University of California, San Diego

November 21, 1994
SUBJECT: Benefits Open Enrollment
Open enrollment for benefit plans will continue through November 30, 1994. All enrollment forms must be in the Benefits Office or to Payroll by that date. This is the month to make changes to your health & welfare plans (excluding life
and disability) for 1995.
HSP - The Health Service Program (HSP) will continue to coordinate with the Prudential High Option Plan for the 1995 plan year. Under HSP, UCSD physicians and the UCSD Medical Center have agreed to accept the insurance payment as payment in full, so participants are not responsible for deductibles and copayments. HSP applies only to services covered by the insurance and provided by full-time UCSD faculty physicians within the UCSD Medical Group, UCSD Medical
Center or Medical Group facilities. (HSP will not be part of the redesigned UC Care).
Disability and Life Insurance Enrollment - Enrollment in disability and life insurance are open to employees who are within a period of initial eligibility (PIE). An employee who wants to enroll outside a PIE needs to complete a "Statement of Health" and apply directly to the carrier. This request may be done at anytime because these two plans are not subject to open enrollment.
The Statement of Health can be obtained by calling the Benefits Office at 534-2816. The information needed to process the request consists of the following: employee's name, social security number, mail code, and type and amount of coverage requested. The form is sent to the employee's mail code for completion of health-related questions and mailed by the employee directly to the carrier. The carrier will notify the employee of its decision to provide or
deny coverage. If the employee is accepted for coverage, the Benefits Office will send an enrollment form to the employee for completion.
UC Care - To enroll in the redesigned UC Care, an employee needs to complete Form 809 for University records and Form 809A for the carrier. Both forms may be obtained from your department benefit contact. All eligible family members will transfer with the employee. The 809 needs to be mailed to Benefits (0926) or Payroll (0952) by November 30, 1994. The 809A needs to be mailed directly to
Prudential at the following address: The Prudential Insurance Company of America, Special Processing / UC Administration, P.O. Box 9232, Van Nuys, CA 91499-4013.
If an employee is already enrolled in UC Care and wishes to continue for 1995, only the 809A needs to be completed and mailed directly to the address above. This form designates your primary care physician (PCP) for utilization of Tier 1
services under the UC Care Medical Plan. If a form is not received by Prudential, they will select a PCP according to zip code. The PCP may be changed in the future by contacting Prudential.
If you have any questions regarding this notice, you may contact the Campus Benefits Office on x42816 or the Medical Center Benefits Office on x36709.
Rogers Davis
Assistant Vice Chancellor