2024
A Complete Guide
to Your UC Healthand Welfare Benefits

MEDICAL, DENTAL, VISION, LIFE AND MOREGETTING HELPMEDICAL PLANS
CORE, UC Care, UC Health Savings Plan uchealthplans.com• Accolade (Health Care Advocate): 866‑406‑1182
or member.accolade.com• Anthem Blue Cross (Medical): anthem.com/ca• Navitus Health Solutions (Pharmacy): 833‑837‑4308
Formulary: benefitplans.navitus.com/university-of-california
Contact Accolade for all your health care questions. Anthem
processes claims and provides ID cards, and Navitus is phar‑macy benefit manager.
Health Savings Account (HealthEquity)866‑212‑4729
learn.healthequity.com/uc/hsa
Kaiser HMO (Kaiser Permanente—California,
Optum Behavioral Health)• Kaiser: 800‑324‑9208 select.kp.org/university-of-california• Optum: 888‑440‑8225 liveandworkwell.com (access code:
11280)UC Blue & Gold HMO (Health Net, MHN Behavioral Health)• Health Net: 800-539-4072 healthnet.com/uc• Health Net Behavioral Health: 800-663-9355

OTHER BENEFITSOTHER PLANS
Adoption Assistance Plan (WEX Health)844‑561‑1338 ucal.us/adoptionassistance
Auto/Homeowner Farmers Insurance ChoiceSM
866‑700‑3113
Family Care Resources (Bright Horizons Enhanced Family Supports)
888-748-2489 clients.brighthorizons.com/universityofcalifornia
Flexible Spending Accounts
Dependent Care
(WEX Health)844-561-1338 uc-fsa.com

Legal (ARAG)
800-828-1395 araglegal.com/ucinfo
Pet Insurance (Nationwide)
877-738-7874 petinsurance.com/uc

UC SYSTEMWIDE RESOURCES
UCnet
ucnet.universityofcalifornia.edu
UCPath855‑982‑7284

ucpath.universityofcalifornia.edu

UC Retirement At Your Service (UCRAYS)
retirementatyourservice.ucop.edu

Delta Dental PPO (Delta Dental)
800-777-5854 www1.deltadentalins.com/group-sites/uc.html

UC BENEFITS OFFICES

DeltaCare® USA Dental HMO (Delta Dental)
800‑422‑4234 www1.deltadentalins.com/group-sites/uc.html

Agriculture & Natural
Resources530-752-1774

VSP Vision Plan (VSP)
866‑240‑8344 vsp.com

Berkeley510-664-9000, option 3

Accident, Critical Illness, Hospital Indemnity, Life, Accidental
Death & Dismemberment (Prudential)
855-483-1438

Davis
530-752-1774

Business Travel Accident
ucal.us/businesstravel
Disability—Basic, Voluntary Short-Term,
Voluntary Long-Term (Lincoln Financial)
800-838-4461 (claims) mylincolnportal.com

Health, Limited Purpose andDavis Health916-734-8099
Irvine949-824-0500
Irvine Health949-824-0500
Los Angeles
310-794-0830
Los Angeles Health310-794-0500
Merced209-355-7178
Office of the President
855-982-7284

Riverside
951-827-4766
San Diego858-534-2816
San Diego Health619-543-3200
San Francisco
415-476-1400
San Francisco Health415-353-4545
Santa Barbara
805-893-2489
Santa Cruz831-459-2013
Lawrence Berkeley
National Lab
510-486-6403
ASUCLA
310-825-7055
UC Law San Francisco(formerly UC Hastings)
415-565-4703

ChapterWelcome
Title
to UC

Welcome to the University of California!
As a University of California employee, you help shape the qualityof life for people throughout California and around the world.
Every faculty and staff member plays an important role in UC’s
mission of education, research and public service; UC’s high-quality,
comprehensive benefits are among the rewards you receive in return.
These benefits are an important part of your total compensation.
Our health and welfare benefits program provides both choice andvalue to meet the needs of our diverse workforce.
We know that making benefits choices can be a bit overwhelming.
So we have tools and information to help you make the right choices
for you and your family.
This booklet offers a comprehensive overview of your healthand welfare benefits options, including details about eligibility,
enrollment and the plans available to you. It also explains howchanges in your life and in your employment status can affect yourbenefits. Keep this booklet, and Your Benefits at a Glance (included
in your Welcome Kit), for future reference.
UCnet (ucnet.universityofcalifornia.edu) offers additional tools andinformation, along with ongoing updates about your benefits. Visit
UCnet whenever you have questions about your benefits or want tomake changes. You can also call your local Benefits Office or any ofthe plans. You’ll find their contact information on the insert at thefront of this booklet.
The information in this booklet reflects the terms of the benefit plans as in effect Jan. 1, 2024. Please note that this is a summary of your benefits only; additional
requirements, limitations and exclusions may apply. Refer to applicable plan documents and regulations for details. The applicable policy issued by the carrier and the
University of California Group Insurance Regulations and other applicable UC policies will take precedence if there is a difference between the provisions therein and thoseof this document.
1Chapter Title

2ChapterTable
Titleof Contents

Table of Contents

General Eligibility Rules for UC Health andWelfare Benefits .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Enrollment .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Medical Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Dental Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Vision Plan .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Accident, Critical Illness and Hospital Indemnity .. . . . . . . . . . . . . . . . . . . . . . 29
Disability Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Basic and Voluntary Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Life Insurance .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Basic and Core Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Supplemental Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Dependent Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Accidental Death and Dismemberment Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Business Travel Accident Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Adoption Assistance Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Legal Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Pet Insurance .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Family Care Resources .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Flexible Spending Accounts .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Health Flexible Spending Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Dependent Care Flexible Spending Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Legal Notices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Participation Terms and Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
HIPAA Notification for Medical Program Eligibility .. . . . . . . . . . . . . . . . . . . . . . . . 52
Notice Regarding Administration of Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

3

4

UC offers three benefits packages for faculty and staff — Full,
Mid-Level and Core. Your eligibility for a particular benefits
package depends on the type of job you have, the percentage oftime you work and the length of your appointment.

REQUIREMENTS FOR EMPLOYEES IN PER DIEM,CASUAL/RESTRICTED (STUDENTS), BY AGREEMENT AND
SEASONAL APPOINTMENTS

The eligibility requirements are listed below. See the chart on
pages 10 to 12 for a list of the benefits available to you, based on
the level of benefits for which you qualify.

You are eligible for Core Benefits if you are appointed to work atleast 75 percent time for at least three months.

REQUIREMENTS FOR EMPLOYEES IN CAREER,
ACADEMIC, LIMITED, PARTIAL-YEAR CAREER, CONTRACT
AND FLOATER APPOINTMENTS
FULL BENEFITS
You are eligible for Full Benefits if you are an active UCRP
member, an active Savings Choice participant or have begun the
90-day election period during which you can choose between
Pension Choice and Savings Choice.1
There are two ways to qualify for these primary retirement
benefits:• You are appointed to work in a retirement-eligible position atleast 50 percent time for a year or more2 or• You complete 1,000 hours in a retirement-eligible position
within a rolling 12-month period (750 hours in certain
instances3).
MID-LEVEL BENEFITS
You are eligible for Mid-Level Benefits if:• You are appointed to work 100 percent time for at least threemonths but for less than one year or• You are appointed to work at least 50 percent time for a year
or more in a position that does not qualify you for the primary
retirement benefits noted above.

CORE BENEFITSELIGIBLE FAMILY MEMBERS
You may enroll one eligible adult family member in addition
to yourself. Your children are also eligible for enrollment as
outlined below.
ELIGIBLE ADULT
You may enroll your spouse or an eligible domestic partner. 4
No declaration form or documentation is needed to initiallyenroll your domestic partner, but you will be asked to submit
documentation after enrollment (see “Supporting
Documentation” in Benefits for Domestic Partners) to establish
ongoing eligibility for health and welfare benefits. To be eligiblefor health and welfare benefits, your domestic partnership mustmeet one of the following requirements:• Registered with the State of California or other valid
jurisdiction OR• Able to meet the requirements on page 13 for a partnershipthat has not been registered, with appropriate supporting
documentation upon request
Please note: Enrolling your domestic partner in health benefits
and successfully completing the eligibility verification process
will establish your partner as your survivor for UC Retirement
Plan benefits, subject to additional eligibility requirements.

CORE BENEFITS
You are eligible for Core Benefits if you are appointed to work atleast 43.75 percent time.
In a few specifically defined situations, UC employees may be eligible toparticipate in UC health and welfare benefits while being enrolled in a non-UC
retirement plan. Eligible employees may have been covered by entities that wereacquired by the University and/or they may have opted to remain in a previous
public retirement plan at the time of UC employment.
2
Or your appointment form shows that your ending date is for funding purposes
only and that your employment is intended to continue for more than a year.
3
If you’re a member of the Non-Senate Instructional Unit, you qualify forparticipation in the Retirement Choice Program after working 750 hours in an
eligible position within a 12-month period.
4
An adult dependent relative is not eligible for coverage in UC plans unless
enrolled prior to Dec. 31, 2003 and continuously eligible and enrolled since that
date. Also, remember: If your eligible adult dependent relative is still enrolled in
the plan, you cannot enroll your spouse or domestic partner. The eligible adult
may be enrolled only in the same plans as you. See the chart on page 10 for
more information on eligible plans.

1

5

ChapterGeneral
Title Eligibility Rules for UC Health and Welfare Benefits

General Eligibility Rules for UC Health and Welfare BenefitsChapterGeneral
Title Eligibility Rules for UC Health and Welfare Benefits

General Eligibility Rules for UC Health and Welfare Benefits

ELIGIBLE CHILD
You may enroll your eligible children up to age 26 in the sameplans as those in which you enroll. A disabled child may becovered past age 26, if the disability is verified by the carrier or aphysician. You may also enroll your legal ward up to age 18 in thesame plan(s) as those in which you enroll. The Family Member
Eligibility chart on pages 13 and 14 gives the eligibility criteria
for children, stepchildren, grandchildren, disabled children andlegal wards. You may enroll your eligible domestic partner’s childor grandchild, even if you do not enroll your partner.
In order to be eligible for UC-sponsored coverage, yourgrandchild, step-grandchild, or legal ward (see Family Member
Eligibility chart) must be claimed as a tax dependent by you or
your spouse. Your eligible domestic partner’s grandchild must
be claimed as a tax dependent by you or your domestic partner.
Also eligible are children UC is legally required by administrative
or court order to provide with group health coverage.
Overage disabled children must be claimed as a tax dependentby either you or your spouse/domestic partner. If overage
disabled children are not claimed as a dependent for income tax
purposes, the overage disabled child must be eligible for Social
Security income or Supplemental Security Income (SSI) as adisabled person or work in supported employment which may
offset the Social Security or SSI.
Your children (or legal ward) are eligible for only the plans forwhich you are eligible and in which you have enrolled (See
“Benefits Overview,” pages 10–12).
Except as provided in the following paragraph, application forcoverage beyond age 26 due to disability must be made to theplan 60 days prior to the date coverage is to end due to thechild reaching limiting age. If application is received within thistimeframe but the plan does not complete determination of thechild’s continuing eligibility by the date the child reaches theplan’s upper age limit, the child will remain covered pending theplan’s determination. The plan may periodically request proof
of continued disability, but not more than once a year after the
initial certification. Disabled children approved for continued
coverage are eligible to participate in university-sponsored
medical, dental, vision, accident, critical illness, hospital
indemnity, legal, dependent life and AD&D plans for faculty andstaff. If enrollment is transferred from one UC plan to another, a
new application for continued coverage is not required; however,the new plan may require proof of continued disability, but not
more than once a year.
If you are a newly hired employee with a disabled child over age
26 or if you acquire a disabled child over age 26 (throughmarriage, adoption or domestic partnership), you may also apply
for coverage for that child. The child’s disability must have begun
prior to the child turning age 26. Additionally, the child must have
had continuous group health coverage since age 26. The plan will
6

ask for proof of continued disability, but not more than once a
year after the initial certification.
TAX IMPLICATIONS OF ENROLLING A DOMESTIC PARTNER
In most cases, your domestic partner and your partner’s children
do not automatically qualify as your dependents under theInternal Revenue Code (IRC). That means any UC contribution
toward their medical, dental and vision coverage will beconsidered “imputed income” or taxable income for federal tax
purposes. This income is reflected in your annual W-2 statement.
If your domestic partner and partner’s children or grandchildren
are your dependents as defined by the IRC, you are not subject
to imputed income on UC contributions toward health coveragefor these family members.
In order for your payroll records to accurately reflect this tax
dependency, you’ll need to report it to UC. Indicate the tax
status of your partner and/or partner’s children on UCPath when
you enroll them in benefits.
UC’s contribution for medical, dental and vision coverage is
not considered imputed income for California state income tax
purposes if you and your domestic partner have registered yourpartnership with the state of California. Also, if your partner’schild is considered your stepchild under state law, federal
imputed income will not apply to UC’s contribution toward thechild’s coverage.
If your domestic partner is covered as your family member andthe two of you marry, be sure to update your information in
UCPath so that imputed income and state taxes no longer apply.

OTHER ELIGIBILITY RULES AND INFORMATIONNO DUPLICATE COVERAGE
UC rules do not allow duplicate coverage. This means you may not
be covered in UC-sponsored plans as an employee and as an eligible
family member of a UC employee or retiree at the same time.
If you are covered as an eligible family member and then become
eligible for UC coverage yourself, you have two options:• You can opt out of your own employee coverage and remaincovered as another employee’s or retiree’s family member or• You can enroll in your own coverage; before you enroll,though, you must make sure the UC employee or retiree
who has been covering you disenrolls you from his or her
UC‑sponsored plan.
Family members of UC employees may not be enrolled in morethan one UC employee’s plan. For example, if spouses both workfor UC, their children cannot be covered by both parents.

ELIGIBILITY VERIFICATION
When you enroll anyone in a plan as a family member, youmust provide documentation specified by the University
verifying that the individual(s) you have enrolled meet theeligibility requirements outlined above. The plan may also
require documentation verifying eligibility status. In addition,
the University and/or the plan reserve the right to periodicallyrequest documentation to verify the continued eligibility ofenrolled family members.
UnifyHR, which administers the family member eligibility
verification process, will send you a packet of materials to help
you complete the verification process. If you fail to provide therequired documentation by the deadline specified in thesematerials, your family member(s) will be disenrolled until
verification is provided (upon verification, re-enrollment isprospective, not retroactive). Individuals who are not eligible
family members will be permanently disenrolled.
You also may be responsible for any UC-paid premiums due toenrollment of ineligible individuals.

WHEN COVERAGE BEGINS
The following effective dates apply provided the appropriate
enrollment transaction (electronic or paper form) has been
completed within the applicable enrollment period.

If you are already enrolled in adult plus child(ren) or family
coverage, you may add additional children, if eligible, at any timeafter their PIE.

CONTINUING ELIGIBILITY
UC bases your ongoing eligibility for benefits on your average
hours of service5 over a 12-month, standard measurement
period (SMP). UC’s SMP for monthly-paid employees isNov. 1–Oct. 31; for bi-weekly paid employees, the SMP includes
the pay periods inclusive of those same dates (for example, in
2024, it runs from Nov. 6, 2023, until Nov. 5, 2024).
If your hours during the SMP meet the threshold to be offeredcoverage, then that coverage must be offered, and if accepted,
will be provided during the subsequent stability period,
regardless of your number of hours during the stability period(as long as you remain employed). UC’s standard stability period
for all employees is Jan. 1–Dec. 31.
If your hours during the SMP do not meet the threshold, then all
coverage ends on Dec. 31.
The required average hours of service threshold is:
Appointment Type

Average Hours Threshold

Career, Academic, Limited, Partial-Year
Career, Contract, Floater

17.5 hours per week

Per Diem, Casual/Restricted (students),
By Agreement or other flat-dollar
payments, Seasonal

30 hours per week

• If you enroll during a Period of Initial Eligibility (PIE), coveragefor you and your family members is effective the date the PIE
starts.
• If you enroll during Open Enrollment, the effective date ofcoverage is the date announced by the University. In mostcases, it is the Jan. 1 following Open Enrollment.
• If you complete a 90-day waiting period for medical coverage,such coverage is effective on the 91st consecutive calendar
day after the date the enrollment form is received.
FAMILY MEMBERS
When you have a family status change, coverage begins on thefirst day you have a new family member — such as a spouse,domestic partner, newborn or newly adopted child. However,
if you request to change to a different medical plan at the time
you add a new family member, coverage under the new plan iseffective the first of the following month for all family members.

5

Defined as all hours on pay status (including hours on call, hours on paidvacation, paid holiday, paid sick leave, paid sabbatical, paid jury duty, or any
other paid leave) as well as hours on unpaid leave protected by the federal
Family & Medical Leave Act, unpaid jury duty, and unpaid leave protected by the
Uniformed Services Employment & Reemployment Rights Act. May also include
up to 501 hours during the SMP due to “employment break periods” of at least
4 consecutive weeks (e.g., academic breaks, etc.).

7

ChapterGeneral
Title Eligibility Rules for UC Health and Welfare Benefits

If duplicate enrollment occurs, UC will cancel the plan withlater enrollment. UC and the plans reserve the right to collectreimbursement for any duplicate premium payments due to the
duplicate enrollment.

