FULL TIME STUDENTS
Office of Retirement Services provides benefit coverage for adult children according to the following criteria:
MEDICAL PLANS: Adult children between ages 19 and 26 without regard to student or marital status.
DENTAL AND VISION PLANS: Adult children between ages 19 and 24 who are unmarried and full-time students.
Office of Retirement Services requires retirees to provide proof of their adult child’s full-time student status in order to establish eligibility for coverage under the City’s dental and vision plans through the following calendar year.
QUALIFYING FULL-TIME STUDENT DEFINITION FOR DENTAL AND VISION PLANS
A full-time student is defined as a retiree’s adult child between the ages of 19 and 24 who is enrolled as a full-time student.
Full-time enrollment is defined as follows:
- Carrying 12 or more undergraduate units per semester or 12 or more undergraduate units per quarter, or 6 or more graduate units per semester or 6 or more graduate units per quarter, at an accredited college or university, or enrolled in a college or university on a full-time basis as defined by the school; or
- Enrolled in a technical, trade or occupational school on a full-time basis (as defined by the school).
Verification Policy For Full-Time Student Dependents
The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to continue health coverage for yourself and your dependents if you involuntarily lose your health benefits.
- Coverage must be continuous and you'll be required to pay premiums from the date your CSJ coverage ended.
- You must submit a COBRA Election Form within 60 days following notification of eligibility.
- Your premium cannot exceed 102 percent of the group monthly premium rate.
Ending COBRA Coverage:
COBRA coverage for you or your dependents remains in effect until one of the following events terminates the coverage:
- Coverage through another group health plan
- Coverage time limit ends
- Eligibility for Medicare coverage
- Failure to pay the required premium
- You request cancellation
You can purchase health coverage through Covered California, California's health insurance marketplace, as an alternative to purchasing COBRA coverage. You may be eligible for premium tax credits through Covered California to help you pay for coverage if you lose your CSJ health benefits. Even if you don't qualify for tax credits, you may shop https://www.coveredca.com for health coverage options as an alternative to COBRA.
INDIVIDUAL CONVERSION POLICY
An Individual Conversion Policy is an alternative to COBRA or can follow COBRA coverage. If you lose your CSJ health benefits or COBRA coverage, you can request an Individual Conversion Policy through your prior health plan. You must request this new policy within 30 days of losing coverage. All CSJ health plans offer this Individual Conversion Policy option, but your cost and benefits will differ from your previous coverage.
Open Enrollment is an annual process that occurs every November 1 through November 30. During this time, you can enroll in or change health plans, add eligible dependents, delete dependents, or cancel coverage. Changes made during Open Enrollment become effective January 1st.
During the Open Enrollment Period, Retirees can submit their changes electronically through their Member Direct account.
Please note, for some changes such as adding a new spouse or adding a new dependent, additional documents are required. These additional documents must be mailed through U.S. postal service or scanned and emailed to SJROpenEnrollment@sanJoseca.gov. Please include your name when sending emails.
IMPORTANT HEALTH ENROLLMENT REMINDERS
- Be aware that a medical group ending its contract with a health plan doesn't create a qualifying event to change plans outside of Open Enrollment.
- ID cards are issued by each health plan, not by the Office of Retirement Services. Contact your health plan directly if you need additional cards.
Carefully review your pension check to ensure the health plan premium deduction was made when you change health plans, enroll for the first time, or add/delete dependents.