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Benefits Frequently Asked Questions

How much do I pay for my benefits?

Medical - You will find the monthly medical plan costs on At Your Service.

Dental - UC pays the entire cost of monthly dental premiums for you and your family members.

Vision - UC pays the entire cost of monthly vision premiums for you and your family members.

Flexible Spending Accounts - The Flexible Spending Accounts (FSA) allow you to pay eligible expenses on a pretax, salary reduction basis.  Dependent Care FSA (DepCare FSA) is for eligible dependent care expenses and Health FSA is for eligible health care expenses not covered by your medical, dental, or vision plans. You decide how much to contribute to your Flexible Spending Accounts.

Life Insurance – You pay for supplemental life insurance for yourself and your eligible family members. Premium is based on your age and annual salary. Use the Insurance Premium Calculator to estimate your premiums based on your salary.

Supplemental Disability Insurance - You pay for supplemental disability insurance for yourself. Premium is based on your age, your annual salary, and the waiting period you select. Use the Insurance Premium Calculator to estimate your premiums based on your salary.

Accidental Death & Dismemberment Insurance – You pay for the cost of this insurance for yourself and your eligible family members. See the Cost Chart for coverage and pricing options.

Legal Insurance – You pay for the cost of this plan for yourself and your eligible family members. Click on Plan Costs to find the monthly premium for legal insurance.

Family Care - UC offers Bright Horizons Care Advantage™, a comprehensive web-based resource, to help you balance work and family responsibilities. The Bright Horizons Care Advantage programs — Sittercity, Years Ahead, BrightStudy and Bright Horizons preferred enrollment — provide information about pre-screened care providers and services so you can choose the solution that’s right for you. Click here to find more about Bright Horizons Care Advantage. Click here to find more about Bright Horizons Care Advantage.

Auto/Renter/Homeowner Insurance - UC Merced is proud to introduce faculty and staff to an opportunity to access discounted auto and home insurance from Farmers GroupSelectSM. Farmers GroupSelect can help you compare savings on auto, home, and renter's insurance using Farmers Insurance ChoiceSM. Farmers Insurance Choice is a powerful tool that gives you access to multiple quotes from top carriers, so you can choose the auto, home, and renter's insurance for your individual needs.

If you’re interested in taking advantage of this employee benefit, call Farmers GroupSelect at 1-866-700-3113, or visit Farmers GroupSelect to go get your quotes today.

Business Travel Accident Insurance - When traveling on official University business you will be covered by ACE USA at no cost to you, but you must register to ensure coverage for each business trip. The coverage is worldwide, 24 hours a day, for a wide variety of accidents and incidents while away from the workplace. Click here to find out more information on UC Travel Insurance.

Long Term Care – UC does not offer a long-term care plan.

Current Enrollments - Sign-in to UC Path to find your current enrollments and monthly deductions.

Total Compensation - The value of your UC employment goes beyond your salary. As a UC employee, you enjoy a full range of benefits, services and programs. Use the Total Compensation Calculator to estimate the value of your total UC compensation.

When will my insurance start?

For most plans, you’re covered on your first day at work (hire date) or eligibility date, but it can take 30-60 days after you enroll for the insurance companies to have a record of your enrollment. So if you need immediate services, check with your insurance carriers first to see if they have a record of your enrollment.

How do I rush my enrollment if I need immediate medical, drug or dental services?

Health and welfare benefits begin on your date of hire, but it can take up to 30 -60 days before the medical, dental, vision and/or legal plans will have your new eligibility added to the insurance membership systems.

To have an urgent request expedited, You would need to contact UCPath Center by Submitting An Inquiry via your UCPath Portal or call UCPath directly at (855) 982-7284

 

Will I receive ID cards for my health insurance plans; if so, when?

Medical - You and each family member you enroll will receive a medical plan ID card. The cards are mailed to your address after your enrollment is processed by the medical plan. It can take 30 - 60 days for the medical plan to process new enrollments. If you have not received your medical ID card, please click on your medical provider and scroll down to ID card section. The ID card section will provide you with information on how to obtain a medical ID card and contact information.