General Eligibility Rules for UC Health and Welfare Benefits

General Eligibility Rules for UC Health and Welfare Benefits

WHEN COVERAGE ENDS
The termination of coverage provisions established by the
University are summarized below.
DISENROLLMENT DUE TO LOSS OF ELIGIBLE STATUS
If you are an employee and lose eligibility, your coverage andthat of any enrolled family members ends at the end of themonth in which eligible status is lost. See pages 48-49 for rules
pertaining to Flexible Spending Accounts.
OTHER DISENROLLMENTS
If you are enrolled in a health and welfare plan that requires
premium payments, and you do not continue payment, yourcoverage will be terminated at the end of the last month forwhich you paid.
You and/or your family members may be disenrolled if you and/or a family member misuse the plan, as described in the Group
Insurance Regulations. Misuse includes, but is not limited to,actions such as falsifying enrollment or claims information;
allowing others to use the plan identification card; intentionallyenrolling, or failing to disenroll, individuals who are not/no longer
eligible family members; threats or abusive behavior toward plan
providers or representatives.
LEAVE OF ABSENCE, LAYOFF, CHANGE IN EMPLOYMENTSTATUS OR RETIREMENT
Coverage may end when you go on unpaid leave or leave UC
employment. For information about continuing your coveragein the event of an authorized leave of absence, layoff, changeof employment status or retirement, contact the person who
handles benefits for your location.
FAMILY CHANGES THAT RESULT IN LOSS OF COVERAGE
If your family member loses eligibility, you must complete theappropriate transaction to remove him or her from coverage
within 31 days of the eligibility loss event.
Divorce, legal separation, termination of domestic
partnership, annulment. Eligibility for your spouse or domestic
partner and any children for whom you are not the legal parent/
guardian ends on the last day of the month in which the event
occurs. Your legally separated spouse, former spouse or former
domestic partner and the former partner’s child or grandchild
may continue certain coverage under COBRA (Consolidated
Omnibus Budget Reconciliation Act of 1985) or they may
seek individual coverage, including through the health caremarketplace (coveredca.com). If a settlement agreement
between you and your legally separated/former spouse ordomestic partner requires you to provide coverage, you must do
so on your own.

8

An eligible child turning age 26. Unless a child is eligible tocontinue coverage because of disability, coverage ends at theend of the month in which the child reaches age 26. This rule
applies to your biological and adopted children, stepchildren,
grandchildren, step-grandchildren and your domestic partner’schildren or grandchildren. Certain coverage may be continued
under COBRA or they may seek individual coverage, including
through the health care marketplace (coveredca.com).
A legal ward turning age 18. Eligibility ends at the end of
the month in which the legal ward turns 18. Your legal ward
may continue certain coverage under COBRA or they may
seek individual coverage, including through the health caremarketplace (coveredca.com).
Death of a family member. Coverage for the family member
ends the last day of the month in which the death occurs. It
is important to contact your local Benefits Office for further
assistance in the event of an enrolled family member’s death.
CONTRACT TERMINATION
Health and welfare benefits coverage is terminated when the groupcontract between the University and the plan vendor is terminated.
Benefits will cease to be provided as specified in the contract andyou may have to pay for the cost of those benefits incurred after
the contract terminates. You may be entitled to continued benefits
under terms described in the plan evidence of coverage booklet. (Ifyou apply for an individual conversion plan, the benefits may not
be the same as you had under the original plans.)
OPPORTUNITIES FOR CONTINUATION
If you separate from UC employment, generally, yourUC-sponsored benefits will stop. If you retire from UC, see
the Group Insurance Eligibility Fact Sheet for Retirees and Eligible
Family Members (available on the UCnet website at
ucnet.universityofcalifornia.edu/forms/pdf/group-insuranceeligibility-factsheet-for-retirees.pdf) for more details.
COBRA (Consolidated Omnibus Budget Reconciliation Act
of 1985): If you or any family member(s) lose eligibility for
UC-sponsored medical, dental and/or vision coverage, you may
be able to continue group coverage through COBRA.
If you are enrolled in the Health Flexible Spending Account (FSA)
and you leave UC employment during the plan year, you may beable to continue your participation under COBRA through theend of the current plan year (Dec. 31) by making direct, after-tax
payments to your account.
If you lose eligibility, the COBRA administrator will send you a“Qualifying Event Notice,” which explains the procedure forcontinuing your participation. If your family member loses
eligibility, you must request a COBRA package through UCPath.
More information about COBRA continuation privileges isavailable online at ucal.us/COBRA or from your Benefits Office.

General Eligibility Rules for UC Health and Welfare Benefits

Conversion/Portability: Within 31 days after UC-sponsoredcoverage ends (if your participation has been continuous), you
may be able to convert your group coverage to individual
policies or continue (“port”) your group coverage. See thespecific plan sections which follow for details.

FOR MORE INFORMATION• Participation Terms and Conditions on page 51• Benefits for Domestic Partners• Your local benefits officeAlso, you may wish to contact the California Department ofManaged Health Care at dmhc.ca.gov or 888-466-2219 todetermine whether you are eligible for HIPAA Guaranteed Issue
individual plan coverage or Covered California, California’s healthinsurance marketplace, at coveredca.com or 800-300-1506 toreview options for purchasing individual plan coverage.

ELIGIBILITY FOR STATE PREMIUM ASSISTANCE
If you are eligible for health coverage from UC, but cannot afford
the premiums, some states have premium assistance programs
that can help pay for coverage from their Medicaid or Children’s
Health Insurance Program (CHIP) funds.
If you live in California, you can contact the California Medicaid(Medi-Cal) office for further information via email (HIPP@dhcs.
ca.gov) or visit their website (dhcs.ca.gov). If you live outside
California, go online to ucal.us/chipra for a list of states thatcurrently provide premium assistance. You can also contact the
U.S. Department of Health and Human Services, Centers for
Medicare & Medicaid Services at cms.hhs.gov; 877-267‑2323.

9

Premium Paid By

AnytimeWith SOH²

Automatic

90-Day Wait¹

During OE

During PIE

When You May Enroll

Core

Mid-Level

HEALTH CARE

Full

Benefits Packages

Benefits Overview

Benefits Overview

Medical³
Choice of various options depending on your address, including healthmaintenance organization (HMO), preferred provider organization (PPO) ora PPO with a health savings account. See page 19.

• •

• • •

You
and
UC

Medical — CORE
Fee-for-service plan with no employee premium and a $3,000 individual
deductible. See page 19.

• • •

• • •

UC

Dental³
Choice of two plans: Delta Dental PPO, a fee-for-service plan, or DeltaCare® USA,a dental HMO (network available in California only). Both cover preventive, basic
and prosthetic dentistry, as well as orthodontics. See page 24.

•

• •

UC

Vision³
Plan covers a variety of vision care services including eye exams, corrective lenses
and frames. See page 28.

•

• •

UC

Accident, Critical Illness and Hospital Indemnity
These plans are designed to complement medical and disability benefits, but
are not a replacement for them. Plans pay cash benefits directly to you if you
experience a covered accident, illness or hospital stay.

• • •

• •

You

DISABILITY INSURANCE
Basic Disability4
Provides basic coverage when unable to work due to pregnancy/childbirth or due toa disabling injury or illness not related to work. Pays 55% of eligible earnings for up
to six months ($800 monthly maximum), after a waiting period. See page 31.

• • •Voluntary Short-Term4 and/or Voluntary Long-Term Disability5
Provides short-term and/or long-term coverage for disabilities that are not related
to work, such as pregnancy/childbirth, injury or illness. Supplements employer-paid
Basic Disability and other sources of disability income you may receive (e.g.,Workers’ Compensation or Social Security), up to 60% of eligible earnings ($15,000
maximum monthly benefit). Enroll in Voluntary Short-Term Disability, VoluntaryLong-Term Disability or both. See page 31.

• • •Workers’ Compensation
Provides state-mandated coverage for work-related injuries.

• • •

•

•

UC

•
•

You

UC

PIE: Period of Initial Eligibility OE: Open Enrollment SOH: Statement of Health
The 90-day waiting period is available when the PIE is missed. See page 19. You
may need to pay part of your premiums on an after-tax basis.
2
If you do not enroll during the PIE, you may apply for coverage by submitting anevidence of insurability/statement of health. The carrier may or may not approveyour enrollment based on medical information in your application.
3
When you enroll in any UC-sponsored medical, dental or vision plan, you will not
be excluded from enrollment based on your health, nor will your premium or level1

10of benefits be based on any genetic information or pre-existing health conditions.
The same applies to your eligible family members.
4
Employees are not covered under California State Disability Insurance for periodof employment at UC.
5
If you have a pre-existing condition which causes you to be disabled in your firstyear of coverage, your Voluntary Long-Term Disability benefits will not be payable.
For more information, see the insurance carrier’s summary plan description andYour Guide to UC Disability Benefits.

Basic Life
Provides employees eligible for Full Benefits with life insurance equal to annual
base salary, up to $50,000. Coverage is adjusted if appointment is less than
100% time. See page 34.
Core Life
Provides employees eligible for Core or Mid-Level Benefits with $5,000 of life
insurance. See page 34.

•• •Premium Paid By

AnytimeWith SOH

Automatic

90-Day Wait

During OE

During PIE

When You May Enroll

Core

Mid-Level

Full

Benefits Packages

Benefits Overview

LIFE AND ACCIDENT INSURANCE

•

UC

•

UC

Supplemental Life
Provides employees with additional life insurance at group rates. Coverage up to
four times annual salary (to $1,000,000 maximum). See page 35.

• •

•

•

You

Basic Dependent Life (Spouse/Domestic Partner)
Provides $5,000 of coverage. See page 37.

• •

•

•

You

Basic Dependent Life (Child/ren)
Provides $5,000 for each child. See page 37.

• ••Expanded Dependent Life (Spouse/Domestic Partner)
Coverage for 50% (up to $200,000) of employee’s Supplemental Life amount.
See page 37.

• ••Expanded Dependent Life (Child/ren)Covers each child for $10,000. See page 37.

• •

•

•

You

Accidental Death & Dismemberment (AD&D)
You may enroll at any time. Provides up to $500,000 protection for employee andfamily for accidental death, loss of limb, sight, speech or hearing, or for complete
and irreversible paralysis. See page 39.

• • •

•

•

You

Business Travel Accident
Provides up to $500,000 of coverage when an employee travels on official UC
business. See page 41 for enrollment instructions.

• • •

•
•

You

You

UC

OTHER BENEFITS
Adoption AssistanceNo enrollment is required; see page 42.

• • •

•

Legal
Provides basic legal assistance for consultation/representation, domestic, consumer
and limited defensive legal services and identity theft benefits. See page 43.

• • •Pet Insurance
You may enroll at any time; see page 45.

• • •

•

You

Automobile and Homeowner
You may enroll at any time, subject to underwriting approval from the insurer.
Call 866-700-3113 for details.

• • •

•

You

Family Care Resources
Provides access to prescreened caregivers, pet sitters, tutors and other family
services. You may enroll at any time; see page 46.

• • •

•

You

UC

• •

You

11

Pretax Salary Reduction

AnytimeWith SOH

Automatic

90-Day Wait

During OE

During PIE

When You May Enroll

Core

Mid-Level

Full

TAX-SAVINGS PROGRAMS

Benefits Packages

ChapterBenefits
Title Overview

Benefits Overview

General Purpose Health Flexible Spending Account (Health FSA)
Lowers taxable income by allowing payment for up to $3,050 of eligible out-ofpocket health care expenses on a pretax basis. Can be paired with any UC medical
plan other than UC Health Savings Plan. See page 47.

• • •

• •

•

Dependent Care Flexible Spending Account (DepCare FSA)
Lowers taxable income by allowing payment for up to $5,000 (or $3,000 if considereda “highly compensated employee” by the IRS; $2,500 if married and filing a separate
income tax return) of eligible dependent care expenses on a pretax basis. See
page 48.

• • •

• •

•

Health Savings Account (HSA) — Paired with UC Health Savings Plan
You and UC contribute to the HSA, up to the limits set each year by the IRS — for2024, this limit is $4,150 for individual coverage and $8,300 for family coverage.
People age 55 and over can make an additional “catch-up” contribution of $1,000.
Can only be paired with UC Health Savings Plan. See page 47.

• •

• •

•

PIE: Period of Initial Eligibility OE: Open Enrollment SOH: Statement of Health12Legal Spouse1

Legal

AD&D

Dependent Life

Accident, Critical Illness
and Hospital Indemnity

VisionDentalMedicalMay enroll in

Eligibility

ChapterBenefits
Title Overview

ELIGIBLE FAMILY MEMBERS

Eligible• • • • • • •Eligible• • • • • • •To age 26• • • • • • •To age 26• • • • • • •To age 18• • • • • • •Domestic Partner
A domestic partnership is eligible if it is:• Registered with the state of California or• A valid union, other than a marriage, entered into in another jurisdiction and recognizedin California as substantially equivalent to a California registered domestic partnership or• Unregistered, but meets all of the following criteria:– Parties must be each other’s sole domestic partner in a long-term, committed
relationship and must intend to remain so indefinitely– Neither party may be legally married or be a partner in another domestic partnership– Parties must not be related to each other by blood to a degree that would prohibit legal
marriage in the State of California– Both parties must be at least 18 years old and capable of consenting to the relationship– Both parties must be financially interdependent– Parties must share a common residence
Biological or adopted child, stepchild, domestic partner’s child2
Grandchild, step-grandchild, domestic partner’s grandchild2• Unmarried• Living with you• Supported by you or your spouse/domestic partner (50% or more)• Claimed as a tax dependent by you or your spouse/domestic partner
Legal ward
• Unmarried• Living with you• Supported by you or your spouse/domestic partner (50% or more)• Claimed as your tax dependent• Court-ordered guardianship required1
2

A legally separated or divorced spouse is not eligible for UC-sponsored coverage.
Domestic partner must be eligible for UC-sponsored health coverage.

13

LegalAD&D

Dependent Life

Accident, Critical Illness
and Hospital Indemnity

VisionDentalMedicalMay enroll in

ELIGIBLE FAMILY MEMBERS

Eligibility

ChapterBenefits
Title Overview

Benefits Overview

Overage disabled child (except a legal ward) of employee• Unmarried• Incapable of self-support due to a mental or physical disability incurred prior to age 26• Enrolled in a UC group medical plan before age 26 and coverage is continuous; if eligible
for enrollment in a UC plan after age 26 (during your PIE, qualifying life event or Open
Enrollment, or if you newly acquire a disabled child over age 26), the child must have had
continuous coverage since age 26• Chiefly dependent upon you, your spouse or eligible domestic partner for support (50%or more)• Claimed as your, your spouse’s or your eligible domestic partner’s dependent for income
tax purposes or eligible for Social Security income or Supplemental Security Income as adisabled person. The overage disabled child may be working in supported employmentthat may offset the Social Security or Supplemental Security Income• Must be approved by the carrier before age 26 or by the carrier upon initial enrollment

14

Age 26or older• • • • • • •Chapter Title

15

Enrollment

Enrollment

To be certain you get the benefits coverage you want, you should
enroll yourself and your eligible family members when you first
become eligible.
For step-by-step instructions on how to enroll, see Your
Benefits at a Glance, which you received in your Welcome Kit.

WHEN TO ENROLL
DURING A PERIOD OF INITIAL ELIGIBILITY (PIE)
A PIE is a time during which you may enroll yourself and/or youreligible family members in UC-sponsored health and welfareplans. A PIE generally starts on the first day of eligibility — forexample, the day you are hired into a position that makes you
eligible for benefits. It ends 31 days later.
You should enroll online and complete the transaction by thelast day of the applicable PIE. Paper enrollment forms areavailable and need to be received at the location noted on theform by the last day of the applicable PIE. (If the last day falls
on a weekend or holiday, the PIE is extended to the following
work day.)
You may enroll your eligible family members during the 31-day
PIE that begins on the first day the family member meets all
eligibility requirements. If your enrollment is completed during
your PIE, coverage is effective the date the PIE began.
The PIE to enroll newly eligible family members starts the day
your family member becomes eligible:• For a spouse, on the date of marriage.

• For an adopted child, the earlier of:– the date the child is placed for adoption with you, or– the date you or your spouse/domestic partner has the legal
right to control the child’s health care.
A child is “placed for adoption” as of the date you assume andretain a legal obligation for the child’s total or partial support
in anticipation of the child’s adoption.
If the child is not enrolled during the PIE beginning on thatdate, there is an additional PIE beginning on the date theadoption becomes final.
• For a legal ward, the effective date of the legal guardianship.
Where there is more than one eligibility requirement, the PIE
begins on the date all requirements are satisfied.
During this family member PIE, some plans allow you to also
enroll yourself and/or any other eligible family member who was
not already enrolled during an earlier PIE. See the plan-specificsections at the back of this booklet. Remember that family
members are only eligible for coverage in medical, dental, vision,accident, critical illness and hospital indemnity, legal, AD&D anddependent life coverage and must be enrolled in the same plansin which you are enrolled.

OTHER ENROLLMENT OPPORTUNITIES
If you don’t enroll in benefits during your initial 31-day periodof eligibility, you may be able to enroll yourself and your family
members in some plans at other times, including:• For a domestic partner, on the date the domestic partnershipis registered or the date that you verify that the partnership
meets UC’s criteria (see page 13).

OPEN ENROLLMENT• For a newborn child, on the child’s date of birth• Transferring to a different medical or dental plan

Usually held in the fall, Open Enrollment is your annual
opportunity to make changes to your benefits, including:• Adding or disenrolling eligible family members• Enrolling in or opting out of UC-sponsored medical, dental,
vision, accident, critical illness, hospital indemnity and legalplans• Enrolling or re-enrolling in the Health and Dependent Care
Flexible Spending Accounts
Meet ALEX!
Choosing benefits doesn’t have to be complicated. ALEX is aconfidential online tool that helps you select the best benefits
for you and your family.
Tell ALEX a little about yourself and get personalized guidance
for making the most of your UC benefits.
start.myalex.com/uc

16

Changes made during Open Enrollment are effective Jan. 1 of
the following year. Not all plans are available during every Open
Enrollment.

