are purchasing a health insurance plan that is ACA compliant.

The United States is one of the leading nations in terms of medical treatment for various diseases and conditions. As a result, the cost of medical treatment in the United States is quite expensive. Since there is not a single nationwide system of health insurance, the cost of medical treatment is the responsibility of the individual needing medical treatment. Many medical providers see patients without health insurance as “cash patients.” This means that if an individual does not have insurance and needs a physical exam that costs $500 USD, then the individual needs to pay the full amount of $500 USD. As you can see, the cost of medical services can get expensive quickly depending on the services being rendered (example: maternity care, treatment for heart conditions, cancer treatment, etc.)

For individuals visiting the United States, one way to offset the medical cost if you saw a doctor or visited a hospital and received medical care, is to buy a health insurance plan that is comprehensive here in the United States. If you are here in the United States under a J1/J2 visa, the U.S. Department of State requires you to obtain health insurance coverage that meets their requirements. Failure to obtain health insurance coverage could result in immediate deportation back to your home country. However, the U.S. Department of State requirements are the minimum level of health insurance coverage a person holding a J1/J2 visa must have, it does not guarantee that all of your medical costs will be covered.

If you are visiting the United States, it is very important that you obtain a comprehensive health insurance plan that will actually cover a lot of your medical cost if you were ever in need of medical attention. A lot of J1/J2 visa holders make the mistake of buying the cheapest health insurance plan based on the cost per month. However, when they actually need the health insurance to pay their medical bills, in most cases the medical bills are denied by the insurance company due to the lack of comprehensive coverage.

At Gallagher Benefits Services, we only recommend quality health insurance plans here in the United States. Gallagher Benefits Services will not sell or promote health insurance plans that will not benefit you or your family. Our main concern is that everyone receives a comprehensive medical plan, so when you need to access medical care, you are not worried about the medical bill, but focused on your well-being.

BRAND-NAME DRUG:

Drugs developed and produced exclusively by a single pharmaceutical company. The formula for these drugs is protected by patent for a period of several years before a generic can be developed.

BROKER:

A broker matches their clients with a health insurance company or plan that best suits the client’s needs. The broker is paid a commission by the insurance company but represents the interests of their client rather than the insurance company. In some cases, as with Gallagher Benefit Services, a broker can also act as a third-party administrator, handling enrollment and billing, benefit and claims questions, etc.

CLAIM:

A request by a plan member, or a plan member's health care provider, for the insurance company to pay for medical services.

COINSURANCE:

The amount that you are required to pay for covered medical services after you've satisfied any copayment or deductible required by your health insurance plan. Coinsurance is typically a percentage of the charge for a service rendered by a healthcare provider. For example, if your insurance company covers 80% of the allowable charge for a specific service, you may be required to cover the remaining 20% as coinsurance.

COPAYMENT:

A flat charge that your health insurance plan may require you to pay for a specific medical service or supply, also referred to as a "copay." For example, your health insurance plan may require a $20 copayment for an office visit or brand-name prescription drug, after which the insurance company pays the remainder of the charges.

COBRA (Consolidated Omnibus Reconciliation Act):

Federal legislation allowing an employee or an employee's dependents to maintain group health insurance coverage through an employer's health insurance plan, at the individual's expense, for up to 18 months after the loss of employment.

DEDUCTIBLE:

A specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Not all health insurance plans require a deductible.

DEPENDENT:

A person who is depending on you for financial support and therefore eligible to enroll in a group sponsored benefit plan that you are eligible for. Dependents are usually: spouse, domestic partners, and children.

EXPLANATION OF BENEFITS (EOB):

The statement sent to you by your health plan explaining the benefit calculation and payment of medical services that details the services rendered and the benefits paid or denied for each service. An EOB lists the charges submitted, the amount allowed, the amount paid, and any balance owed as the patient's responsibility.

FORMULARY DRUG:

List of prescription drugs approved for a health plan's prescription drug benefit. Formulary lists are available at Anthem's website or you can call Anthem's Customer Service number and request a copy.

GENERIC DRUG:

A prescription drug that is chemically equivalent to a brand name drug dispensed under its generic chemical name. Generic drugs are cheaper versions of expensive brand name drugs with the same active ingredients, strength and dosage form.

INSURANCE CARRIER:

The company responsible for providing you with your health insurance plan by paying your claims, maintaining provider networks, coordinating billing, and offering member assistance services.

IN-NETWORK PROVIDER:

A healthcare professional, hospital or pharmacy that has a contractual relationship with your health insurance company. This contractual relationship typically establishes allowable charges for specific services. In return for entering into this kind of relationship with an insurance company, a healthcare provider typically gains patients, and a primary care physician may receive a capitation fee for each patient assigned to his or her care. An Out-of-Network provider is a healthcare professional, hospital, or pharmacy that is not part of your health plan's network of preferred (In-Network) providers. You will generally pay more for services received from out-of-network providers, in part because you may be responsible for out of-pocket costs that are considered above the “reasonable and customary” fees.

LIFETIME MAXIMUM:

The maximum dollar amount that a health insurance company agrees to pay on behalf of a member for covered services during the course of his or her lifetime.