Kaiser, scroll down to ID cards
UC Blue & Gold, scroll down to ID cards
UC Care, scroll down to New ID Cards
UC Health Savings Plan, scroll down to New ID Cards
Western Health Advantage, scroll down to ID cards
CORE, scroll down to New ID Cards
 
Dental Plans – You don’t need a dental plan ID card for Delta Dental PPO or DeltaCare USA. To receive your dental benefits just provide your name, your date of birth, your enrollee ID or social security number and the name of your employer (if you have an employer-sponsored plan). If you want and ID card anyway, visit Get your ID card.
 

Vision Plan – An ID card, or Member Vision Card, isn't required for you to receive services or care. If you want and ID card anyway, VSP members can download ID cards from the VSP Benefits & Claims website.

How do I order medication by mail to save money?

Your medical plan's mail order pharmacy is the most cost effective way to purchase medication that you take over a long period of time. When you order your maintenance medication by mail, you get a 90 day supply for the cost of 60 days at a retail pharmacy.

  • Go to your plan's website to find a Prescription Mail Order Form or call the Member Services number on your medical plan ID card.

You will need a new prescription to send with the mail order form.  Ask your physician for a 90-day mail order prescription with refills, if medically appropriate.

How do I get a second opinion outside of my HMO medical group?

California law allows for a second opinion consultation when you have questions about a diagnosis, want more information about a treatment plan or if you are not satisfied with the results of treatment you have received. 

If you’ve seen a specialist in your medical group (e.g. Mercy Medical Center), you may request a second opinion consultation with a physician outside of your medical group from your insurance plan (e.g. Health Net, Kaiser, Anthem Blue Cross).  See the requirements by plan listed below.

The consulting physician must be a provider for your insurance plan.  The approval will go faster if you know which specialist you wish to consult for the second opinion.

Second opinion referrals are for consultation ONLY.  The consulting physician will not be able to order tests or provide any treatment unless that level of care is pre-approved in the referral authorization. You should provide the second opinion specialist with all relevant medical records and test results for review - take them with you or send them to the specialist prior to your appointment. (Make sure you request your records well in advance of the appointment.)

You pay your normal office visit copay.

Call your insurance plan to request a second opinion consultation. 

  • The member services representative will ask you a few questions to clarify your situation:
    • what is your diagnosis
    • the name of the specialist you consulted in your medical group
    • the name of the physician you wish to see for the second opinion consultation
  • The insurance will confirm the consulting physician is in the HMO network.
  • Once the consultation is approved, the insurance will send both you and the consulting physician a written authorization explaining the limits of the consultation.

1-800-539-4072          Health Net Member Services

1-800-464-4000          Kaiser Member Services

1-888-209-7975          Anthem Blue Cross Plus Member Services

Requirements by Plan:

Blue Cross Plus – In-Network (HMO):
Blue Cross Plus members must FIRST ask their HMO physician for an authorization to see a physician outside of their HMO medical group for the second opinion.  If that request is denied by the physician or the medical group, the member can call Anthem member services to request a second opinion consultation.  

Tell Anthem Member Services that you wish to use your in-network benefits for the consultation.  Ask Member Services to refer the request to the Transition Department for review. You can select from Anthem Plus and Anthem PPO providers for the second opinion.

Health Net HMO
The second opinion physician MUST be in the SAME specialty as that of the specialist seen within the medical group.  You may select from Health Net and Health Net Blue Gold physicians.

When can I change my Primary Care Physician (PCP)?

HMO medical plans require you to select a Primary Care Physician (PCP) to manage your care.  You may request a different Primary Care Physician (PCP) at any time.  You do not have to wait until Open Enrollment to change your PCP.

How do I change my Primary Care Physician (PCP)?
  1. Call your medical plan’s customer service number to request the change. You can find the number on your medical ID card.
  2. Ask the insurance representative when the PCP change will be effective. If you call the medical plan before the 15th of a month, the change will be effective the first of the next month. If the change is made after the 15th, it will be effective the first of the next month.
  3. Use your medical plan’s website to search for a PCP.  Your PCP must be located within a 30-mile radius of your primary residence or workplace and in your medical plan’s service area.
  4. Each family member may choose a different PCP from the doctors who are contracted with your medical plan.

When you pick your PCP you are also choosing a medical group (e.g. Mercy Medical Center).  HMO physicians are affiliated with a medical group of specialists and hospitals that you may use for non-emergency care.  The PCP you select  will oversee your care and authorize visits to specialists in the medical group.

Can each family member have a different Primary Care Physician (PCP)?

Yes. Each family member may choose a different PCP from the doctors who are contracted with your medical plan.

How do I find a doctor in my medical plan?

Go to Find a Doctor on At Your Service. You will find lists of participating physicians on each insurance plan website. 

HMO medical plans require you to select a Primary Care Physician (PCP) to manage your care.  When you pick your PCP you are also choosing a medical group (e.g. Mercy Medical Center).  HMO physicians are affiliated with a medical group of specialists and hospitals that you may use for non-emergency care.  The PCP you select  will oversee your care and authorize visits to specialists in the medical group.

I’m going on vacation, how can I get my prescription drug refilled early?

Call the Member Services number on your medical ID card.  They can authorize a “vacation override” so you can get a 30 day supply of medication to take with you. 

If you need more than a one month supply, please contact the Health Care Facilitator.

How do I change my address?

Sign-in to UCPath Portal to change your address. Navigate to Employee Actions > Personal Information > Personal Information Summary.

How do I add a family member to my benefits?

You have 31 days from the "qualifying event" to add a family member to your benefits. Qualifying events include birth, adoption, marriage, or establishing a domestic partnership.

Instruction for how to enroll on UCPath.

How do I remove a family member from my insurance?

Family members become ineligible for UC-sponsored benefits through divorce, the end of a domestic partnership, death, or when children become too old (generally age 26).  Whenever a family member loses eligibility to participate in UC-sponsored plans, it is your responsibility to de-enroll that family member.

Go to UCnet for information about eligibility and sign on to your online UCPath account to disenroll your family member.

How do I opt-out of or cancel an insurance plan?

If you are a new hire within the 31 day period of initial eligibility (PIE), you can opt of your benefits in UCPath. To opt out of your benefits, go to the UCPath Benefits Enrollment page, and then select Waive.

If you do not enroll in your benefits within your PIE, you automatically waive your benefits.

 

How do I enroll in or make changes to my life insurance coverage?
After your 31-day period of initial eligibility (PIE) has ended, you can still enroll in or increase Supplemental Life Insurance coverage. To enroll in or increase Supplemental Life Insurance coverage, complete the Short-Form Health Questionnaire then follow the Prudential form instructions. Prudential will review your request to determine eligibility – approve or deny. Contact Prudential for further eligibility questions at 877-889-2070.

If approved by Prudential, you must complete the HSA, Life Insurance, Supplemental Disability, and AD&D Change form. Follow the form instructions, and then submit the form with approval notification from Prudential to UCPath by Submitting An Inquiry. If you do not submit the approval notification and form, your enrollment will not occur

How do I enroll in or make changes to disability coverage?
To enroll in disability coverage after you first became eligible (the first 31 day Period of Initial Eligibility), Complete the Evidence of Insurability form through Lincoln Financial and Fax the completed form to Lincoln Financial at 603-427-1813.
  • Requesting to enroll in disability after your PIE ended requires Lincoln Financial approval. Lincoln Financial will contact you if any additional information is required. For more information, contact Lincoln Financial at 800-838-4461
If approved, you must then complete the HSA, Life Insurance, Supplemental Disability, and AD&D Change form and submit to UCPath by Submitting An Inquiry, along with the approval notification. If this is not complete, enrollment will not occur.
 
Resources

Disability and Life Insurance Premium Calculator

Health and Welfare Benefits Information

Life Insurance Information

Family Changes Fact Sheets

How to make changes (UCPath)

Plan Contacts

Workers' Compensation FAQ

This FAQ was prepared by the UC Merced Benefits Team to help you understand the Workers' Compensation Program at UCM. You will find answers to the most frequently asked questions about what happens if you have a work-related injury or illness. 

What is Workers' Compensation? 

Workers' Compensation is a state mandated insurance plan to provide benefits and assistance to all workers who are injured as a result of thier employement or who develop job-related illnesses. This is a "no fault" system that does not try to place blame on either the employer or the employee. 

Benefits may include: medical costs, temporary disability, permanent disability, vocational rehabilitation, or death benefits. The objective of the UCM Workers' Compensation Program is to assist in your quick recovery and return to work. 

What is a work related injury? 

The California Labor Code's definition of the term "injury" includes "any injury or disease arising out of employment and occuring in the course of employment." The injury may result from a trauma or disease. 