Enrollment

WHEN YOU HAVE A FAMILY CHANGE
When you have a new family member, such as a spouse, domestic
partner, newborn or newly adopted child, you may enroll yourself,
the new family member and any other eligible family members notalready enrolled in your UC-sponsored health plans. Other plans
have different rules; see the plan-specific sections in this guidefor details.
If you are enrolled in a UC-sponsored medical plan, you may
transfer to a different plan. (This change to a new medical plan
will go into effect the first day of the following month.) You
may also enroll in or increase your Legal insurance, Accident,
Critical Illness and Hospital Indemnity insurance, Supplemental
Life insurance and Dependent Life insurance during thiseligibility period (however, restrictions apply to Dependent Life
insurance). There is no opportunity to enroll in Voluntary
Short-Term or Voluntary Long-Term Disability insurance.

coverage under CHIP or Medicaid was lost because you/they
were no longer eligible for those programs.
• You properly file an enrollment form with the University
during the 31-day PIE which starts on the day after the othercoverage ends. Note that if you lose coverage under CHIP or
Medicaid, your PIE is 60 days. You may need to provide proofof loss of coverage.
OTHER SPECIAL CIRCUMSTANCES
For medical, dental and vision coverage, you may enroll without
waiting for the University’s next open enrollment period if you
are otherwise eligible under any one of the circumstances below:

You have 31 days from the date your new family member becomes
eligible to enroll the new member or to make any permitted planchanges (for example, 31 days from the day you marry or yourchild is born). You must enroll family members in your UCPathaccount; enrollment is not automatic.

• You or your eligible family members are not currently enrolled
in UC-sponsored medical, dental or vision coverage and youor your eligible family members become eligible for premium
assistance under the Medi-Cal Health Insurance Premium
Payment (HIPP) Program or a Medicaid or CHIP premium
assistance program in another state. Your PIE is 60 days fromthe date you are determined eligible for premium assistance.
If the last day of the PIE falls on a weekend or holiday, the PIE
is extended to the following work day if you are enrolling withpaper forms.

You will be required to complete the Family Member Eligibility
Verification process after enrolling the new family member. If
you do not respond by the given deadline, your new family
member may be disenrolled from the plans.

• A court has ordered the University of California to provide
coverage for a dependent child under your UC-sponsored
medical, dental or vision plan pursuant to applicable law. The
child must meet UC eligibility requirements.

WHEN YOU LOSE OTHER COVERAGE

IF YOU ARE A NEW FACULTY MEMBER

If you decline UC-sponsored coverage because you and/or yourfamily members are covered elsewhere, and you later lose theother coverage, you may be eligible to enroll yourself and/or
your eligible family members in a UC-sponsored plan. The sameis true if you are enrolled in another employer-sponsored planand the employer stops contributing to the cost of the coverage.

Newly appointed faculty members who don’t enroll within 31 daysof their start date have a second period of eligibility that begins
on the first day of classes for the semester or quarter in which theappointment starts or the first day the faculty member arrives atthe campus, whichever comes first.

For medical, dental and vision coverage, you may enroll without
waiting for the University’s next open enrollment period if you
have met all of the following requirements:• You were covered under another health plan as an individual
or dependent, including coverage under COBRA or CalCOBRA(or similar program in another state), the Children’s Health
Insurance Program or “CHIP” (called the Healthy Families
Program in California), or Medicaid (called Medi-Cal in
California).
• Coverage under another health plan for you and/or youreligible family members ended because you/they losteligibility under the other plan or employer contributions
toward coverage under the other plan terminated, coverage
under COBRA or CalCOBRA continuation was exhausted, orAppeals
Any appeals regarding coverage denials that relate toeligibility or enrollment requirements are subject to the
University of California Group Insurance Regulations. To
obtain a copy of the Eligibility Claims Appeal Process, pleasecontact the person who handles benefits for your location orvisit UCnet.

17

Chapter Title

18

ChapterMedical
Title Plans

Medical Plans

Benefits packages: Full, Mid-Level, Core

TRANSITIONING TO MEDICARE

Who’s covered: You and your eligible family members

If you continue working at UC past age 65 and you have a UCsponsored employee medical plan, you are not required to sign
up for Medicare Parts A, B or D. Any family member covered byyour employee plan, with the exception of your domestic partnerin some cases, who becomes eligible for Medicare may also defer
signing up for Medicare.

Who pays the premium: You and UC, for most plans
Medical coverage is one of the most important benefits that
UC offers you and your eligible family members, and UC makes
medical coverage as accessible and affordable as possible.
UC offers a range of high-quality medical plans withcomprehensive coverage so you can choose the coverage thatbest meets your needs.
You should carefully evaluate your family circumstances and plan
costs before selecting medical plan coverage. If you need more
information about a specific medical plan, you’ll find telephone
numbers and links to all the plans’ websites on the inside cover ofthis guide.
In addition to the general eligibility rules beginning on page 5
and plan eligibility rules found in each plan’s evidence ofcoverage booklet, the following rules and information apply to
UC medical plans.

If you and/or any covered family members lose eligibility for
the UC-sponsored employee plan, you and/or your Medicareeligible family members should immediately enroll in Medicare or
another employer group health plan to avoid any penalties fromthe Centers for Medicare and Medicaid Services (CMS).
If you plan to retire in 2024 and take a monthly retirement
benefit, are eligible for retiree health insurance and expect toenroll in Medicare during the year, think carefully about the UC
medical plan you choose. The choice you make will affect which
Medicare plan you’re transferred into when you turn 65. See
ucal.us/medicare for more information.

WHAT THE PLANS COVER
ELIGIBILITY
The medical plans you’re eligible for are based on whether youroverall benefits package is Full, Mid-Level or Core.
If you are eligible for coverage, you must take action to enroll.
You may enroll in certain medical plans only if you meet theplan’s geographic service area criteria.
If you or a covered family member is enrolled in Medicare,
you are not eligible for the UC Health Savings Plan due to IRS
rules that do not allow Medicare members to make or receive
contributions to a Health Savings Account.
WITH A 90-DAY WAITING PERIOD
If you miss your initial enrollment period, you may enroll yourself
and/or your family members in medical coverage at any time bysubmitting an enrollment form to your Benefits Office. Your
medical coverage will become effective 90 calendar days fromthe date your form is received. Your premiums will be paid on anafter-tax basis until the following Jan. 1.

UC’s medical plans provide comprehensive coverage, including
doctor visits, hospital services, prescription drugs and behavioral
health services. Preventive care such as physical exams andimmunizations are free of charge in all plans; some restrictions,such as using in-network providers, may apply.
There are no exclusions for pre-existing conditions.
An overview of the plans UC offers is on pages 20 to 22. The
chart on page 23 provides a comparison of the plans. Only UC
Health Savings Plan is compatible with a health savings account(HSA). Other UC medical plans can be paired with UC’s HealthFlexible Spending Account (FSA). See page 47 to learn more.

COST OF COVERAGE
Your medical plan’s monthly cost depends on:• The plan you choose• Whether you choose to cover yourself only or yourself andother family members and

IF YOU MOVE OUT OF A PLAN’S SERVICE AREA

• Your annual full-time equivalent salary from UC

If you move out of a plan service area, or will be away for morethan two months, you and your eligible family members must
transfer into a different plan available in your new location. If
you later return to your original location, you will have a Period
of Initial Eligibility during which you can re-enroll in your originalplan if you choose.

Premium costs are available online at ucal.us/medicalpremiums
and in Which Medical Plan is Right for You? included in yourWelcome Kit.If you enroll in a medical plan that requires you to
pay a premium, your premium is deducted from your paycheckeach month before taxes are calculated.

19

ChapterMedical
Title Plans

Medical Plans

Please note: Premium rates for certain employee groups mayvary from those posted or printed. If you are represented by aunion, your premiums are subject to collective bargaining. To
confirm your premiums, sign in to your online benefits accountor talk to your Benefits Office.

You must live (or work, depending on the plan’s rules) in theplan’s service area to be eligible. Service areas are established
by ZIP codes; you cannot use a P.O. box to establish eligibility.
If you want to know whether your ZIP code is in a plan’s service
area, check the plan’s website or call the plan directly.

HEALTH MAINTENANCE ORGANIZATIONS (HMO)

UC’s HMOs are available only if you and your covered family
members live and work in certain counties in California.

HMOs require you to choose a primary care physician (PCP) fromtheir network of providers to coordinate your care. To see a
specialist, you must have a referral from your PCP. The HMO
covers your expenses only if your PCP has authorized the services,
unless it’s an emergency. You pay a copayment for some products
and services, and there is no annual deductible.

Health Net is the administrator of medical, behavioral healthand pharmacy benefits for UC Blue & Gold HMO. Kaiser
Permanente — CA is the administrator of medical, behavioral
health and pharmacy benefits for Kaiser HMO. The
administrator of your plan processes claims, creates a network ofhealth care providers and pharmacies and sets clinical policies
and guidelines.

UC’S HMO PLANS
UC Blue & Gold HMO

Offers a tailored network of medical groups, doctors and hospitals, and includes all of UC’s medical centersand medical groups. For more information, see healthnet.com/uc.

Kaiser HMO

Offers a closed network, meaning you must use only Kaiser doctors and hospitals. For more information, seeselect.kp.org/university-of-california.

PREFERRED PROVIDER ORGANIZATIONS (PPO)
PPOs offer a broad network of providers and allow you theflexibility to see non-network providers if you wish. You don’t
need a referral to see specialists. Usually, you must meet theplan’s deductible and then you pay coinsurance, which is apercentage of the cost of services. You pay a smaller percentage
for in-network providers.

Anthem Blue Cross is the administrator of medical andbehavioral health benefits for UC’s PPO plans, and Navitus
Health Solutions (Navitus) is the administrator of prescription
drug benefits.
Contact Accolade Health Care Advocate for all member services,
including benefits and coverage questions.
UC’s PPOs are the best option if you or your covered family
members live outside California.

UC’S PPO PLANSUC Health Savings Plan with
Health Savings AccountThis is the only UC medical plan paired with a Health Savings Account (HSA), which you can use to pay youreligible medical expenses. UC contributes to the HSA every year you are enrolled in the plan, and you can,too — federal tax-free. You pay the cost of medical services until you meet the deductible, then you pay apercentage of the cost of services, with lower costs when you use in-network providers. Your unused HSA
funds roll over each year (funds are not use-it-or-lose-it). And, any funds you or UC contributes to your HSA
are yours to keep, even if you leave UC. You can continue to contribute to your HSA as long as you areenrolled in a qualifying high deductible health plan. For more information, see uchealthplans.com andlearn.healthequity.com/uc/hsa

UC CareThis is a PPO plan with three tiers of doctors and hospitals. If you use providers in the UC Select Network,
which includes UC medical center doctors, hospitals and other facilities as well as select providers near UC
locations without a medical center, you pay copayments for services. If you use other providers in the
Anthem Preferred network, you pay 30 percent coinsurance once you’ve met the deductible. You pay ahigher deductible and a greater percent of the coinsurance if you use a provider outside the network. For
more information, see uchealthplans.com

CORE

This plan has no monthly employee premium, but has a higher deductible. You can choose any doctor, hospital,
clinic or behavioral health provider, but you pay less if you use a provider in the Anthem Blue Cross PPO
network. After you have met the plan’s annual deductible, the plan pays for part of the cost of services. If you
use non-network providers, you may need to pay for services up front and submit a claim; you receive
reimbursement if the plan covers the service. For more information, see uchealthplans.com

20ChapterMedical
Title Plans

ABOUT THE UC HEALTH SAVINGS PLAN (HSP) WITHHEALTH SAVINGS ACCOUNT (HSA)The Health Savings Account (HSA), which is part of the UC
Health Savings Plan (HSP), lets you pay for your out-of-pocket
health care expenses with pretax contributions from you andfederal tax-free contributions from UC.
With the HSA, administered by HealthEquity, you can use thefunds at any time for qualified medical expenses or save them for
future health care needs. Your HSA account balance rolls overannually; you keep the balance in the account, even if you don’t
use it or leave UC. You can use your HSA funds for qualifying
medical expenses without paying any federal taxes — whether you
pay with your HSA debit card or you pay out-of-pocket and file aclaim directly with HealthEquity to get reimbursed. You earninterest on your account, and can invest any funds in excess of$1,000 — the same way you invest funds in retirement savings
accounts, except interest accrues federal tax-free. Contributions
and earnings are subject to California income tax.
For 2023, the IRS allows HSA contributions up to $3,850 for
single/individual coverage and up to $7,750 for family coverage(if you are covering at least one family member), inclusive of UC
contributions. UC contributes up to $500 for individual coverage
and up to $1,000 for all other coverage levels, depending on theeffective date of your HSP coverage. You can also contribute withpretax payroll deductions, subject to payroll deadlines. You areresponsible for making sure the combined HSA contributions arewithin the IRS limits. Individuals age 55 and older can make an
additional “catch-up” contribution of $1,000. You can make theadditional contribution through your UCPath account. If you
enroll in the UC Health Savings Plan anytime after January,
UC’s contribution to your HSA will be prorated for thecalendar year. The proration schedule is available online(ucnet.universityofcalifornia.edu/compensation-and-benefits/
health-plans/medical/hsa-proration-schedule.html).
Because of IRS rules, you must enroll in the UC Health Savings
Plan and have a valid Social Security number and U.S. address tobe eligible for and establish your HSA. In addition, you and yourcovered family members cannot enroll in UC’s or in any
general-purpose Health Flexible Spending Account.
If you or your dependent(s) are enrolled in Medicare, covered under
TRICARE, or receiving Social Security Disability Insurance (SSDI),
you cannot enroll in this plan, according to the IRS. Due to the UC
contribution to your HSA, if you cover a family member and thefamily member is enrolled in Medicare, you cannot enroll in thisplan unless you disenroll your Medicare-enrolled family member
from your coverage. Remember that the entire UC contribution isdeposited automatically at the beginning of the year and is basedon your coverage level (individual or family).
Here are a few things to keep in mind if you become an HSP
member. As an HSA owner, you must decide:• Whether you are eligible to make contributions to an HSA• The amount of the eligible contribution to the HSA for any
calendar year
• The withdrawal of any excess contributions• How funds in your HSA will be spent
You cannot delegate these responsibilities to the University
or to HealthEquity. As the HSA owner, you are responsible forreporting all contributions and distributions to the IRS on yourForm 1040.

BEHAVIORAL HEALTH AND SUBSTANCE ABUSE BENEFITS
Kaiser members have access to Kaiser’s integrated behavioral
health services as well as Optum Behavioral Health in-network
services. Kaiser and Optum do not coordinate care or costs of
behavioral health services. Each plan has specific requirements.
Kaiser members should understand plan and authorization
guidelines when they consider their options for behavioral
health services.
UC Blue & Gold HMO members have behavioral health andsubstance abuse coverage provided by Managed Health
Network (MHN, a Health Net company).
The first three in-network outpatient mental health office visits
are covered at no cost to you for UC Blue & Gold and Kaiser
members.
Behavioral health and substance abuse coverage is provided by
Anthem Blue Cross for employees and retirees enrolled in:• CORE• UC Care• UC Health Savings Plan (HSP)
The first three in-network mental health office visits are covered at
no cost to you for UC Care.
If you enroll in CORE, UC Health Savings Plan or UC Care, youhave access to both in-network and out-of-network behavioral
health services. All other plans have in-network benefits only.

UC LIVING WELL PROGRAM
UC is committed to the well-being of employees and theirfamily members and supports healthy living through thesystemwide UC Living Well program.
UC Living Well offers faculty, staff and retirees access to programs,
activities and resources that support healthy lifestyles.

21

ChapterMedical
Title Plans

Medical Plans

UC Living Well includes:• Campus and health system wellness activities• Programs and support from UC’s benefits providers• Preventive exams and screenings through UC’s health plans• Disease management programs offered by UC’s medical plans
to help manage chronic conditions such as diabetes and heartdiseaseParticipation in on-site campus and health system wellness
programs varies by location; contact your location’s wellness
coordinator for details.
For more information, visit the UC Living Well website(uclivingwell.ucop.edu).

You may be able to convert your coverage to an individual policy
if you apply within 31 days of the date your UC-sponsoredcoverage or COBRA continuation coverage ends. Conversion
options are generally more expensive and may provide fewer
benefits than UC-sponsored plans. See your medical plan
booklet or call your plan for more information. You may alsoseek individual coverage, including through the health caremarketplace (coveredca.com).

FOR MORE INFORMATION
Evidence of Coverage booklets for all of UC’s medical plans areavailable online at ucal.us/EOCs or from the carriers (see frontof booklet for contact information).
If you have other questions about your medical benefits, including
services, benefits, billing and claims, call the medical plan directly.

GENERAL INFORMATIONCHOOSING A PRIMARY CARE PHYSICIAN (PCP)
UC’s HMO plans require you to select a primary care physician(PCP). You may choose a different PCP for each family member orthe same PCP for the entire family. You may choose a pediatrician
as the PCP for your child(ren). If you use your work address toqualify for a plan, you must pick PCPs in the service area of yourwork address.
If you or your eligible family members do not select a PCP, your
medical plan will assign one to you. You may change your PCP at
any time by calling the plan directly.