MEDICAL EVACUATION AND REPATRIATION INSURANCE:

This coverage, required of all J-Visa holders, is for arranging and paying for emergency evacuation to the nearest adequate medical facility, and the repatriation of mortal remains.

NON-FORMULARY DRUG:

Any brand-name prescription drug that is not included in a particular health plan's list of approved formulary drugs.

OPEN ENROLLMENT:

The time period each year when you have an opportunity to change your benefit elections. Examples of changes: switch from one medical plan to another; add dependent(s) to medical/dental if not enrolled in your plan.

OUT-OF-NETWORK PROVIDER:

A doctor, dentist, hospital or other practitioner who does not have a contract with a health plan.

OUT-OF-POCKET MAXIMUM:

Out-of-pocket maximums apply to all medical plans. This is the maximum amount you will pay for health care costs in a calendar year. Once you have reached the out-of-pocket maximum, the plan will fully cover most eligible medical expenses for the rest of the plan year.

PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA):

ACA was signed into law on March 23, 2010. The ACA impacts only U.S. Citizens and Resident Aliens (“Green Card Holders”). This new law requires that all U.S. Citizens and Resident Aliens obtain health insurance coverage. In addition, the new law required changes to the level of coverage offered by each insurance carrier. Some of the changes include: coverage for pre-existing conditions and free preventive care.

PHYSICIAN:

Generally, a doctor that is categorized as a general practitioner, family practitioner, pediatrician, internist or OB/GYN.

PREFERRED PROVIDER ORGANIZATION (PPO):

A PPO is a network of doctors and hospitals that contracted with a health plan and have agreed to provide their medical services at rates lower than their standard fees. A PPO offers both in-network and out-of-network benefits.

PRIMARY CARE PHYSICIAN (PCP):

A primary care physician usually serves as a patient's main healthcare provider, especially under an HMO plan. The PCP serves as a first point of contact for healthcare and may refer a patient to specialists for additional services.

SPECIALIST:

Generally, a doctor that is NOT categorized as a general practitioner, family practitioner, pediatrician, internist or OB/GYN. Examples of a specialist would include a dermatologist or cardiologist.

Postdocs Traveling Abroad

Medical Assistance

When postdocs are traveling outside of the United States, The Standard offers medical assistance only in life threatening situations.

• Travel Assistance Employee Flyer: https://www.standard.com/eforms/14684.pdf
• Extended Travel Assistance Employee Flyer: http://www.standard.com/eforms/17506.pdf

In addition, below is an intro video to Assist America as well as a short video on their Mobile App.

Mobile App Video:

https://youtu.be/3jBDCeE9d8g

Assist America Services Introduction

https://www.youtube.com/watch?v=Sts_BFC2uWI&t=30s

Business Travel

Postdocs are covered by the UC travel insurance policy when traveling on UC-affiliated business. For additional information, review the links under the Employee Resources section of the Travel Risk & Insurance webpage [https://www.ucop.edu/risk-services-travel/index.html].

Personal Travel

Postdocs traveling for personal reasons are eligible to purchase coverage through the UC Personal Travel Insurance Program  [https://www.ucop.edu/risk-services-travel/personal.html].

In the event, you needed to seek medical care before you received your insurance ID cards from as an enrolled Health Net member, you will be able to file a claim if you paid out-of-pocket for the medical services rendered.   

If approved, your claim will only reimburse the amount that Health Net would have covered as the benefit. 
To submit a claim: 

1. Complete one of the claim forms below: ·        
   1. PRESCRIPTION CLAIM FORM 
   2. MEDICAL CLAIM FORM 
   3. VISION OUT-OF-STATE CLAIM FORM
   4. DENTAL HMO CLAIM FORM 
   5. FOREIGN CLAIM QNR 
2. Obtain a copy of an itemized bill that includes diagnosis codes 
3. Copy of the receipt, showing the amount you paid
4. Complete the HIPPA form ·       
   1. HIPAA FORM 
5. Mail all the documents to the address listed on the claim form.   

EXPLANATION OF BENEFITS DOCUMENT

After you use your Health Net benefits, you may receive a document called an Explanation of Benefits, also known as the EOB. This document is not a bill, but a detailed description of the services you received and the relative cost. To view a descriptive sample that can assit you in understanding this document, please click below:

UNDERSTANDING YOUR EOB 

MOBILE APPS

You can access your health plan information (such as ID cards, copays, deductible info, etc) with Health Net by using their mobile friendly site. Click below for further details or visit www.healthnet.com/mobile:

HEALTH NET MOBILE 

HEALTHNET CUSTOMER SERVICE

If you have questions relating to your EOB or to a recent claim that was submitted to Health Net, please call the Health Net customer service department at 1-800-522-0088.

Postdocs who missed enrolling in the LTD plan during their Period of Initial Eligibility can complete, print, sign, date and email the attached Medical History Statement (EOI) form to musc@standard.com or can complete their request online (www.standard.com/MHS). Please note the postdoc will need to include the policy number: 643383.

Note: Voluntary Long-Term Disability cannot be added during Open Enrollment.

OPEN THE LTD FORM 

Business Hours:

Monday - Friday, 8am - 5pm

Call:

800-254-1758

Email:

Mailing Address: