Eligibility for CSU Benefit Programs

Eligibility for CSU Benefit Programs

Employees appointed half-time or more for a period of more than six months are eligible to enroll themselves and eligible dependents in their benefit plans. There is currently no exclusion for pre-existing physical conditions.

Faculty Employee Benefits Eligibility

  • Academic year with an appointment of halftime (.50) or more. For continuance of benefits for the spring semester, your time base for spring must be half time or more. If your time base decreases to less than half time your benefits will be canceled.
  • Part-Time Faculty with an appointment of at least .40 (6/15) weighted teaching units for at least one semester or academic year. The employee will then need to maintain an active status of .40 (6/15) weighted teaching units each month to continue benefit eligibility. If your time base decreases to less than .40 (6/15) your benefits will be canceled.
  • Part-Time Faculty Benefits Eligibility
    Note: Part-time Faculty with appointments in classifications—2358, 2375, 2378, 2381 or 2384

Dependent Eligibility

All health plans will require a Social Security number and a copy of the Birth Certificate for each enrolled dependent (i.e., exceptions spouse and domestic partner).

Eligible employees may enroll for self only or for self and all eligible family members (who are not otherwise enrolled as an employee, annuitant or dependent under another CalPERS plan- the PEMHCA Health Benefits Program). All dependent(s) are required to provide a Social Security number and proof of appropriate dependent eligibility (i.e. marriage certificate, declaration of domestic partnership, birth certificate, certificate of adoption).

Family members are defined as:

  • Spouse (Requires a copy of Marriage Certificate)
  • Domestic Partners: same-sex domestic partners over age 18 and opposite-sex domestic partners with one partner age 62 or older whose domestic partnership is registered with the Secretary of State are eligible. (Requires a copy of Declaration of Domestic Partnership.)
  • Your natural children, adopted children, or stepchildren must be under age 26 regardless of whether or not they are living with you.
  • A child over age 26, who is incapable of self-support due to a mental or physical condition that existed prior to age 26, may be included when you first enroll. A Questionnaire for Disabled Dependent Benefit Form (HBD-98) and Medical Report for the CalPERS Disabled Dependent Benefit Form (HBD-34) must be approved by CalPERS prior to enrollment and must be updated upon request. Note: The enrollment of a disabled child over age 26 is subject to CalPERS approval.
  • Another person's child under age 26 may be eligible for coverage if a parent-child relationship exists.  An Affidavit of Parent - Child Relationship form (HBD-40) must be filed prior to enrollment with appropriate documentation.   Recertification is required on an annual basis.   Please contact Human Resources for additional information (559) 278-2032.

Enrollment Eligibility

Split Enrollments: Members who are married and who both work or worked (retirees), for agencies in the CalPERS Health Program can enroll separately. If you and your spouse enroll separately, you must enroll all eligible family members, regardless of the relationship, under only one of you. Dependents cannot be split between parents. For example, if a CalPERS member with children marries another CalPERS member with children and each member has their own enrollment in the CalPERS Health Program, all children must be enrolled under one parent. The effective date of coverage will be the first of the month following the date of marriage. If split enrollments are discovered, they will be retroactively corrected. You will be responsible for all costs incurred from the date the split enrollment began.

Dual Coverage: You cannot be enrolled in a CalPERS health plan as a member and a dependent or as a dependent on two enrollments. This is called dual coverage and it is against the law. When dual coverage is discovered the coverage will be retroactively canceled. You may have to pay for all costs incurred from the date the dual coverage began.