TIPS:
If you want access to UC medical centers and doctors:• UC Health Savings Plan
• UC Blue & Gold HMO (if you are within service area)• UC Care• CORE
If you want lower monthly premiums:

If you want to receive care from a particular doctor, you should
call the plan or check the plan’s online doctor directory to confirm
that the doctor is in their network and accepting new patients.

• CORE• Kaiser HMO• UC Blue & Gold HMO

ID CARDS

If you want more flexibility in choosing doctors:

Once you enroll, the medical plan will send identification cards foryou and your enrolled family members. Although you’re covered
as soon as you enroll, it may take 30 to 60 days for the plan tohave a record of your membership and send your ID card(s). If you
need immediate services before you receive your card, first checkwith your plan to see if it has a record of your enrollment; if not,contact UCPath. You may also be able to download and print a
temporary card from your carrier’s website.
WHEN COVERAGE ENDS
Please note that if you lose eligibility for medical coverage while you
are hospitalized or undergoing treatment for a medical condition
covered by your medical plan, benefits will cease and you may haveto pay for the cost of those services yourself. If you or a family
member loses eligibility for medical coverage, you can, however,continue coverage under COBRA (Consolidated Omnibus Budget
Reconciliation Act of 1985) for a period of time. If you are laid off,you may transfer to UC’s lowest cost medical plan through COBRA.
22• UC Health Savings Plan with HSA• UC Care• CORE
If you want predictable costs:• UC Blue & Gold HMO• Kaiser HMO
If you reside or have a child in college outside California:• UC Health Savings Plan
• UC Care• CORE
If you want one doctor to manage all your care:• UC Blue & Gold HMO• Kaiser HMO

ChapterMedical
Title Plans

UC MEDICAL PLANSYour Costs for Services

Your Cost for
Prescription Drugs:
Generic/Brand/
Non-formulary

CORE
You may use any doctor, but you’ll
pay less if you use a network
provider.

$$$+

20%

UC Blue & Gold HMO
Must use custom networkof providers, except inemergencies

No deductible; you pay a
copay for office visits andhospital stays; most otherservices have no charge.

• Want to pay no monthly premium• Want protection for catastrophic care

Except for certain
preventive services, you
pay the full cost until you
reach the $3,000 individual
deductible. Then you pay
20%.
$

Best Fit for People Who:

• Are willing to risk incurring high out-of-pocket costs• Want direct access to many providers without needfor referrals (includes UC Health providers)

Retail (30-day supply)$5/$25/$40• Want low, predictable out-of-pocket costs at timeof service

Mail order (up to 90 days)$10/$50/$80• Are comfortable with HMO model: primarycare physician manages care; no out-of-network
coverage• Are content with the selection of community
providers (includes UC Health providers)

Kaiser HMO
Must use network providers,
except in emergencies$

UC CareMay use most doctors without
referral from a primary care
physician; you pay copayment for
UC Select Network providers;in-network providers cost lessthan out-of-network providers.

$/$$/$$$UC Health Savings Plan
May use most doctors without
referral from primary care
physician; in-network providers
cost less. Health Savings
Account (HSA) covers part ofannual deductible before PPO
coinsurance applies.

No deductible; you pay a
copay for office visits andhospital stays; most otherservices have no charge.

UC Select Network
providers: no deductible,and copay for office visits
and hospital stays; Anthem
Preferred providers:calendar year deductible
and then 30% coinsurance;out-of-network: calendar
year deductible and then
50% coinsurance.
$$
You have higher out-ofpocket costs until the
deductible is met; you pay
coinsurance thereafter.
You may make pretax
contributions to the Health
Savings Account to help
pay your out-of-pocket
costs.

Retail (30-day supply)$5/$25/NA• Want low, predictable out-of-pocket costs at timeof service

Mail order (31–100 days)$10/$50/NA• Appreciate the integrated care provided within the
Kaiser network

Retail (30-day supply)$5/ $25/ $40• Want direct access to many providers without areferral (includes UC Health providers)

Mail order (up to 90 days)$10/$50/$80• Want no deductible and fixed copay for using
providers in the UC Select network• Want coverage when you are traveling or living
abroad• You and/or your family members live outside
California

Full cost up to deductible;
then 20% at in-network
pharmacies; 40% at
non‑network pharmacies• Want broad access to providers• Are able to risk incurring greater out-of-pocket
costs• Want tax-free savings for current and future healthcare costs• Want direct access to many providers without needfor referrals (includes UC Health providers)$ Lowest costs in relation to all plans $$ Mid-range of costs in relation to all plans $$$ Highest costs in relation to all plans

23

ChapterDental
Title Plans

Dental Plans

Benefits packages: Full
Who’s covered: You and your eligible family members
Who pays the premium: UC
Proper dental care plays an important role in your overall health.
That’s why UC provides dental coverage for you and your family,
including routine preventive care and fillings, oral surgery,dentures, bridges and braces. You have a choice of two plans, a
PPO and an HMO.
The following rules and information about UC’s dental plans arein addition to the general eligibility rules beginning on page 5.

ELIGIBILITY
You are eligible to enroll in dental coverage only if you have Full
Benefits.
If you are eligible for dental benefits, you must take action toenroll.
You may enroll in DeltaCare® USA only if you meet the plan’sgeographic service area criteria.
IF YOU MOVE OUT OF A PLAN’S SERVICE AREA
If you move out of a DeltaCare® USA plan service area, you andyour eligible family members must transfer into a different plan
available in your new location. If you later return to your original
location, you will have a Period of Initial Eligibility to re-enroll in
the DeltaCare® USA plan if you choose.

UC’S DENTAL PLANS
DELTA DENTAL PPO
The Delta Dental PPO plan, available worldwide, provides you andyour family with the flexibility to choose any licensed dentist or
specialist. Your share of the cost of services depends on whether
you use a dentist in Delta Dental’s PPO network or an out-ofnetwork dentist.
If you choose a PPO dentist from Delta Dental’s network, youwill usually pay less for services, so it makes sense to use a PPO
dentist. In-network PPO dentists agree to accept a reduced fee
for services, and the dentist will complete and submit all claim
forms for you at no charge. Preventive dentistry (exams andcleanings) is free of charge. After a small deductible, basic
dentistry (such as fillings and extractions) is covered at 80
percent, and most other dental care is covered at 50 percent,
up to $1,700 per year.

24

Delta has more than 43,000 PPO dentists in California and270,000 nationwide. To see a list of Delta Dental PPO dentists,
visit the Delta Dental website: www1.deltadentalins.com/
group-sites/uc.html.
Delta’s Premier dentists are not in the PPO network but haveagreed to accept a reduced fee for services and also will complete
and submit claim forms for you. Delta Dental covers 75 percent
of basic dentistry costs if you use a Premier dentist, up to $1,500
per year.
If you go to a dentist not affiliated with Delta Dental, the plan will
cover 75 percent of allowed basic dentistry costs, up to $1,500
per year. However, you may have to pay the dentist’s total fee andthen submit your claim form to Delta Dental for reimbursement.
Non-Delta Dental dentists have not agreed to Delta Dental’s
allowed costs and are free to bill you for any difference between
what Delta Dental pays and the submitted fee.
DELTACARE® USA
DeltaCare® USA is a dental HMO that provides you and yourfamily with comprehensive benefits and easy referrals to
specialists. You must live in California to enroll.
Preventive services are provided at no cost. Other services areprovided for modest copayments with no deductibles or annual
plan maximum.
When you enroll, you select a network dentist to provide all
your basic dental services and to refer you to specialists whennecessary. The DeltaCare® USA network consists of privatepractice dental facilities that have been screened by Delta
Dental for quality. Some areas of California have more network
providers than others, so be sure there are dentists available inyour area before choosing this plan. You are required to obtaincovered services through your assigned network dentist, except
for emergency services or those preauthorized in writing by
Delta Dental.
You may change your dentist at any time by calling the Delta
Care Customer Service number to request the change. Visit
the DeltaCare® USA website (www1.deltadentalins.com/
group-sites/uc.html) for a list of participating dentists.

BENEFITS AND SERVICES
For a comparison of benefits and services, see the chart on
pages 25 to 27.
If you need major dental work, such as a crown, dentures or oral
surgery, you and/or your dentist should contact your plan to filea pre-determination before you begin treatment to confirm thatthe procedure is covered and to determine your portion of thecost for services.

ChapterDental
Title Plans

COST OF COVERAGE

FOR MORE INFORMATION

UC pays 100 percent of your monthly dental plan premium. UC’scontribution toward the monthly cost is determined by UC andmay change or stop altogether. You pay a certain percentage or
copayment for some services.

Evidence of Coverage booklets are available online atucal.us/EOCs.
If you have other questions about your dental benefits including
services, benefits, billing and claims, call the plan directly.
Delta Dental PPO
800-777-5854, www1.deltadentalins.com/group-sites/uc.html

WHEN COVERAGE ENDSOPPORTUNITIES FOR CONTINUATION
If you or a family member loses eligibility for dental coverage,
you can continue coverage under COBRA for a period of time.
There is no conversion option for dental coverage.

DeltaCare® USA
800-422-4234, www1.deltadentalins.com/group-sites/uc.html

DENTAL SERVICES

Delta Dental PPO Plan

DeltaCare® USA HMO Plan

Service Area

Worldwide1

California only

Preventive Dentistry

No deductible

Copayments apply as noted

Cleaning of teeth — prophylaxis cleanings

You are covered at 100% (up to 2 times in acalendar year; additional cleanings by report)

100% up to 2 times in any 12-month period;
additional cleanings when necessary: $45
copayment for adults, $35 copayment forchildren

Oral examinations

100% (limited to 2 per calendar year — routine,
non-routine or a combination of both; additionalroutine exam is covered for members withidentified risk factors)

100%

Emergency office visit for pain relief

100%

100%

Topical fluoride treatment

100% (includes cleaning; up to 2 times in acalendar year)

100% (up to 2 times in any 12-month period
through age 18)

Space maintainers

100% (through age 12)

100%

X-rays (full mouth, bitewings, other films)

100% (full mouth x-rays limited to 1 set in 5
years unless necessary)

100% (full mouth x-rays limited to 1 set in any
12-month period)

Pit and fissure sealants (under age 16 only)

100% PPO/75% Premier for first permanentmolars through age 9 and second permanentmolars through age 15

100% for first permanent molars through age 9
and second permanent molars through age 15

1

Nationwide — Delta Dental PPO, Delta Dental Premier and non-Delta
dentists (licensed); Worldwide — Coverage available only from non-Delta
dentists (licensed).

25

DENTAL SERVICES

Delta Dental PPO Plan

DeltaCare® USA HMO Plan

Basic Dentistry

Deductible applies.

Copayments apply as noted.

Fillings

80% PPO/75% Premier

100% for standard benefit

Anesthesia1

80% PPO/75% Premier (generalanesthesia for covered oral surgery)

Local — 100%. General and intravenous
sedation — 100%; limited to medically necessary
extractions

Prosthetic appliance repair

80% PPO/75% Premier

100%

Extractions

80% PPO/75% Premier

100% if uncomplicated (not covered if done only
for orthodontics)

Oral surgery

80% PPO/75% Premier$15 copayment for impactions; other covered
services at 100%

Endodontics

80% PPO/75% Premier$20–$60 copayment for each canal; other covered
services at 100%

Periodontics

80% PPO/75% Premier

Denture Relining and Rebase

80% PPO/75% Premier

Major Dentistry

Deductible applies.

Crowns

50%

Inlays/onlays

50%

TMJ Disorder Benefits
Temporomandibular joint (TMJ)
dysfunction: occlusal devices/occlusal
guards (night guards)

50% up to $500 for all benefits in a
lifetime (not applied to calendar year
maximum). Deductible applies.

100%

Prosthetic Dentistry

Deductible applies.

Copayments apply as noted.

Standard, full or partial dentures

50%

Upper — $65 copayment per denture

After an annual deductible of $50 per person2

ChapterDental
Title Plans

Dental Plans$100 copayment per quadrant for surgery(mucogingival and osseous gingival);$150 copayment for soft tissue graft procedures;periodontal maintenance: 100% for 1 in each
6-month period; additional maintenance whennecessary: $55 copayment
Relining — 100% (limited to 1 in any 12-month
period). Rebase — $20 copay
Copayments applied as noted.
$50 per unit copayment ($150 extra charge for
precious metals)
100% for standard benefit

Lower — $65 copayment per denture (extra charge
for precious metals)
Removable partial denture with flexible base —$115
Bridges

50%$50 per unit copayment (extra charge for precious
metals)

Implants50%

Not covered

Total Benefit(Total benefit for preventive, basic and major
dentistry, and prosthetic dentistry)$1,700 if a Delta Dental PPO dentist isused; otherwise $1,500 per person per
calendar year

No maximum

26

ChapterDental
Title

DENTAL SERVICES

Delta Dental PPO Plan

DeltaCare® USA HMO Plan

Orthodontics

No deductible

Copayments apply as noted below

Who is eligible for service

All covered family members

All covered family members

Benefit

50% copayment; maximum of $1,500 foreach eligible patient under age 26 and $500
for each eligible patient age 26 and older$1,000 copayment (plan covers 36 months ofusual and customary treatment — a monthly
office visit fee of $75 applies after the 36
months)Work in progress when you join

Only services that you receive on or after youreffective date of coverage are covered.

Only services received from a DeltaCare®
USA provider on or after your effective dateof coverage are covered3.

Predetermination of benefits

If services are expected to be $400 or more,
your dentist files a treatment plan first; Delta
reviews it and notifies you and your dentist of
the benefits payable.

Before any work is done, ask your DeltaCare®
USA dentist what the charges will be. If
you have any questions about what will becovered, call DeltaCare® USA.

Alternate treatment provision

If more than one professionally acceptable
and appropriate treatment can be used, Delta
benefits will be based on the least expensive
method.

If you select a treatment plan different fromthat customarily provided by DeltaCare® USA,you will pay the applicable copayment, plus
the additional cost of the alternate treatment.

Replacement of crowns, dentures, partial
dentures and bridges

Not covered if crown or prosthetic appliance isfewer than 7 years old

Not covered if crown or prosthetic appliance isless than 3 years old

Out-of-area emergencies

Coverage applies worldwide.

Plan pays up to $100 in 12-month period forpain relief when you are more than 25 miles
from your dentist’s office.

Teeth bleaching

Not covered$125 copayment per arch. External bleachingis limited to one bleaching tray per arch per
36-month period; bleaching gel for two weeks
of patient self treatment.

Tobacco counseling for prevention of oral disease

Not covered

100%

Special Provisions, Limitations, Exclusions

NOTE: Other limitations and exclusions may apply. See the Delta Dental or DeltaCare® USA booklet.

Disabled members may receive anesthesia for any covered dental service
if needed to receive treatment. Preauthorization is required.
2
Combined for basic and major dentistry, TMJ disorder benefits andprosthetic dentistry.
3
Exception: DeltaCare® USA may cover orthondontia treatment in progressfor new enrollees/family members if treatment meets specific DeltaCare®
USA criteria.

127ChapterVision
Title Plan

Vision Plan

Benefits package: Full
Who’s covered: You and your eligible family members
Who pays the premium: UC
UC provides the Vision Service Plan (VSP) to enable you and yourfamily to get the vision care you need. VSP is a preferred-provider
organization with more than 5,000 providers in California
and 33,000 nationwide in the Advantage network. The vision
plan has no exclusions for pre-existing conditions.

ELIGIBILITY
See the general eligibility rules beginning on page 5.

WHAT THE PLAN COVERS• One vision examination per calendar year — including testing
and analysis of eye health and any necessary prescriptions forlenses or contact lenses. You pay a $10 copay.
• One set of corrective lenses per calendar year — including
single vision, bifocal, trifocal, standard progressive or othercomplex glass or plastic lenses. Photo-chromatic lenses,
tints and polycarbonate lenses are fully covered if you use aprovider in the VSP network. You pay a $25 copay.
• One set of frames every other calendar year up to $160.
• Contact lens maximum benefit of $160; contact lens exam
is covered separately with a copay of up to $60. If you
choose elective contact lenses, you cannot also have frames
and corrective lenses covered in the same calendar year.
If contact lenses are medically necessary and you use a
VSP provider, the cost is fully covered. Generally, contacts
are covered for those who have had cataract surgery,have extreme acuity problems that cannot be correctedwith glasses or have some conditions of anisometropia or
keratoconus.
• You may also purchase annual supplies of select contact lenses
at a reduced cost. Talk to your VSP provider or see the VSP
website (vsp.com) for additional details.
• Discounts on laser corrective vision surgery through VSPcontracted laser centers. Call VSP for more information.
• Covered-in-full retinal screening for members with diabetes
who do not have diabetic eye disease. Additional exams
and services that track and monitor diabetic eye diseaseprogression, diagnose and monitor glaucoma and cataracts,
treatment for dry eye, pink eye, and foreign body removal.
You pay a $20 copay. Contact a VSP doctor for more
information.

28

If you use a VSP network doctor or provider, you pay only therequired copays for covered services and the cost of any services
or materials beyond the allowance. Additional discounts areavailable for services the plan doesn’t cover, including:• 20 percent discount on additional pairs of glasses, including
sunglasses, if purchased from the VSP doctor who provides
the member’s eye exam on the same day as the exam.
• 20 percent discount for additional pairs of prescription glasses
purchased within 12 months following the last covered eye
exam, if purchased from the VSP doctor who provided the exam.
• 15 percent discount for contact lens professional services; forexample, fittings or adjustments.

