Frequently Asked Questions
There are always exceptions, so please contact the Benefits Office for information regarding your specific situation at (805) 546-3161 or send an email to firstname.lastname@example.org
Q: Why didn't the insurance pay for my service?
- To get the most benefit from your plan you must go to a participating provider and present your ID card when you receive services.
- Most plans have a deductible that you as an individual or a family must meet before certain services are covered.
- Check your Evidence of Coverage/Plan Summary Description booklet to see if the service you received is covered under your plan.
- Sometimes the insurance company needs more information from you or your doctor to process the claim. See below.
Q: I have a claim problem. What do I do?
- You should contact customer service for the insurance company in question. Have your Explanation of Benefits/Member Statement from the insurance company, your ID card and the doctor's bill in hand when you call.
- Ask why they denied payment on your claim.
- Follow the instructions of the customer service person to get the claim resolved.
Q: When can I add my dependent?
- You can add a spouse, domestic partner or child at Open Enrollment.
- Outside of Open Enrollment, you can add dependents when you acquire them (marriage, establishment of domestic partnership, birth of a child, court ordered coverage).
- You can add dependents if they experience a loss of health converge under another group plan. Documentation is required. Call the insurance office for more details.
- The Insurance Office must be notified within 30 days of the event for your dependent to be added outside of Open Enrollment.
Q: What happens if I get separated or divorced?
- Your spouse may stay on your plan if you become legally separated. In California you are still married even if you are separated.
- If you file for divorce, your spouse will no longer be eligible to continue on your insurance plan as of the date of the final dissolution of marriage.
- You MUST inform the office within 30 days of your divorce becoming final.
- Your former spouse will be offered COBRA continuation.
Q: How long can I keep my child on my insurance?
- Dependent children (including step-children and adopted children) may stay on your plan until their 26th birthday.
- After age 26 your child is not eligible unless he/she is disabled.
Q: When is Open Enrollment?
- Open Enrollment for SISC Blue Cross (faculty medical) happens in August for the new plan year starting on October 1.
- Open Enrollment for MCSIG/Anthem Blue Cross, Delta Dental, VSP Vision and American Fidelity happens in November/December for coverage beginning on January 1.
Q: How do I get a new ID card?
- You may request a replacement MCSIG/Anthem Blue Cross card by calling customer service or by requesting one through the company's website. Phone number and websites are listed on the Insurance Benefits Home Page.
- If you need a new SISC/Blue Cross card contact the Insurance Benefits Office for assistance.
- Delta Dental ID cards is not required to receive services. You simply give them your name and the subscriber's (employee) Social Security number.
- VSP Vision does not print ID cards. Similar to the dental plan, all you need is your group number #30071230 and SSN to access benefits.
Q: How do I know if my doctor is a Participating Provider/Preferred Provider?
- Each of the medical, dental and vision plan websites allow you to search for a provider in their network. See the Benefits Home Page for websites.
- Call Customer Service to see if your doctor is a provider.
Q: How do I change my TSA (403b) or 457 contribution?
- 403(b)/457 contribution changes must go through Envoy Plan Services. Forms are available online at www.envoyplanservices.com.
Q: How do I get information about Medicare?
- Please visit Medicare online for more information. Please click for the Medicare and You Handbook.