Insurance Benefits

Graduate Medical Education offers Anthem Blue Cross Health, Vision Services Plan (VSP) vision, Standard dental, Standard life, and Standard long-term disability insurance at no cost to House Officers. Please note that initial enrollment and enrollment changes to your health benefits are your responsibility. It is not an automatic process. Once enrolled, your benefits will automatically continue until the termination of your training.

Open Enrollment
Open Enrollment occurs every year for the entire month of June. Changes made to plans during Open Enrollment will be effective on July 1st. Please allow the insurance carriers some time to receive the data and process the changes. Log on to the enrollment website at https://www.eenroller.net/btrac/broker.asp?ST=UCSD0001 to make your elections. 

• Instructions for online enrollment system
  
• AY2011-12 changes to plans 

Detailed Plan Description

For a summary of benefits, including a breakdown of covered services and co-payment amounts, please refer to the Benefits Booklet   - [224 kb]. Please print or save the following Certificates of Coverage for your records: 

• Anthem Blue Cross (formerly Blue Cross):
  • Prudent Buyer (PPO)   
  • California Care (HMO)  
  • Prescription Drug Plan
    • PPO Rx Benefits 
    • HMO Rx Benefits 
    • Home Delivery Service Form (Express Scripts) 
    • Pharmacy Listing
      
• Standard Pro-Dent (Dental)
• Vision Service Plan (VSP)
• Life Insurance
• Long Term Disability (LTD) Insurance

Important Notices

• Medicaid and the Children's Health Insurance Program (CHIP) Notice
  
• Prescription Drug Coverage and Medicare
  
• Medicare Part D Notice (Oct 2011)
  
• Disclosures of Healthcare Reform Changes in 2011
  

Online Insurance Enrollment

Newly employed House Officers (including returning trainees from a break of service) will have 31 days to make elections.  There are no exceptions to this thirty-one day eligibility period, barring documented physical or mental incapacity that would prevent you from completing the enrollment process.

House Officers can now enroll online by clicking on this link  and using these instructions  .  If you can not access the link or are having trouble with the site, please contact Elaine Garrido.  Although we are phasing out the paper enrollment forms, you have the option of using them if you do not have access to a secured computer.  Forms should be faxed to 619-543-7850, scanned and emailed to Elaine Garrido, or walked into the GME office.

• Anthem Blue Cross Enrollment Form - [166 kb]: For initial enrollment or for changing between PPO and HMO only.
• Anthem Blue Cross Change Form   - [75 kb]: Please only use this form if you are already enrolled in Blue Cross and simply need to make adjustments to your current insurance coverage.
  
• Anthem Blue Cross Affidavit of Domestic Partnership  - [101 kb]: Please complete this form to enroll your domestic partner.
• Standard Insurance Enrollment and Change Form 
• Vision Services Enrollment Form
  
  
  

Enrollment Changes

You may only add dependents to your insurance plans during the open enrollment period which occurs in the month of June of every year, or, the thirty-one day period following a qualifying event.*  A qualifying event may be the birth of a child, marriage, adoption, the six-month anniversary of a domestic partnership, loss of insurance coverage, etc. Please note, you may need to send in certification of the qualifying event, such as an Affidavit of Domestic Partnership  or an official letter from your (or your dependent's) insurance carrier or benefits office of termination of insurance coverage.  There are no exceptions to this thirty-one day eligibility period, barring documented physical or mental incapacity that would prevent you from completing the enrollment change.

To add or delete a dependent, or to change your name or address, please visit our Online Enrollment Website (see heading "Online Insurance Enrollment" above).  

* For Standard Dental and Vision Services Plan (VSP) Insurance, you may enroll your child at any point during the year up to their second birthday.

Insurance Cards

If you have not received your insurance card, please contact the Insurance Carrier directly to verify enrollment and order a replacement card. You will only receive insurance cards from Anthem Blue Cross and Standard Dental. To print out an Anthem Blue Cross temporary ID card for immediate use, please follow these instructions (you will need your Member ID number from Anthem Blue Cross).

If you wish to see a doctor but do not have an insurance card, you will need your social security number and the following Group Numbers:

• Anthem Blue Cross PPO - #1230CA
• Anthem Blue Cross HMO - #57J13A
• Standard Dental - #515691-0001
• Vision Services Plan - #12170630-0003-0003

Reimbursements

If you have incurred charges for covered services before your insurance was processed, but after the effective start date of your coverage, you may receive a reimbursement for those charges. Please be sure to save all receipts of payments and/or any billing statements. Please contact the insurance carrier directly for Reimbursement Claim Forms.

Locating a Provider

The following faculty physicians have volunteered to be listed as eager to provide primary care to UCSD House Officers: UCSD Primary Care Physicians for House Officers

• Anthem Blue Cross PPO
  • For 100% coverage, you may go to any UCSD Medical Center or the Children's Hospital of San Diego
  • For 80% coverage, please visit Anthem Blue Cross
  • For 60% coverage, you may see any doctor you like
• Anthem Blue Cross HMO
  
  • Anthem Blue Cross HMO Network 
  • UCSD Medical Group Physicians
• Standard Dental  (PPO Nationwide)
• Vision Services Plan (VSP) 

Billing Disputes

The GME office can only provide information on the payment status of your insurance premiums.  For all billing disputes, please contact the insurance carrier directly.  Please always make sure to verify the coverage of any medical services before seeking medical care.

If you have questions about medical charges, please:

1. Review the Certificates of Coverage (see above under heading "Detailed Plan Description").
2. Call the Financial or Billing department. The contact information should be located on your bill. Clarify any charges incurred.
   • Many problems are caused by the billing office incorrectly coding your medical services.  Any errors can be corrected by your doctor's financial or billing department.
3. If the charges were incurred in error, please contact the Insurance Carrier directly to resolve your dispute.
   • You may need to fill out a reimbursement claim form or your doctor's office may need to resubmit the bill.
4. If you were charged correctly, please pay the bill promptly.  You may also contact the Insurance Carrier for an explanation of why the services were not covered.