WHEN COVERAGE BEGINS
Please see “When Coverage Begins” on page 7 of the Eligibility
section.

COST OF COVERAGE
UC pays the full cost of the monthly vision plan premium. UC’scontribution toward the monthly cost of coverage is determined
by UC and may change or stop altogether.
You pay copays — $10 for a vision exam and, if you need glasses,$25 for materials. You also pay for additional care, services or
products that VSP does not cover.

WHEN COVERAGE ENDSOPPORTUNITIES FOR CONTINUATION
If you or a family member loses eligibility for vision coverage,
you can continue coverage under COBRA. There is no option forconversion to an individual plan for vision coverage.

FOR MORE INFORMATIONVSP website: vsp.com
VSP phone: 866-240-8344
VSP Evidence of Coverage Booklet, available online atucal.us/EOCs.

ChapterAccident,
Title
Critical Illness and Hospital Indemnity Plans

Accident, Critical Illness and Hospital Indemnity Plans

Benefits package: Full, Mid-Level, Core

COST OF COVERAGE

Who’s covered: You and your eligible family members,
depending on the coverage you selectYour cost depends on the plan(s) and level of coverage
you choose.

Who pays the premium: You
UC offers three supplemental insurance options — Accident,
Critical Illness and Hospital Indemnity plans that pay cash
benefits if you experience a covered accident, illness or hospital
stay.
These plans are not a substitute for medical or disability
coverage, but they can complement your coverage with extra
protection against the unexpected. Depending on the coverage
you select, you’ll receive a pre-determined cash payment if
you experience a covered incident — regardless of your actual
medical costs or lost income. The payment is yours to use
however you choose.

WHEN TO ENROLL
You may enroll for coverage during your PIE, following
a qualifying event, or during Open Enrollment. You candiscontinue your enrollment in Accident, Critical Illness andHospital Indemnity plans at any time.

WHEN COVERAGE ENDS
If you leave UC employment, you may continue your coveragethrough direct payment to Prudential (referred to as “porting”)
if you apply within 31 days of the date your UC-sponsoredcoverage ends.

EXCLUSIONS
See the Certificate of Insurance booklets for complete
information.

FOR MORE INFORMATION
Certificate of Insurance booklets are available online at
ucplus.com.
If you have other questions, call 888-212-7201 or visit
ucplus.com.

WHAT THE PLANS COVER
ACCIDENT INSURANCE
Pays cash benefits if you receive services related to an accident,such as ER and urgent care visits, ambulance rides, X-rays,
surgery, physical therapy and more.
CRITICAL ILLNESS INSURANCE
The plan provides a lump-sum payment if you are diagnosed
with certain critical illnesses, such as cancer, heart attack, stroke
and more. Rates are age-based and may differ for you and your
spouse or domestic partner. Coverage for eligible children is
free when you enroll. You select a coverage level of $10,000 or$30,000.
HOSPITAL INDEMNITY
Pays a pre-determined dollar amount if you’re admitted to thehospital due to an accident or illness, or for maternity care,and continues to pay a cash benefit for every day you’re in thehospital, up to 30 days.

29

Chapter Title

30

ChapterBasic
Titleand Voluntary Disability

Basic and Voluntary Disability

Benefits package: Full, Mid-Level or Core

WHEN COVERAGE BEGINS

Who’s covered: You

You must be actively at work in order for new or increased
coverage to be effective.

Who pays the premium: You and UC
Time away from work for a pregnancy, illness or unexpectedinjury could mean months without a paycheck. While UC’s basic
employer-paid disability insurance offers some protection — abenefit capped at $800 per month for six months — it probably
won’t be enough to cover your expenses. UC’s Voluntary
Disability Insurance replaces much more of your income —60 percent of your eligible pay up to a benefit of $15,000 per
month — for increased financial security when you need it most.
UC’s disability benefits, along with state-mandated Workers’
Compensation and Social Security disability benefits, create
a comprehensive safety net, whether for a few months or a
lifetime. UC’s disability benefits also provide coverage for female
employees during pregnancy disability and the first few weeks
after childbirth.
UC does not participate in the California State Disability
Insurance (CA SDI) program, although employees who haveworked for UC for fewer than 18 months may have someresidual CA SDI benefits based on their prior employment.
If you are eligible for Full, Mid-Level or Core Benefits, you areautomatically enrolled in Basic Disability at no cost to you. If you
choose to enroll in Voluntary Short-Term Disability (VSTD) and/or Voluntary Long-Term Disability (VLTD), you pay the premium.

WHEN TO ENROLL
You are automatically enrolled in Basic Disability, if eligible, on
your first day of work.
For Voluntary Disability Insurance, you need to take action toenroll. To obtain coverage without submitting a statement ofhealth, enroll during your PIE when you are first eligible. As a
new employee, you may want to consider enrolling in both VSTD
and VLTD for the most comprehensive coverage for all types of
disabilities. You can discontinue your enrollment in VSTD and/or
VLTD at any time.
ENROLLMENT WITH STATEMENT OF HEALTH
If you do not enroll in VSTD and/or VLTD when you are first
hired, you must submit an application, along with evidence of
insurability, and be approved by the insurance company in orderto enroll.
Previous or existing medical conditions may prevent approval if
you try to enroll or add coverage outside of your initial period of
eligibility. You cannot enroll in VSTD or VLTD during UC’s annual
Open Enrollment or due to family changes.

WHAT THE PLANS COVER
BASIC DISABILITY
UC provides the Basic Disability plan at no cost to you.
Basic Disability insurance provides coverage if you are unable
to work due to a pregnancy/childbirth or non-work-related
disabling injury or illness. It pays 55 percent of your eligible
earnings, up to a maximum benefit payment of $800 per month.
The six-month benefit period includes a 14-day waiting period
before you begin receiving benefits, and you must use up to
22 days of sick leave, if available. While you’re receiving Basic
Disability income, UC continues to pay its portion of your
medical premiums. Your Basic Disability income is generally
taxable.
VOLUNTARY DISABILITY
Voluntary Short-Term Disability (VSTD) and Voluntary LongTerm Disability (VLTD) plans work in conjunction with Basic
Disability and other sources of disability income (for example,
Social Security) you may receive as a result of your pregnancy/
childbirth or disabling injury or illness.
VSTD offers more comprehensive coverage than Basic
Disability — 60 percent of your eligible earnings, with a maximum
benefit of $15,000 per month. The six-month benefit period
includes a 14-day waiting period before you begin receiving
benefits, and you must use up to 22 days of sick leave, if available.
This plan is a good option to cover short-term needs such as
pregnancy, most illnesses, minor surgeries, etc.
VLTD benefits don’t start until six months after your date ofdisability or when VSTD benefits end, whichever is later. The
plan pays 60 percent of your eligible earnings, with a maximum
benefit payment of $15,000 per month, and benefits can last
until your Social Security normal retirement age, if you qualify.
This plan doesn’t pay for the first six months of disability, butoffers long-term benefits in cases of catastrophic injury orillness, or permanently disabling conditions.
You pay the entire premium for VSTD and VLTD. The cost varies
depending on your age, salary and your UC Retirement Planeligibility. You may choose to purchase VSTD, VLTD or both.
Voluntary Disability income is generally not taxable, since you
pay the premiums with after-tax dollars.

31

ChapterBasic
Titleand Voluntary Disability

Basic and Voluntary Disability

OTHER SOURCES OF DISABILITY BENEFITS
UC employees may be eligible for other disability benefits,
including:• Workers’ Compensation, which covers work-related injuries
and illnesses• UC Retirement Plan Disability Income, which is available to
UCRP members with five or more years of service credit in
the event of a permanent or long-term disability (12 months
or longer)• Social Security disability benefits• California State Disability Insurance (only if you worked
outside of UC and paid into the system within the past
18 months)
The Basic and VSTD plans do not pay benefits for work-related
injuries or illnesses that cause disabilities. Instead, Workers’
Compensation provides benefits. The VLTD plan pays benefits
for work-related disabilities only in coordination with Workers’
Compensation.
For Workers’ Compensation claims, UC contracts with a third
party administrator to manage its claims. More information isavailable in the Business and Finance Bulletin BUS 81 —Insurance Programs, available on UCPath or from your local
Workers’ Compensation Manager. A directory of UC Workers’
Compensation Managers is available online at ucop.edu/
risk-services/staff-contacts/workers-compensation-managers.
Any disability income you are eligible to receive from theseother sources of disability benefits will be deducted from yourdisability benefits payable under UC’s disability plans. If theother sources of income you receive exceed 60 percent of youreligible income, VLTD will pay a minimum of $100 per month.

HOW THE PLANS WORK
In order to receive disability benefits, you must be under adoctor’s direct, continuous care. For more information about
how to apply for benefits, see Your Guide to UC Disability Benefits
on UCnet (available with related publications at ucal.us/
disabilitypubs) or contact your Benefits Office.
No one type of coverage is right for everyone. It is importantthat you carefully consider your circumstances and how yourselection will affect major events in your life. For example:• Are you considering becoming pregnant? If you think you
may become pregnant, it’s wise to sign up for VSTD. For mostpregnancies, the disability period begins two weeks before
birth and ends six weeks after birth (eight weeks after birth
for a Caesarian section), so a plan such as VLTD, which only
covers disabilities lasting more than six months, wouldn’t pay
32

a benefit. Don’t wait until you’re pregnant to enroll. You’ll be
required to submit a statement of health, and your enrollment
application will not be approved if you’re already pregnant.
• Do you have a lot of non-negotiable monthly expenses?
You may not want to risk a long period without income if you
would have difficulty covering your mortgage payment or rent,
for instance. Enrolling in both VSTD and VLTD provides you
with the most protection for all types of disabilities.
• How much sick leave have you accrued? If you have beenwith UC for a long time and have a lot of accrued sick leavethat you could use during the first six months of a disability,
you might only need VLTD. If you don’t have much, you might
consider VSTD.
• How’s your savings cushion? If you have substantial savings
that could tide you over the first six months of a disability,
you might choose VLTD only. If not, you should consider both
VSTD and VLTD for the most protection.

IMPORTANT CONSIDERATIONS FOR FACULTY
UC faculty members and other academic appointees who do notaccrue sick leave may be eligible to request a paid medical leave
for personal illness, injury or disability from their department
or their location’s Academic Personnel Office. The amount ofsalary replacement and leave time available under the faculty
policies may be equal to or greater than those provided in the
Voluntary Short-Term Disability plan. See the Disability Benefits
for Faculty fact sheet available online at ucal.us/disabilityfaculty
for additional information. Contact your local Benefits Office or
Academic Personnel Office with questions.

IMPORTANT CONSIDERATIONS AND
LIMITATIONS TO COVERAGE• Definition of disability: The definition of disability changes
with the type of coverage you receive:– Basic and Voluntary Short-Term Disability — To receive
benefits, you must be disabled from your job at UC, basedon the demands and duties of your position.
– Voluntary Long-Term Disability — For the first 24 monthsof VLTD benefits, in order to receive benefits, you must be
disabled from your own occupation, based on the demands
and duties that employers (throughout the national
economy) ordinarily require for that occupation. Fromthe 25th month onward, you must be disabled from any
occupation (throughout the national economy) for which
you are reasonably suited.
(Note that UCRP defines disability differently; for details,
please see Your Guide to UC Disability Benefits.)

WHEN COVERAGE ENDS
Your coverage stops on your last day actively at work. You may
not continue these plans through COBRA or convert them toindividual plans.

However, your VLTD benefits will not be payable if:– Your disability leave is related to a condition you werediagnosed with, or had treatment for, in the 90 days prior toyour initial enrollment in VLTD and

FOR MORE INFORMATION
The following publications are available online atucal.us/disabilitypubs:– Your disability leave begins within one year of your initialenrollment into VLTD

• Your Guide to UC Disability Benefits

You will, however, be eligible for VLTD benefits for conditions
that were not pre-existing.

• Pregnancy, Newborn Child and Adopted Child Fact Sheet• Mental Illness and Substance Abuse: VLTD benefits forthese issues are generally limited to a 24-month lifetime
maximum benefit, unless you remain continuously
hospitalized or in an extended treatment plan.

• Disability Benefits for Faculty Fact Sheet• Partial Disability: Stay at Work/Return to Work Fact Sheet• Disability Insurance Policy

COST OF COVERAGE
The university provides the Basic Disability plan at no cost
to you.
You pay a monthly premium if you enroll in voluntary coverage.
The premium depends on your monthly salary, age, retirement
plan and the level of coverage you choose (Voluntary Short-Term
Disability, Voluntary Long-Term Disability or both). To estimate
your premium, use the online Insurance Premium Estimator(ucal.us/premiumestimator).

33

ChapterBasic
Titleand Voluntary Disability• Pre-existing conditions: Once you are enrolled in the VSTD
Plan and the Basic Disability Plan, there are no benefits
limitations related to pre-existing conditions. Additionally, as
soon as you’ve been covered by the VLTD Plan for more than
12 months there are no restrictions or limitations on the VLTD
Plan related to the pre-existing condition.

ChapterBasic
Titleand Core Life Insurance

Basic and Core Life Insurance

Benefits package: Full (Basic), Mid-Level (Core) and Core (Core)

CORE LIFE

Who’s covered: You

If you are eligible for the Mid-Level or Core Benefits package,
this plan provides $5,000 of life insurance. 2

Who pays the premium: UC
Life insurance provides financial protection for your dependents
in the event of your death, and can be important to their future
security. UC automatically provides basic life insurance coverage
for all eligible employees. And you may be eligible to buy
additional coverage for yourself and your family members.
UC’s life insurance plans carry no exclusions based on the causeof death. They are group term life plans that provide coverage at
special rates to group members — in this case, UC employees.
UC’s life insurance is in effect only as long as you remain
an eligible employee, and does not accumulate a cash value
over time.
UC provides a minimum amount of life insurance coverage at no
cost to you. The plan and amount of coverage varies, dependingon your appointment rate and average regular paid time.

WHEN COVERAGE BEGINS
You must be actively at work in order for new or increased
coverage to be effective.

WHAT THE PLANS COVER

Benefits are paid to your beneficiaries if you die while employedor on paid leave, or during the first four months of approved
leave without pay or temporary layoff. Your beneficiaries receive
these benefits in addition to any other death benefits for which
you may qualify.

OTHER FEATURES OF THE PLANS
LIVING BENEFIT OPTION
The “living benefit” option allows terminally ill employees toreceive some of their life insurance benefits before death; themoney can be used for any purpose. The insurance company
pays you 75 percent of the total coverage amount in a lump sum
or in 12 equal monthly installments. Benefits paid to yourbeneficiaries at the time of your death are reduced by theamount previously paid to you. See the life insurance plan
booklet for more information.
EXTENDED DEATH BENEFIT
The Basic or Core Life insurance protection may continue up to
one year beyond the date coverage terminates if you become
totally disabled while covered under the plan and you are underage 65. You must remain continuously unable to engage in any
occupation until the date of death. Protection continues for
one year, until you reach age 65 or until your disability ends,
whichever occurs first.

BASIC LIFE
If you are eligible for the Full Benefits package, this plan
provides life insurance equal to your annual base salary, up to$50,000.1 The coverage amount is based on your UC salary andappointment rate as of your date of hire or Jan. 1 of thecurrent year, whichever is later.
Benefits are paid to your beneficiaries if you die while employedor on paid leave, or during the first four months of approved
leave without pay or temporary layoff. Your beneficiaries receive
these benefits in addition to any other death benefits for which
you may qualify.

COST OF COVERAGE
UC pays the entire cost of your coverage for Basic or Core Life
insurance. UC’s contribution toward the monthly cost of coverageis determined by UC and may change or stop altogether.

WHEN COVERAGE ENDS
If you wish to convert your coverage to an individual policy, youhave 31 days from the date your coverage ends to submit yourconversion application and appropriate premiums to Prudential,
the plan administrator.
Conversion options are generally more expensive and may
provide fewer benefits than UC-sponsored plans. See your plan
booklet or call your plan for more information.

If you are a member of the California Public Employees’ Retirement System(CalPERS), CalPERS provides $5,000 of coverage and UC provides coverage
equal to your annual base salary less $5,000, up to $45,000.
2This plan does not cover CalPERS members.
134ChapterSupplemental
Title
Life Insurance

Supplemental Life Insurance

EXCEPTION TO DUPLICATE UC COVERAGE RULE

Benefits package: Full and Mid-Level

You may be enrolled in Basic Life Insurance, Core Life Insurance
or Senior Management Life Insurance and also be covered as adependent of another UC employee.

Who’s covered: You

BENEFICIARIESYou should designate your beneficiaries online by signing in
to UC Retirement At Your Service (UCRAYS). If you don’t namebeneficiaries, benefits are paid to the first survivor in this list:• Your legal spouse or domestic partner• Your child or children, including your adopted children; if
your child is deceased, your deceased child’s share will go tothat individual’s child or children• Your parent or parents• Your sibling or siblings
If there is no such survivor, any lump sum death payment will be
paid to your estate.
You may change your designated beneficiary at any time using
UCRAYS. Once your new designation is processed, all previous
designations are invalid. Changes in your family situation —such as marriage, divorce or birth of a child — do not
automatically alter or revoke your previous designations. A will
also does not supersede a beneficiary designation. Prior
designations remain valid until you change your designations
online. However, a beneficiary designation may be subject tochallenge if it will result in your spouse receiving less than your
spouse’s community property share of the benefit.
If you do not have access to the Internet, you may complete
UC’s Designation of Beneficiary form (UBEN 116), available fromyour Benefits Office.

