Health Benefits FAQ's
Health Benefits:
Q: I am a new employee. When do I have to return the Health Benefits enrollment paperwork?
A: 30 days from the date of hire. (ex. Hire Date: 05/01/25, Return Forms By: 05/31/25)
Q: I am a new employee. When will my Health Benefits become effective?
A: The first day of the month following the completion of a 30-day waiting period. (ex. Hire Date: 05/01/25, Benefit Eligibility Date: 06/01/25)
Q: Do I have to enroll in medical, dental, and vision?
A: No, you can enroll in any combination of the medical, dental and/ or vision benefits. Please be aware that whatever you are enrolled in, all dependents must be enrolled in the same. (ex. If you are enrolled in medical only, your dependents will only have medical only as well. If you are enrolled in medical, dental and vision, your dependents will be in medical, dental and vision. Their coverage has to mirror yours).
Q: What qualifies a child as a dependent?
A: Natural children, legally adopted, legal guardianship, or stepchildren under the age of 26.
Q: Who does not qualify as an eligible dependent?
A: A boyfriend, girlfriend, ex-spouse/ partner, former stepchildren, parents, nieces/ nephews, siblings, aunts/ uncles and grandparents.
Q: What is a qualifying event that would allow me to add or drop coverage for a child or spouse outside of Open Enrollment?
A: Marriage, filing a domestic partnership, divorce, birth, loss of other coverage, eligibility for coverage for employee or dependents under spouse’s coverage.
Q: What is the time frame I have to add or delete a dependent (child/ spouse)?
A: Within 30 days from the date of birth, marriage, divorce or eligibility for/loss of other coverage. (ex. Qualifying Event Date: 05/01/25, Return Forms By: 05/31/25, Health Benefit Eligibility Date: 05/01/25)
Q: When does coverage begin or end when adding or deleting a dependent (child/ spouse)?
A: First of the month following the event date. (ex. Qualifying Event Date: 05/01/25, Return Forms By: 05/31/25, Health Benefit Eligibility Date: 05/01/25)
Q: What is required to add/ delete a dependent (child/ spouse)?
A: You will need to complete and return an enrollment/ changes form and acceptable documentation for your spouse and/ or children; for removing dependents, the divorce decree or proof of other coverage.
Q: At what age do my dependent children drop off my coverage?
A: Last day of coverage is the end of the month that the child turns 26 (ex. Dependent Child's Birthday: 11/13/1992, Health Benefits Terminate: 12/01/2018). For a legal guardianship, the dependent drops off at age 18.
Q: Do my dependent children need to be financially dependent on me for support, claimed as dependents on my tax return, residents of my household, enrolled as students, or unmarried?
A: No.
Q: Is it my responsibility to notify the Insurance Department when a dependent (child/ spouse) becomes eligible or ineligible?
A: Yes, with the exception of when a child turns 26 as the dependent will be automatically removed form your plan.
Q: Will I be responsible for the District portion of insurance premiums paid if ineligible dependents have not been deleted from my plan?
A: Yes.
Q: How do I change my personal and/ or or contact information with the Insurance carriers?
A: You can send an email to one of our Insurance department contacts and cc Human Resource Services (hrservices@capousd.org). We will then relay your information changes to VEBA (the trust that administers our insurance) and they will relay it to the insurance carrier(s).
Q: If I do not make changes within the appropriate time frame, when will the next opportunity be?
A: During Open Enrollment or due to another qualifying event.
Q: When is Open Enrollment?
A: Open Enrollment usually occurs in the fall (October/ November) and any changes or selections made during that time will become effective the first of the following year (ex. Open Enrollment: 2024, Changes Become Effective: January 1, 2025).
Q: Where can I see what health benefit plans I am currently enrolled in?
A: You can log into your MyCUSD account and click on 'Employee Portal', then the 'My Insurance' tab to view your current plan selections, premiums, and dependents.
Q: How do I check my paystub to make sure the correct deductions are being taken each month?
A: You can review your current enrollments and premiums by logging into your MyCUSD account and logging into your OCDE EIS account to review your current and past paystubs.
Q: I don't have a VSP insurance card, how can I use services?
A: VSP is a paperless service. You can visit the Vision Plans section of our department website for more information.
Q: I don't have a Delta Dental PPO insurance card, how can I use services?
A: Delta PPO is a paperless service. You can visit the Dental Plans section of our department website for more information.
Q: I'm trying to pick up a prescription with United Health Care and it says I'm not covered, what do I do?
A: United HealthCare uses Express Scripts for prescription coverage. If you do not have an Express Scripts ID card please call them at (800) 918-8011 to review the option to virtually access your ID card(s).
Q: I'm a teacher who is considering Article 15 Reduced Workload Program (RWP), what happens to my insurance coverage?
A: Please review the information regarding Article 15 on Human Resource Services Webpage.
Q: I'm an employee and may not be coming back to work for the next school year. What happens to my health benefits?
A: If you are a Classified 9.5 mpy employee that was newly hired within the current school year and do not return to your position after completing your current work calendar, your health benefits will remain intact through August 31st. All other employees that complete their current work calendar/ contracted year will have health benefits remain intact through September 30th. This is due to a difference in health deduction schedule.
COBRA:
Q: If I lose district-sponsored health benefits, will I be offered any type of coverage?
A: You will be offered continuation coverage for your current health plans through COBRA (Consolidated Omnibus Budget Reconciliation Act) at the full premium cost, plus a 2% administrative fee.
Q: Where would I find the COBRA rates and information?
A: Visit the COBRA section of our department wesbite.
Retirement:
Q: At what age may I retire from the District?
A: CUEA: 55 years old, per union contracts.
CSEA: 50 years old; however, the Retiree will pay the full cost of coverage until reaching age 53, per union contracts.
Q: How many consecutive years of service with the District do I need to be eligible for retiree medical benefits?
A: 10 or more, per union contracts.
Q: What percentage of the monthly premium is the district responsible for during my retirement?
A: Based on years of service, the percentage is anywhere between 50% to 100%. Please visit the Retiree section of our department page for more information.
Q: I am thinking of retiring. If I complete my contracted school year, when do my health benefits with the District end?
A: September 30th.
Q: Is there an option to keep dental coverage?
A: Yes, with the full cost being the responsibility of the Retiree.
Q: Is there an option for Vision?
A: Not through the Retiree plan. However, vision coverage can be temporarily continued through COBRA for up to 18 months or until the participant turns 65, whichever comes first.
Q: Until what age may I keep my Retiree Medical Benefits with the District?
A: The first of the month that you turn sixty-five, due to Medicare eligiblity and union contracts. We do not communicate with Medicare, therefore, it is your responsibility to contact them at least three months prior to ensure that there is no lapse in coverage.
Q: Is there option to keep Dependents on my Retiree coverage?
A: Only a dependent spouse is applicable to retiree medical and dental coverage. You can keep dependent children (under the age of 26) on your medical coverage, but not your dental. As a reminder, Retirees pay the full cost of dental coverage.
Workers' Compensation:
Q: If I get hurt on the job, what do I need to do?
A: Report the injury immediately to your immediate supervisor and/ or office manager. You can visit home page of our department website and scroll down to the 'Workers' Compensation' tab under 'Important Information' for more information.