  • Specific Injury - Injury to one or more parts of the body resulting from a specific injury
  • Cumulative trauma injury - Injury from repetative traumatic activities over a period of time, such as exposure to chemicals or fumes.
  • Aggravation - A pre-existing condition or non-work-related condition aggravated by an occupational injury or disease. The employer provides medical treatment until the employee returns to the pre-injury status of the pre-exisiting condition.

When am I covered by Workers' Compensation? 

Generally, Workers' Compensation coverage begins the first minute you are on the job and continues any time you are officially on the job performing a service for the University as an employer or official volunteer.

Workers' Compensation does not provide coverage for injuries that occur during the normal commute to or from work; that occur during an unpaid mealtime; that result from recreational activities; that result from substance abuse or intoxication; or that result from starting a physical fight or engaging in horseplay.

What should I do if I'm injured on the job? 

Immediately report your injury to your supervisor. If in normal business hours, you will be sent to the Occupational Health Clinic on campus for treatment. If you want to be treated by your own doctor, you must fill out the Designation of Physician form in advance and have it on file with the Workers' Compensation Office. 

You or your supervisor need to complete the Employee RSS Injury & Illness Report. See the Injury and Illness Reporting Procedure.

What are my responsibilities? 

  1. Report your inury or illness to your supervisor.
  2. Forward any disability or work status slips from your doctor to your supervisor and keep your supervisor up to date about your progress.
  3. Keep track of any time you are away from work due to Workers Comp appointments
  4. Participate in your recovery.
  5. Advise your supervisor when your doctor releases you to return to work either as fully recovered or able to participate in the Transitional Return to Work Program.
  6. Keep all pertinent documents for your records.

Who will decide if my claim is accepted? 

The Workers' Compensation Office coordinates all decisions concerning claims with Sedgwick CMS (Claims Management Services), the company contracted to administer all Workers' Compensation Claims for the UC campuses.

When is a decision made about my claim? 

Within 14 days after filing a workers' compensation claim, Sedgwick CMS will notify you of your claim's status. Your claim will be accepted, denied, or delayed. 

If the injury or illness clearly arises from your employment it will be accepted. If if clearly does not, it will be denied. If the administrator needs more time to gather information, the claim is delayed. The administrator may gather additional information by talking directly with you, with your supervisor or colleagues, or by asking your consent to review your medical records. The administrator will notify you by letter when a decision will be made. 

What will my cost be for Workers' Compensation? 

There is no charge to you if your claim is accepted. Medical care approved by Sedgwick CMS will be covered at no cost to you. 

What do I do when I receive Work Status Report? 

The treating physician may state that you can return to work, return to work with modified duty due to work restrictions, or that you require time off work to heal. Whatever the recommendation by the treating physician, you must present a Work Status Report to your supervisor. This report is completed by the treating physician. If the supervisor is not available, email the Work Status Report to the Workers’ Compensation office.

When you have been released from the physician’s care, the physician should indicate so on the Work Status Report. Present this to your supervisor or the Workers’ Compensation office.

How does Prescription Medication work?

If your medical provider issues you a prescription for a work-related injury/illness, you must contact the Workers’ Compensation office for a “first-fill” letter to get your first prescription filled. The University of California has a contract with Optum/Tmesys to administer the Pharmacy Benefit Network (PBN) for workers’ compensation claims. Optum/Tmesys utilizes specific pharmacies in their network.

For additional information, see the Pharmacy Benefit Network poster (English or Spanish).

What if my injury/illness has been developing gradually? 

If your injury or illness developed gradually, such as hearing loss, report it as soon as you learn it was caused by your job.

How soon after an incident must it be reported? 

Incidents must be reported within 24 hours of University’s first notice of incident so that prompt and appropriate remediation can take place. Always report an incident, no matter how small.

What if the employee requires time off of work or needs ongoing treatment? 

  • Follow up with employee continuously on medical treatments
  • Forward all medical notes to the Workers’ Compensation office.
  • If the employee is out for more than 3 continuous working days, contact Human Resources to request a Family Medical Leave (FMLA) packet.
  • Work with the Disability Specialist on a transitional return to work agreement during the employee’s recovery period.

Who can I contact for further assistance? 

Contact our workers' compensaton department at benefits@ucmerced.edu

What do I put on my timesheet if I have a workers compensation appointment? 

If you have an appointment outside of on campus OCC Health, you will need to record sick or vacation hours. If the appointment is after work hours, no action is needed.