Who pays the premium: You
Eligible employees may supplement their Basic or Core Life
insurance coverage by enrolling in this plan and paying monthly
premiums. You can choose the amount of coverage that meets
your needs up to the maximum listed under Coverage Amounts.

WHEN TO ENROLLENROLLMENT
To obtain coverage without the need for a statement of health,enroll during your first PIE or during a PIE that occurs as theresult of the acquisition of a new family member. During
a PIE that occurs as the result of the acquisition of a new
family member, you can also increase your Supplemental Life
Insurance. Otherwise you can enroll at any time, but a statementof health will be required.
ENROLLMENT WITH STATEMENT OF HEALTH
If you do not enroll in the Supplemental Life Insurance plan during
a period of eligibility, you must submit your request throughyour UCPath account. The insurance company will reach out by
email with a Statement of Health for you to complete. If it isapproved, UCPath will finalize your enrollment and send you aconfirmation statement. Previous or current medical conditions
may prevent your approval if you try to enroll outside of aneligibility period.
WHEN COVERAGE BEGINS
You must be actively at work in order for new or increased
coverage to be effective. If you are on leave for health reasonson the day you become eligible for Supplemental Life coverage,
your coverage will start the day after your first full day at work.

COVERAGE AMOUNTS
You may choose one of several coverage amounts:• $20,000• One times your annual salary, up to $250,000• Two times your annual salary, up to $500,000• Three times your annual salary, up to $750,000• Four times your annual salary, up to $1 million
Coverage is based on your UC salary rounded to the nearest
thousand and your appointment rate as of your date of hire or
the full-time salary rate for your position as of Jan. of the current
35ChapterSupplemental
Title
Life Insurance

Supplemental Life Insurance

year, whichever is later — even if you work part time. If your fulltime salary rate is reduced, coverage will not be reduced until the
beginning of the next calendar year.
Benefits are paid to your beneficiaries if you die while enrolled.
They are payable in addition to any other death benefits for which
you may qualify — for example, from the Basic Life insurance planor your retirement plan.

PLAN FEATURES
LIVING BENEFIT OPTION
The “living benefit” option allows terminally ill employees
covered by the plan to receive a portion of their life insurance
benefits before death. The benefit — 75 percent of the total
coverage, up to $250,000 — is paid directly to you in a lump sum
or in 12 equal monthly installments. The money can be used forany purpose. The benefit that would otherwise be payable toyour beneficiaries at death is reduced by this amount. Your life
insurance plan booklet has more information.
WAIVER OF PREMIUM
If you become totally disabled before age 65 and your disability
continues for six consecutive months, you may qualify forcontinuation of life insurance protection without paying thepremiums.
You must provide written proof of your disability no later than
one year after the disability starts and submit proof of yourcontinuing disability each year. Your life insurance will continue
until you reach age 70, as long as you remain totally disabled.
You may need to continue your premium payments to yourPayroll or Benefits Office while your application is pending.
See your insurance booklet or call the insurance carrier for
more information.

COST OF COVERAGE
Your cost for Supplemental Life Insurance depends on
your age and the amount of coverage you purchase. Use
the online Premium Estimator for Life Insurance (ucal.us/
lifepremiumestimator) to determine your monthly premium.

36

WHEN COVERAGE ENDS
If you leave UC employment, you are no longer eligible for
Supplemental Life Insurance. You may port or convert yourcoverage if you apply within 31 days of the date yourUC-sponsored coverage ends.
The portability benefit allows you to continue your current UC
Supplemental Life coverage at Prudential’s Portability groupterm-life rates, which are lower than the conversion premium
rates. A statement of health is not required, but you must submit
proof of good health satisfactory to Prudential to qualify
for preferred rates. There are additional requirements for
portability. See the Supplemental Life Insurance plan booklet for
details.
You may also convert to an individual policy without a statementof health.
You have 31 days from the date your coverage ends to submit
your application and the appropriate premiums to Prudential.
See your Benefits Office for more information.
Conversion options are generally more expensive and may
provide fewer benefits than UC-sponsored plans. See your plan
booklet or call your plan for more information.

ChapterDependent
Title
Life Insurance

Dependent Life Insurance

Benefits package: Full and Mid-Level

WHEN COVERAGE BEGINS

Who’s covered: Your spouse or domestic partner and/or youreligible children

If your dependent is confined for medical care or treatment,
your dependent’s new or increased coverage will begin on thefirst day after medical release. This does not apply to yournewborn child.

Who pays the premium: You
UC offers two plans for insuring your eligible family members.
You can enroll your dependents in the Basic Dependent Life planif you are enrolled in Basic Life or in the Expanded Dependent
Life plan (which provides more coverage) if you are also enrolled
in the Supplemental or Senior Management Life plan. You may
cover your family members under either plan, but not under both.

WHEN TO ENROLL
To obtain coverage for a spouse or domestic partner without theneed for a statement of health, enroll during your own initial PIE,
or if the marriage or partnership occurs later, during the 31-day
PIE following the marriage or partnership date. Otherwise they
can be enrolled only by submitting an application along withevidence of insurability, and the insurance company decides
whether to approve the application. A spouse or domestic
partner may not be enrolled during a PIE resulting from the birthor adoption of a child.
Children may be enrolled during their PIE or at any time withouta statement of health.

ELIGIBILITY
If both you and a family member are UC employees, you may
choose to cover yourself under the Supplemental Life plan or, if
eligible, under your family member’s Dependent Life plan. You
cannot be covered by both plans.
If you miss your period of initial eligibility, you must submit yourrequest through your UCPath account. The insurance company
will reach out by email with a Statement of Health for you tocomplete. If it is approved, UCPath will finalize your enrollment
and send you a confirmation statement. This is not required forchildren — children may be enrolled at any time.
You may transfer your dependents from the Expanded plan to
the Basic plan at any time. However, to transfer your spouse ordomestic partner from the Basic plan to the Expanded plan, youmust submit an application, along with a statement of health, forthat person.

WHAT THE PLANS COVER
BASIC DEPENDENT LIFE
This plan covers your spouse or domestic partner and/or youreligible children; the benefit is $5,000 for each dependent. See
pages 13 and 14 for each family member’s requirements for
eligibility. You are the beneficiary if a covered dependent dies.
EXPANDED DEPENDENT LIFE
You may choose to cover:• Your legal spouse or domestic partner with a benefit amountequal to 50 percent of your Supplemental Life Insurance
amount, up to a maximum benefit of $200,000, and/or• Your eligible children with a benefit of $10,000 each
You are the beneficiary if a covered dependent dies. You may
designate someone else to receive benefits if a covered spouseor domestic partner dies. You cannot designate an alternate
beneficiary for covered children. Use the Designation of Alternate
Beneficiary — Expanded Dependent Life and AD&D Insurance form
(UBEN 119), available online at ucal.us/UBEN119.
Living Benefit Option: This option allows a terminally ill
spouse or domestic partner covered for at least one year toreceive some life insurance benefits before death. The benefit —50 percent of the total benefit, up to $50,000 — is paid directly
to the spouse or partner in a lump sum or in 12 equal monthly
installments. The money can be used for any purpose. The
benefit that would otherwise be payable to beneficiaries atdeath is reduced by the amount paid to the spouse or partner.
Your life insurance plan booklet has more information.

COST OF COVERAGE
Use the online Life Insurance Premium Estimator (ucal.us/
lifepremiumestimator) to determine your monthly premium.

37

Dependent Life Insurance

Dependent Life Insurance

WHEN COVERAGE ENDS

FOR MORE INFORMATION

If you leave UC employment, you are no longer eligible for Basicor Expanded Dependent Life insurance. You may port orconvert your coverage if you apply within 31 days of the dateyour UC-sponsored coverage ends.

A copy of the life insurance plan booklet is available online atucal.us/EOCs.

If you participate in Prudential’s group term-life Portability benefit
for your Supplemental Life Insurance (see page 36), you may also
continue Dependent Life coverage within the same Portability
benefit. See your Benefits Office for more information.
You may also convert your Dependent Life to an individual
policy without a statement of health if:• Your UC-sponsored coverage ends, or• You become totally disabled and you are covered under the
Supplemental Life Insurance waiver of premium benefit.
You have 31 days from the date your coverage ends to submit
your application and the appropriate premiums to Prudential,
the plan administrator.
Conversion options are generally more expensive and may provide
fewer benefits than UC-sponsored plans. See your plan booklet orcall your plan for more information.

38

Benefits package: Full, Mid-Level, Core
Who’s covered: You and your eligible family members
Who pays the premium: You
The financial impact of an accident can be devastating. To
help protect you and your family from the financial hardshipof an unforeseen accident, UC offers Accidental Death andDismemberment (AD&D) insurance.

WHEN TO ENROLL
You may enroll at any time.

WHAT THE PLAN COVERSThe plan provides $10,000 to $500,000 coverage for accidental
death, dismemberment or loss of sight, speech or hearing causedby an accident. It offers three levels of coverage:• Individual coverage for you only
• Family coverage for you, your spouse or eligible domestic
partner and your child(ren). This plan covers your spouse ordomestic partner for 60 percent of your coverage amount. If
eligible children are covered, then your spouse or domestic
partner is covered for 50 percent of your amount and eachchild for 20 percent.

Education Benefit: Under family or modified family coverage,
if you die in a covered accident, the plan pays for your child’s
higher education — the lesser of the actual tuition, 5 percent of
your coverage amount, or $1,500 annually. The child must be
enrolled in an institution of higher learning on the date of theaccident, or be a high school student and enroll in an institution ofhigher learning within 365 days of high school graduation.
Day Care Benefit: The plan will pay for up to four years of
day care expenses (up to the plan limit) for covered children underage 13 if you die due to a covered accident.
Repatriation of Remains: If you or a covered dependent suffer
an accidental death while at least 100 miles from home, the plan
will pay for covered expenses up to $50,000 to return your bodyor the body of a covered dependent to your home.
Common Disaster Benefit: If you and your covered spouse or
eligible domestic partner both die within 90 days of the same
covered accident, your spouse’s or eligible domestic partner’s
principal benefit amount will be increased to equal yours to a
maximum of $500,000.
Coma Benefit: The plan will pay a portion of your benefits whena covered accident renders you or a covered family member
comatose within 30 days of the accident.
Natural Disaster: The plan will pay an additional 10 percent
if you or a covered family member suffers loss as a result of
an officially declared natural disaster (e.g., storm, earthquake,flood).

• Modified family coverage for you and your child(ren). Eacheligible child is covered for 20 percent of your amount.

Permanent and Total Disability Benefit (for employee only):
See plan booklet for details.

If you are on leave for health reasons on the day you become
eligible for coverage, your coverage starts the day after your firstfull day at work.

COST OF COVERAGE

THE PLAN OFFERS THESE ADDITIONAL BENEFITS:
Seatbelt Benefit: The plan pays an additional 10 percent if you
or a covered family member dies in a car accident while using aseatbelt or an airbag.
Indemnity for a Child’s Dismemberment or Paralysis: The plan
pays a percentage of the covered amount if an accident causes
irreversible paralysis of a covered child. The percentage payabledepends on the degree of the paralysis.
Rehabilitation Benefit: The plan will pay up to $10,000 forcovered rehabilitative expenses for two years after the date ofan accident that causes dismemberment or paralysis. Workrelated injuries covered under Workers’ Compensation or othersimilar laws are excluded.

Your cost depends on the level of coverage and coverageamount you choose. Use the rate chart online at ucal.us/
adanddpremiums to determine your monthly premium.

WHEN COVERAGE ENDS
If you leave UC employment, you may convert your coverage toan individual policy if you apply within 31 days of the date yourUC-sponsored coverage ends.
Conversion options are generally more expensive and may
provide fewer benefits than UC-sponsored plans. See your plan
booklet or call your plan for more information.

39

Accidental Death and Dismemberment Insurance

Accidental Death and Dismemberment InsuranceChapterAccidental
Title
Death and Dismemberment Insurance

Accidental Death and Dismemberment Insurance

EXCLUSIONS
There are certain exclusions under the AD&D insurance. Seeyour plan booklet for more information.

FOR MORE INFORMATIONThe AD&D plan booklet is available online at ucal.us/EOCs, withadditional details.

40Benefits package: Full, Mid-Level, Core

HOW THE PLAN WORKS

Who’s covered: You and your traveling companion(s)When you travel on official university business, you areautomatically covered by UC’s business travel insurance when
you make your arrangements through any of UC’s preferred
travel agencies found in ConnexUC, UC’s systemwide travel
program. For all other travel, you must register your travel
online at ucop.edu/risk-services-travel/registering.html. Onceregistered, you will receive confirmation of coverage for your trip
and information to use in the event of an emergency.

Who pays the premium: UC
UC faculty and staff traveling on official UC business are covered,
at no cost to you, worldwide 24 hours a day for a variety ofaccidents and incidents.

WHAT THE PLAN COVERSThe coverage includes:• Accidental death• Accidental dismemberment• Paralysis

You will also receive current travel alerts for your destinationand information about changing conditions that may arise
during the course of your travel. The plan also gives you accessto general information about your destination, including
information about security, health, communications andtechnology, transportation, legal, entry and exit, financial,weather and environment, language and culture.

• Permanent total disability benefits• Evacuation in the event of a security emergency• Travel assistance services when you are 100+ miles from yourhome and workplace (see below for more information)
Your spouse/domestic partner, dependent child(ren) or othertraveling companion are covered when accompanying you on abusiness trip.

BENEFICIARIESFor purposes of accidental death benefits, the insurancecompany automatically designates as your beneficiary the firstsurvivor in this list:• Your legal spouse or domestic partner• Your child or children• Your mother or father

TRAVEL ASSISTANCE SERVICES• Your sisters or brothers

In addition to insurance protection, the plan gives you access totravel services around the world, including:• Your estate• Medical assistance such as referral to a doctor or medical
specialist, medical monitoring if you are hospitalized,
emergency medical evacuation to an adequate facility,
medically necessary repatriation and return of remains• Personal assistance such as embassy and consular
information, assistance with lost documents, emergency
message transmission, emergency cash advance, emergency
referral to a lawyer, access to a translator or interpreter,
medical benefits verification and assistance with medical
claims• Travel assistance, including emergency travel arrangements
for the return of your traveling companion or dependents

If you wish to designate your beneficiaries differently than thissequence, you must complete a Faculty Beneficiary Designation
form which can be requested by calling UC Risk Services at
510‑987‑9832.
Your beneficiary designation remains in effect until it is either
changed or revoked. It does not automatically end with thereturn from a business trip.

FOR MORE INFORMATION
Additional information, including frequently asked questions, asummary of coverage and claim forms is available online at
ucop.edu/risk-services-travel/index.html.

41

ChapterBusiness
Title Travel Accident Insurance

Business Travel Accident InsuranceAdoption Assistance Plan

Adoption Assistance Plan

Benefits package: Full, Mid-Level, Core
Who’s covered: You
Who pays the costs: UC
UC supports eligible faculty and staff who wish to expand their
immediate families through adoption. The Plan provides
financial support through reimbursement of up to $5,000 ofeligible expenses per adoption.

INELIGIBLE EXPENSES• Surrogate parenting arrangements• Embryo adoption• Expenses paid or reimbursed by other sources, including but
not limited to other benefit or insurance plans• Expenses claimed as a credit or deduction on personal tax
returns• Expenses that violate state or federal law• Expenses incurred prior to your employment with UC

HOW TO ENROLL
Unlike other UC Health & Welfare benefits, no enrollment isrequired in the Adoption Assistance Plan. After your adoption
is legally finalized you complete the UC Adoption Verification
and Claims Filing Forms and send them to the Plan’s Claims
Administrator to receive benefits from the plan.

HOW THE PLAN WORKS
You pay for your adoption-related expenses throughout the
adoption process, retaining receipts and other documentation.
After the adoption is legally finalized, you can request
reimbursement for up to $5,000 of eligible expenses per
adoption. The Plan limits covered adoptions to two per
employee, with a maximum of $10,000 in benefits in theemployee’s lifetime. If both adoptive parents are employees of
the University the Plan limits covered adoptions to two perhousehold, with a combined maximum of $10,000 in benefits
during their lifetime.

EXPENSES
To receive reimbursement, incurred expenses must be directly
related to and for the principal purpose of adoption. Guidanceby the IRS determines which expenses are eligible forreimbursement.

• Personal items including clothing and food
• Medical expenses for the adopted child or birth mother
LIMITATIONS• Qualified Expenses incurred throughout the adoption process
are not eligible for reimbursement until after the adoption islegally finalized.
• Expenses incurred for adoptions that are unsuccessful (notlegally finalized) do not qualify for reimbursement.
• Expenses related to adoptions finalized prior to theJuly 1, 2021, establishment of the Plan are not eligible forreimbursement.
• Expenses incurred prior to employment with UC are noteligible for reimbursement, even if the adoption is finalized
while you are a participant in the Plan.

WHEN COVERAGE ENDS
Participation in the Plan ends on the last day of the monthin which employment with the University terminates or an
employee ceases to meet the eligibility requirements of the Plan.

WHO ADMINISTERS THE PLAN
WEX Health is the Claims Administrator. They process claims forreimbursement on behalf of the University.

ELIGIBLE EXPENSES• Attorney fees and court costs• Licensed adoption agency and placement fees
• Immigration, translation and document authentication fees
• Re-adoption expenses for a foreign child• Travel expenses, including meals and lodging while awayfrom home• Parent, child and family adoption counseling fees
• Home suitability study fees

42

FOR MORE INFORMATION
Additional information including frequently asked questions,
the Adoption Assistance Plan Policy, and instructions for filingclaims are available online at ucal.us/adoptionassistance.

ChapterLegal
TitleInsurance

Legal Insurance

Benefits package: Full, Mid-Level, Core
Who’s covered: You and your family members
Who pays the premium: You• Consumer protection issues including personal bankruptcy,
debt collection defense and legal representation for
enforcement of warranties or promises in connection withlease or purchase of goods or services

Most people need legal advice at one time or another. UC offers
the ARAG Legal Insurance plan, which gives you access to arange of personal legal services. The plan provides assistancewith routine matters and covers most basic legal needs.

• Real estate matters including purchase, sale or refinance,home equity/construction loans, real estate disputes,
residential contractor disputes and secondary residence
matters including foreclosure, neighbor disputes, property
tax, zoning and variances, building codes and easements

You may enroll during your PIE or during Open Enrollment.

• Tax planning, preparation2 and audit support

WHAT THE PLAN COVERS• Legal advice, representation and preparation for covered
matters or review of specific documents in-office from an
ARAG network attorney• Network attorney fees are paid in full for most covered
matters. For any personal legal matter not covered and not
excluded — including immigration assistance — receive atleast 25 percent off a network attorney’s normal hourly rate.

• Assistance with administrative hearings including educational,
building/zoning/easements, Social Security/veterans/
Medicare benefits, and more
• Domestic violence protective orders• Enforcement and modification of child support orders,modification of alimony orders, guardianship andconservatorship accounting, and establishment of restraining
orders• Defense of traffic offenses, including traffic tickets• Driving privilege protection, driving restoration — DWI• Legal advice via phone from ARAG’s nationwide network oftelephone attorneys• Defense of misdemeanor charges such as trespassing, public
intoxication and vandalism• Estate planning documents, including wills, trusts, powers
of attorney, health care directive, funding a trust and trust
dispute• General In-Office — six hours of attorney time per family percertificate year for advice, negotiation and service for personal
legal matters that are not covered or excluded• Diversity and Inclusion services, including domestic
partnership agreements, funeral directives, hospital visitationrights and gender-identifier changes on government-issued
documents• Online legal tools and resources, such as DIY Docs® thatenable you to create documents like a standard will, power ofattorney, child medical authorization, HIPAA authorization,
contractor agreement and more

• Family legal matters, including divorce, separation andannulment (with a 25-hour cap in coverage if contested);pre-nuptial agreements; child custody and support; visitation
and/or alimony; Qualified Domestic Relations Orders; defense
and establishment of paternity; adoption, guardianship/conservatorship; executor appointment; elder care and namechangeGo to araglegal.com/ucinfo or refer to the plan booklet for thefull list of covered services, plan limitations and exclusions.

• Identity Theft Protection, including single-bureau credit
monitoring, internet surveillance, child identity monitoring,full-service identity restoration, lost wallet services, change ofaddress monitoring and identity theft insurance1
The Identity Theft Insurance is underwritten and administered by American
Bankers Insurance Company of Florida, an Assurant company. Please refer tothe actual policies for terms, conditions, and exclusions of coverage. Coverage
may not be available in all jurisdictions. Please see the identity theft plansummary for details.
2
There is a flat $50.00 charge for each personal tax return prepared (federal,state, local), limited to the preparation of tax forms 1040, 1040A or 1040EZ(includes Schedule A, Schedule B and Schedule D). If the tax return requires
any other schedules, an additional fee of $60.00 per hour will be billed to themember. If a different type of personal tax return is required, the member will
be billed $60 per hour for the preparation of the return and any schedules.
1

HOW TO USE THE PLAN
Before consulting any attorney, call ARAG to be sure the plan serves
you to your best advantage. When you call ARAG, a customer carespecialist will advise you on the services the plan will cover andsend you a CaseAssist confirmation package, which includes a
description of coverage and a list of network attorneys available inyour area.
All network attorneys have met ARAG’s requirements and agreed
to provide the services described in the plan booklet. When you use
a network attorney, fees for most covered matters are paid in full.

43

Legal Insurance

Legal Insurance

ARAG network attorneys provide services in two ways:

FOR MORE INFORMATION• Telephone: You may call a telephone network attorney who
will either work with you over the phone or recommend thatyou meet with an attorney in person. Using telephone network
attorneys can help you get the most from the plan.

Visit the ARAG website: araglegal.com/ucinfo• Office appointments: The plan covers a wide range of legal
matters, most of which are fully paid when you work with a
network attorney. For matters not listed, and not excluded, theplan provides a general in-office benefit for up to four hours
per year.
If you prefer, you may use an attorney outside the ARAG network
on a matter covered under the plan. In that case, the plan
reimburses you up to the benefit amount indicated in the plan
booklet.

COST OF COVERAGE
Your monthly cost depends on whether you choose individual or afamily coverage option. See the plan costs online at ucal.us/legal.

WHEN COVERAGE ENDS
If you leave UC employment, you may convert your coverage toan individual policy if you apply within 31 days of the date yourUC-sponsored coverage ends. See your plan booklet or call ARAGfor more information.

44

See the plan booklet online at ucal.us/EOCs
Call ARAG: 800-828-1395 or TTD: 800-383-4184

Pet Insurnace

Pet Insurance

Benefits package: Full, Mid-Level, Core

WHEN COVERAGE ENDS

Who’s covered: Pets owned by you or your eligible family
members

If you leave UC, Nationwide will automatically continue yourcoverage. However, the premium may change at policy renewal,
as group preferred pricing may no longer apply.

Who pays: You pay premiums directly to Nationwide
Nationwide offers preferred pricing on pet insurance for UC
faculty, staff and retirees. Plans are available for dogs, cats,
birds, small mammals and exotics (such as reptiles); animals
categorized as livestock (including horses) are not eligible.

FOR MORE INFORMATIONPetinsurance.com/uc
877-738-7874

You can enroll in pet insurance at any time, and your coverage
will be effective approximately 14 days after your application isapproved by Nationwide. Once enrolled, your policy will renew
automatically each year.

WHAT THE PLAN COVERSNationwide provides coverage for treatment of accidents andillness. Pre-existing conditions are excluded. For complete
information about coverage visit petinsurance.com/uc.

HOW THE PLAN WORKS
Learn more and enroll on the Nationwide website at
petinsurance.com/uc. To enroll in coverage for your bird, small
mammal, reptile or other exotic pet, or to speak to arepresentative, call Nationwide at 877-738-7874.
You’re free to visit any licensed veterinarian, anywhere in theworld — even specialists and emergency providers. Simply pay
your vet bill and then submit a claim to Nationwide forreimbursement.

COST OF COVERAGE
Premiums vary depending on your type of pet and where you
live, and you’ll pay your premiums directly to Nationwide.

45

ChapterFamily
Title Care Resources

Family Care Resources

Benefits package: Full, Mid-Level, Core1

COST OF COVERAGE

Who’s covered: You and your family members

UC pays the fee that gives you access to the Enhanced Family
Supports Program with its networks of prescreened providers.
You make all the arrangements, including selecting, hiring andpaying providers.

Who pays: UC pays for access; you pay for care
Finding the right caregivers for loved ones is one of the toughest
challenges many working families face. UC offers Bright
Horizons Enhanced Family Supports Program to help employees
find the right match for their family care needs, including childcare centers, nannies, babysitters, elder care planning, pet care,tutoring/test prep, and more. Their online resources help you
find quality caregivers that fit your family’s needs.

WHEN COVERAGE ENDS
If you leave UC employment or move to an ineligible position,
you may convert your Bright Horizons account to an individual
consumer membership for an annual fee.

Bright Horizons Enhanced Family Supports Program includes
access to:• Sittercity, which offers individual in-home caregivers,
including babysitters, nannies, senior caregivers, pet sitters,
tutors and housekeepers• Years Ahead, which offers a nationwide network of memory
and hospice care facilities, independent and assisted living
communities, and in-home health care and senior carecompanions• Preferred enrollment at select Bright Horizons centers
nationwide, tuition discounts at partner centers anddiscounted tutoring and test prep through BrightStudy

HOW THE PLAN WORKS
On the UC-specific Bright Horizons website(clients.brighthorizons.com/universityofcalifornia), you canregister for Sittercity and/or Years Ahead. You must register foreach separately. Once you’ve registered, you can read provider
profiles and reviews to help you find the right caregiver for you.
Sittercity allows you to post jobs and providers can respond.
Years Ahead offers certified senior care advisers to help you andyour family through the process of finding the right caregiver.
Bright Horizons also offers preferred enrollment and tuition
discounts at some Bright Horizons child care centers anddiscounts on tutoring and test prep services throughBrightStudy. Use the center search locator on the website to
identify centers near you that participate in preferred
enrollment or offer a discount. Sign up online to learn more
about BrightStudy, and a representative will contact you to help
you find the resources you need.

1

Participation in Bright Horizons Enhanced Family Supports Program is subject
to bargaining with individual unions at UC. Contact your local Benefits Office tofind out whether your union is participating in Bright Horizons Enhanced Family
Supports Program benefit.

46

FOR MORE INFORMATION
clients.brighthorizons.com/universityofcalifornia
888-748-2489

Benefits package: Full, Mid-Level, Core

HOW THE PLANS WORK

Who’s covered: You and your family members

You determine the annual amount of your contributions to aplan, subject to the contribution limit for that plan. An equal
portion of that amount is deducted from your paycheck andcredited to your Health FSA and/or DepCare FSA account. Whenyou have eligible expenses, you pay them from your account.

Who pays: You
UC’s Health and Dependent Care Flexible Spending Accountplans (FSAs) allow you to pay for eligible out-of-pocket expenses
for yourself and your eligible family members on a pretax basis.
As a result, your salary is reduced before taxes are assessed, andyou pay less in taxes.

ELIGIBILITY
You are eligible to enroll in the Health and Dependent Care
Flexible Spending Accounts while you are eligible for Full,
Mid-Level or Core Benefits.
IRS rules do not allow enrollment in a Health FSA and a Health
Savings Account (HSA) at the same time. This means thatmembers of UC Health Savings Plan (paired with an HSA) arenot eligible to participate in the Health FSA, and Health FSA
participants may not switch their enrollment to UC Health
Savings Plan midyear (for example, if they become eligible due toa life change).
If your spouse is covered by a High Deductible Health Plan
(HDHP) with a Health Savings Account (HSA) through theiremployer, you may not participate in the Health FSA, unless you
are enrolled in a Limited Purpose FSA. Please refer to page 48 for
information about the Limited Purpose FSA.

ENROLLMENT AND CHANGES IN PARTICIPATION
You may enroll when you first become eligible, when you have an
eligible change in family or employment status, or during Open
Enrollment. If you enroll in the UC Health Savings Plan for your
medical coverage, you cannot enroll in the Health FSA.
You enroll in the FSAs for the plan year, which ends on Dec. 31
of each year. You must re-enroll during Open Enrollment toparticipate the following year.
You may also change your contribution or cancel participation
during a 31-day period of eligibility resulting from an eligible
change in family or employment status. Midyear changes must
be on account of and consistent with the change in status. See
the Health or DepCare FSA Summary Plan Description for details
regarding what types of changes are allowed.
Enrollment and changes in contributions take effect on the first of
the month following the action taken, subject to payroll deadlines.

It’s important to estimate your annual expenses carefully,
because, based on Internal Revenue Service (IRS) regulations andplan rules, unclaimed funds in your account after the closing date
for the plan year will be forfeited.
Each plan has its own rules, so be sure to read the details about
each plan below.

PLAN ADMINISTRATIONWEX Health is the plan administrator for the FSAs; they handle
all claims processing and reimbursement. WEX must receive
claims for a plan year by April 15 of the following year in order toreimburse the expenses; for example, they must receive claims
for the 2024 plan year by April 15, 2025.

HEALTH FSA
The Health FSA allows you to pay for eligible out-of-pocket
health care expenses on a pretax basis. The Health FSA covers
expenses for yourself, your legal spouse, your children up to
age 26 or anyone else you claim as a dependent on your federal
income tax return. Expenses must meet the requirementsof Internal Revenue Code (IRC) §213(d) to be eligible forreimbursement.
Eligible expenses include:• Copayments and deductibles, but not premiums• Prescription drugs• Menstrual care products• Certain over-the-counter medications• Orthodontia• Eyeglasses and contact lenses• Laser eye surgery• Other health care expenses that are not reimbursed by your
medical, dental or vision plan
Note that while an expense may be an eligible tax deduction,
it may not be an eligible expense under the Health FSA (forexample, medical plan premiums). Expenses reimbursed under the
Health FSA may not be deducted on your federal income tax form.
If you enroll in a Health FSA in 2024, you can carry over unused
Health FSA funds up to $640 to the 2025 plan year.
With the carryover, if your balance is less than $640 you do nothave to rush to spend all of your Health FSA funds or worry

47

ChapterHealth
Title and Dependent Care Flexible Spending Account Plans

Health and Dependent Care Flexible Spending Account Plans

ChapterHealth
Title and Dependent Care Flexible Spending Account Plans

Health and Dependent Care Flexible Spending Account Plans

about losing money when the current plan year ends — even
if you do not re-enroll for the next plan year. Here’s how it works:• You have until Dec. 31 of the plan year to incur eligible
expenses, and until April 15 of the following year to file them.
• After the run-out period ends (on April 15), unused funds up
to $640 will be credited automatically to your account. Unused
funds greater than $640 will be forfeited.
• If you do not re-enroll for the next plan year, you may still
carry over up to $640, but only for one year. In addition, if you
do not re-enroll you must have at least $25 remaining in youraccount to be able to carry over funds to the next plan year.
Funds under $25 are forfeited.
• To be eligible for a carryover, you must be actively enrolled
in the plan as of Dec. 31. For example, if you have a statuschange and cancel your participation before December, any
unused balance will be forfeited.
If you enroll midyear, expenses incurred before the date yourenrollment is effective are not eligible for reimbursement. The
effective date generally is the first of the month following yourenrollment, but it may be later, depending on payroll deadlines.
If you enroll in the Health FSA, you will be issued a debit cardthat can be used to pay for eligible health care expenses atapproved health care merchants such as doctors’ offices andpharmacies. Instead of paying first and then filing a claim forreimbursement, the expenses are automatically deducted fromyour account. In some cases you may need to provide WEX
Health, the plan administrator, with documentation to
substantiate the eligibility of your expenses.
Expenses submitted for reimbursement are carefully evaluatedagainst the IRC (§213) list of eligible expenses. If you use your
FSA debit card at a merchant with a health care inventory
information approval system (IIAS) in place, you will not needto go through this process. You may be asked for supporting
documentation if your expenses are not recognized as eligible
expenses. See the WEX Health website (uc-fsa.com) or the
Health FSA Summary Plan Description for more information.
CONTRIBUTION LIMITS AND FORFEITURE RULES
You may contribute a minimum of $180 to a maximum of $3,050
annually to your Health FSA. If both you and your spouse are UC
employees, you may each contribute up to $3,050. The carryover
does not count against the $3,050 maximum contribution.
Be sure to estimate your expenses carefully before enrolling.
Unless you experience a permitted status change (see the
Health FSA Summary Plan Description for details), once elected,
you cannot change the amount of your contribution if you
miscalculate your anticipated expenses or misunderstand what
expenses are eligible. As noted above, you may be required toforfeit some unclaimed funds in your account after the closing
date for the plan year.

48

LIMITED PURPOSE FLEXIBLE SPENDING ACCOUNT
If you are participating in the Health FSA and wish to transfer tothe UC Health Savings Plan (with Health Savings Account) at thestart of a new plan year, the balance remaining in your Health
FSA may be transferred to a Limited Purpose Flexible Spending
Account (FSA).
The Limited Purpose FSA is available only if you meet all thefollowing criteria:• Are eligible for the Faculty/Staff Benefits program• Participated in the Health FSA during a plan year
• Have a carryover balance greater than $25 at the end of thatplan year• Enroll in the UC Health Savings Plan for the following plan year
In the above circumstances, a Limited Purpose FSA will becreated for you automatically by WEX Health (you do not haveto elect to participate). The balance of the Health FSA that iseligible for carryover is placed in the Limited Purpose FSA andavailable for you to obtain reimbursement for allowed expenses
on a pretax basis.
Contributions to the Limited Purpose FSA are limited to
the Health FSA balance; the participant may not contributeadditional funds.
The effective date of the Limited Purpose FSA is Jan. 1 of the year
in which it is created, and the plan terminates on Dec. 31 of thatyear. For example, a Limited Purpose FSA created Jan. 1, 2024,
funded by the remaining Health FSA balance from 2023, is ineffect until Dec. 31, 2024.
There is no carryover provision for the Limited Purpose FSA. Anybalance remaining at the end of the run-out period for the planyear is forfeited.
Participation in the Limited Purpose FSA is limited to one year; aparticipant may not re-enroll for a subsequent plan year.
The Limited Purpose FSA can be used to cover eligible expenses
incurred by you, your spouse and your eligible dependents as
defined by IRS rules (the same as for Health FSA).
The types of expenses that qualify for Limited Purpose FSA
reimbursement are more limited than for the Health FSA, and are
generally restricted to expenses for dental, vision and preventive
care services. Refer to uc-fsa.com or Section 213 of the Internal
Revenue Code for eligible expenses.
To be paid, claims must be for eligible dental, vision andpreventive care services that are not reimbursable from anyother source and must include valid supporting documentation.
Eligible expenses must be incurred between Jan. 1 and Dec. 31of the plan year. Claims must be filed by April 15 of the following
year.
As with the Health FSA, if you terminate employment withfunds left in the Limited Purpose FSA, you may submit claims forany eligible expenses incurred before employment ended. Any

WHEN COVERAGE ENDS AND OPPORTUNITIESFOR CONTINUATION
If you are paid monthly, Health FSA coverage ends the last dayof the month in which you separate from UC. If you are paid
biweekly, coverage ends the last day of the pay period in which
you make your final Health FSA contribution.
If you lose eligibility for the Health FSA, you may continue yourparticipation through COBRA.
The Limited Purpose FSA is also eligible for COBRA continuation,
which allows you to submit claims for eligible expenses incurred
through the end of the plan year. COBRA continuation is valid forthe current plan year only; no funds can be carried forward to thefollowing plan year.

DEPENDENT CARE FSA
The DepCare FSA allows you to pay for eligible expenses forcare of your child or eligible adult dependent on a pretax basis.
After you incur eligible dependent care expenses, you can use
the debit card issued by WEX Health or submit a claim form andreceipts for the expenses to WEX Health. If you file a claim, WEX
Health will reimburse you through an automatic deposit to yourbank or by check.
ELIGIBLE EXPENSES
Dependent care must be necessary so that you, or you and your
spouse, can work or look for work. You must have work income
during the year to participate in the DepCare FSA. If you aremarried, your spouse must also have earned income during theyear, unless your spouse is incapable of self-care or is a full-timestudent.
If care is provided in a day-care center, the center must charge
a fee. If the center cares for six or more children who are notresidents, it must comply with all state and local licensing laws
and applicable regulations.
To be eligible, expenses must be for the following eligible family
members:• A child under age 13 in your custody whom you claim as adependent on your tax return;• A legal spouse (as defined under federal law) who is physicallyor mentally incapable of self-care; and• A dependent who lives with you — such as a child over age 13,
a parent, sibling, in-law or other adult — who is physically or
mentally incapable of self-care, and whom you claim as adependent on your tax return.
If care is provided outside the home for a spouse or a family
member age 13 or older, either of whom is incapable of self-care,
the spouse or family member must live in your home at least
eight hours each day.

There is no carryover feature in the DepCare FSA. However, theplan has a grace period, which ends on March 15, 2025, for the2024 plan year. This means that unused funds contributed in
the 2024 plan year can be used for reimbursement of claims
incurred from your 2024 enrollment date through March 15,2025. The deadline for submitting claims is April 15, 2025.
Expenses incurred after your DepCare FSA participation ends
are not eligible for reimbursement. If you enroll midyear, expenses
incurred before the date your enrollment is effective are noteligible for reimbursement. The effective date generally is thefirst of the month following your enrollment, but may be later
depending on payroll deadlines.
Expenses submitted for reimbursement are carefully evaluatedagainst the IRC requirements for eligible expenses. If yourexpenses are not clearly eligible according to the IRC, you willneed to submit additional information to WEX Health and you
may not be reimbursed for these expenses. In some cases, you
may need a tax adviser’s statement certifying the eligibility ofthe expense.
See the WEX Health website (uc-fsa.com), IRS Publication 503,
Child and Dependent Care Expenses (available on the IRS website
at irs.gov) or the DepCare FSA Summary Plan Description for more
information.
CONTRIBUTION LIMITS AND FORFEITURE RULES
When you enroll in the DepCare FSA, you determine how muchyou want deducted from your monthly pay, from a minimum of$180 per year ($15 per month) to the least of:• Employees who earned under $150,000 in 2023: $5,000 per
plan year ($2,500 if you are married and filing a separate
income tax return);• Employees who earned $150,000 or over in 2023: $3,000 per
plan year;• Your total earned income; or• Your spouse’s total earned income. (You may not contribute to
the DepCare FSA if your spouse’s earned income is $0 and your
spouse is capable of self-care or is not a full-time student.)
The maximum contribution to the DepCare FSA is the same
regardless of your marital status or the number of eligible
dependents.
If your spouse is also eligible to participate in UC’s or another
employer’s dependent care FSA, your combined contributions
cannot exceed the contribution maximum.
Be sure to estimate your expenses carefully before enrolling.
Unless you experience a permitted status change (see DepCare FSA
Summary Plan Description for details) once elected, you cannotchange the amount of your contribution due to miscalculating youranticipated expenses or to misunderstanding what expenses are
eligible. The IRS requires that you forfeit any unclaimed funds inyour account after the closing date for the plan year.

49

ChapterHealth
Title and Dependent Care Flexible Spending Account Plans

unused funds will be forfeited after the run-out period unlessparticipation is extended through COBRA.

Health and Dependent Care Flexible Spending Account Plans

Health and Dependent Care Flexible Spending Account Plans

DEPCARE FSA AND DEPENDENT CARE TAX CREDIT
Your participation in the DepCare FSA may or may not provide
more tax savings than using the federal dependent care tax credit.
Any payment from the DepCare FSA reduces, dollar for dollar,
the expenses eligible for the dependent care tax credit. Your tax
savings from the FSA depend on your particular tax situation. Fora general comparison of the DepCare FSA with the tax credit, see
the DepCare FSA Summary Plan Description.
If you need specific advice about how the DepCare FSA applies
to your tax situation, please consult a tax adviser.

WHEN COVERAGE ENDS
If you lose eligibility for DepCare FSA, contributions and coverageend. If you are paid monthly, DepCare coverage ends the last
day of the month in which you separate from UC. If you are paid
biweekly, coverage ends the last day of the pay period in which
you made your final DepCare contribution. There are no options tocontinue or convert your coverage.

FOR MORE INFORMATIONThis is only an overview of the Health and DepCare Flexible
Spending Account plans. Be sure to review the Summary Plan
Descriptions, available online at ucal.us/EOCs. Additional
information about the FSA plans is available on the WEX Healthwebsite (uc-fsa.com).

50

ChapterLegal
TitleNotifications

Legal Notices

PARTICIPATION TERMS AND CONDITIONSYour Social Security number, and that of your enrolled family
members, is required for purposes of benefit plan
administration, for financial reporting, to verify your identity,
and for legally required reporting purposes all in compliancewith federal and state laws.
If you are confirmed as eligible for participation in UC-sponsoredplans, you are subject to the following terms and conditions:
ARBITRATIONWith the exception of benefits provided or administered by
Optum Behavioral Health, UC-sponsored medical plans require
resolution of disputes through arbitration.
With regard to each plan, except a Kaiser Foundation Health Plan,by your written or electronic signature, IT IS UNDERSTOOD AND
YOU AGREE THAT ANY DISPUTE AS TO MEDICALMALPRACTICE — THAT IS, AS TO WHETHER ANY MEDICALSERVICES RENDERED UNDER THE CONTRACT WEREUNNECESSARY OR UNAUTHORIZED OR WERE IMPROPERLY,NEGLIGENTLY OR INCOMPETENTLY RENDERED — WILL BE
DETERMINED BY SUBMISSION TO ARBITRATION AS
PROVIDED BY CALIFORNIA LAW AND NOT BY A LAWSUIT OR
RESORT TO COURT PROCESS, EXCEPT AS CALIFORNIA LAWPROVIDES FOR JUDICIAL REVIEW OF ARBITRATIONPROCEEDINGS. BOTH PARTIES TO THE CONTRACT, BY
ENTERING INTO IT, ARE GIVING UP THEIR CONSTITUTIONALRIGHT TO HAVE ANY SUCH DISPUTE DECIDED IN A COURT OF
LAW BEFORE A JURY AND INSTEAD ARE ACCEPTING THE USE
OF ARBITRATION.
With regard to enrollment in a Kaiser Foundation Health Plan
(KFHP), I understand that (except for Small Claims Court cases,
claims subject to a Medicare appeals procedure or the ERISA
claims procedure regulation, and any other claims that cannot be
subject to binding arbitration under governing law) any dispute
between me, my heirs, relatives, or other associated parties on
the one hand and Kaiser Foundation Health Plan, Inc., any
contracted health care providers, administrators, or otherassociated parties on the other hand, for alleged violation of any
duty arising out of or related to membership in KFHP, including
any claim for medical or hospital malpractice (a claim that
medical services were unnecessary or unauthorized or were
improperly, negligently, or incompetently rendered), forpremises liability, or relating to the coverage for, or delivery of,services or items, irrespective of legal theory, must be decided
by binding arbitration under California law and not by lawsuit orresort to court process, except as applicable law provides forjudicial review of arbitration proceedings. I agree to give up ourright to a jury trial and accept the use of binding arbitration. I
understand that the full arbitration provision is contained in the
Evidence of Coverage.

For more information about each plan’s arbitration provision
please see the appropriate plan booklet or call the plan.
• UC and UC health and welfare plan vendors comply withfederal/state regulations related to the privacy of personal/
confidential information including the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) as
applicable. To fulfill the responsibilities and perform theservice required under contracts with UC, health plans andassociated service vendors may share UC member healthinformation between and among each other within the limits
established by HIPAA and federal/state regulations forpurposes of health care operations, payment, and treatment.
• By making an election with your written or electronic
signature you are authorizing the University to takedeductions from your earnings (employees)/monthly
Retirement Plan income (retirees)/designated bank account(direct payment retirees) to cover your contributions toward
the monthly costs (if any) for the plans you have chosen for
yourself and your eligible family members. You are also
authorizing UC to transmit your enrollment demographic data
to the plans in which you are enrolled.
• You are subject to all terms and conditions of the UCsponsored plans in which you are enrolled as stated in theplan booklets and the University of California Group
Insurance Regulations.
• By enrolling individuals as your family members you arecertifying that those individuals are eligible for coveragebased on the definitions and rules specified in the Universityof California Group Insurance Regulations and described in
UC health and welfare plan eligibility publications. You arealso certifying under penalty of perjury that all theinformation you provide regarding the individuals you enroll istrue to the best of your knowledge.
• If you enroll individuals as your family members you must
provide, upon request, documentation verifying that thoseindividuals are eligible for coverage. The carrier may also
require documentation verifying eligibility. Verification
documentation includes, but is not limited to, marriage orbirth certificates, domestic partner verification, adoption
papers, tax records and the like.
• If your enrolled family member loses eligibility for UCsponsored coverage (for example because of divorce or loss ofeligible child status) you must notify UC by disenrolling that
individual. If you wish to make a permitted change in yourhealth or flexible spending account coverage you must notify
UC within 31 days of the eligibility loss event; for purposes of
COBRA, eligibility loss notice must be provided to UC within
60 days of the family member’s loss of coverage. However,regardless of the timing of notice to UC, coverage for the
ineligible family member will end on the last day of the month51

Legal Notifications

Legal Notices

in which the eligibility loss event occurs (subject to any
continued coverage option available and elected).
• Making false statements about satisfying eligibility criteria,
failing to timely notify the University of a family member’s
loss of eligibility, or failing to provide verification
documentation when requested may lead to disenrollment of
the affected family members. Employees/retirees may also be
subject to disciplinary action and disenrollment from healthbenefits and may be responsible for any cost of benefits
provided and UC-paid premiums due to misuse of plan.
• Under current state and federal tax laws, the value of thecontribution UC makes toward the cost of health coverage
provided to domestic partners and certain other family
members who are not “your dependents” under state andfederal tax rules may be considered imputed income that will
be subject to income taxes, FICA (Social Security andMedicare), and any other required payroll taxes. (Coverage
provided to California registered domestic partners is not
subject to imputed income for California state tax purposes.)• If you specifically ask UC representatives to intercede on yourbehalf with your insurance plan, University representatives
will request the minimum necessary protected healthinformation required to assist you with your problem. If more
protected health information is needed to solve your problem,in compliance with state laws and federal privacy laws(including HIPAA), you may be required to sign an
authorization allowing UC to provide the health plan with
relevant protected health information or authorizing thehealth plan to release such information to the University
representative.

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITYACT OF 1996 (HIPAA) NOTIFICATION FOR MEDICALPROGRAM ELIGIBILITY• If you are declining enrollment for yourself or your eligible
family members because of other medical insurance or group
medical plan coverage, you may be able to enroll yourself andyour eligible family members1 in a UC- sponsored medical planif you or your family members lose eligibility for that othercoverage (or if the employer stops contributing toward theother coverage for you or your family members.) You must
request enrollment within 31 days after you or your family
member’s other medical coverage ends (or after the employer
stops contributing toward the other coverage).
In addition, if you have a newly eligible family member as aresult of marriage or domestic partnership, birth, adoption, or
placement for adoption, you may be eligible to enroll your newly
eligible family member. If you are an employee you may be
eligible to enroll yourself, in addition to your eligible family
member(s). You must request enrollment within 31 days after
the marriage or partnership, birth, adoption, or placement for
adoption.
If you decline enrollment for yourself or for an eligible family
member because of coverage under Medicaid (in California,
Medi-Cal) or under a state children’s health insurance program(CHIP) you may be able to enroll yourself and your eligible family
members in a UC-sponsored plan if you or your family members
lose eligibility for that coverage. You must request enrollment
within 60 days after your coverage or your family members’
coverage ends under Medicaid or CHIP.

• Actions you take during Open Enrollment will be effective thefollowing Jan. 1 unless otherwise stated — provided allelectronic and form transactions have been completed
properly and submitted timely.
• By enrolling in the Critical Illness, Hospital Indemnity or
Accident plans you acknowledge that you have read and agree
to the below Product Disclaimers. You understand the terms
and requirements of the fraud warnings included as part ofthe disclaimers and you declare that all information given istrue and complete to the best of your knowledge and belief.
Hospital Indemnity
https://gi.prudential.com/groupinsurance/forms/Disclaimers/
HIP_DISCLAIMERS.pdf
Accident
https://gi.prudential.com/groupinsurance/forms/Disclaimers/
ACCIDENT_DISCLAIMERS.pdf
Critical Illness
https://gi.prudential.com/groupinsurance/forms/Disclaimers/
CRITICAL_ILLNESS_DISCLAIMERS.pdf

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1

To be eligible for plan membership, you and your family members must meet all
UC employee or retiree enrollment and eligibility requirements. As a conditionof coverage, all plan members are subject to eligibility verification by the
University and/or insurance carriers, as described above in the participation
terms and conditions.

IF YOU DO NOT ENROLL YOURSELF AND/OR YOUR FAMILYMEMBER(S) IN MEDICAL COVERAGE WITHIN THE 31 DAYS
WHEN FIRST ELIGIBLE, WITHIN A SPECIAL ENROLLMENTPERIOD DESCRIBED ABOVE, OR WITHIN AN OPEN
ENROLLMENT PERIOD, YOU MAY BE ELIGIBLE TO ENROLL AT
A LATER DATE. However, even if eligible, each affectedindividual will need to complete a waiting period of 90
consecutive calendar days before medical coverage becomes
effective and employee premiums may need to be paid on anafter-tax basis (retiree premiums are always paid after-tax).
Otherwise, you/they can enroll during the next Open Enrollment
Period.
To request special enrollment or obtain more information,
employees should contact their local Benefits Office and retirees
should call the UC Retirement Administration Service Center(800-888-8267).
Note: If you are enrolled in a UC medical plan you may be able tochange medical plans if:• you acquire a newly eligible family member; or• your eligible family member loses other coverage.
In either case you must request enrollment within 31 days of theoccurrence.
In addition to the special enrollment rights you have under
HIPAA, the University’s Group Insurance Regulations (GIRs)
permit you to change medical plans under certain otherconditions. See UC GIRs for additional detail.

Legal Notifications

Also, if you are eligible for health coverage from UC but cannot
afford the premiums, some states have premium assistanceprograms that can help pay for coverage. For details, contact the
U.S. Department of Health and Human Services, Centers for
Medicare and Medicaid Services at www.cms.gov or
1‑877‑267‑2323.

NOTICE REGARDING ADMINISTRATION OF BENEFITSBy authority of the Regents, University of California Human
Resources, located in Oakland, administers all benefit plans inaccordance with applicable plan documents and regulations,custodial agreements, University of California Group Insurance
Regulations, group insurance contracts, and state and federallaws. No person is authorized to provide benefits information
not contained in these source documents, and information notcontained in these source documents cannot be relied upon as
having been authorized by the Regents. Source documents areavailable for inspection upon request (800-888-8267). What is
written here does not constitute a guarantee of plan coverageor benefits — particular rules and eligibility requirements
must be met before benefits can be received. The Universityof California intends to continue the benefits described here
indefinitely; however, the benefits of all employees, retirees andplan beneficiaries are subject to change or termination at thetime of contract renewal or at any other time by the University
or other governing authorities. The University also reserves theright to determine new premiums, employer contributions andmonthly costs at any time. Health and welfare benefits are
not accrued or vested benefit entitlements. UC’s contribution
toward the monthly cost of the coverage is determined by UC
and may change or stop altogether, and may be affected by thestate of California’s annual budget appropriation. If you belong
to an exclusively represented bargaining unit, some of yourbenefits may differ from the ones described here. For more
information, employees should contact their Human Resources
Office and retirees should call the UC Retirement Administration
Service Center (800-888-8267).
In conformance with applicable law and University policy, theUniversity is an affirmative action/equal opportunity employer.
Please send inquiries regarding the University’s affirmative
action and equal opportunity policies for staff to Systemwide
AA/EEO Policy Coordinator, University of California, Office of
the President, 1111 Franklin Street, Oakland, CA 94607, andfor faculty to the Office of Academic Personnel and Programs,
University of California, Office of the President, 1111 Franklin
Street, Oakland, CA 94607.

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