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Participation terms and conditions

Your Social Security number, and that of your enrolled family members, is required for purposes of benefit plan administration, for financial reporting, to verify your identity, and for legally required reporting purposes all in compliance with federal and state laws.

If you are confirmed as eligible for participation in UC-sponsored plans, you are subject to the following terms and conditions:

Arbitration

With the exception of Optum Behavioral Health and UC Medicare Choice, all UC medical plans require resolution of disputes through arbitration.

This arbitration agreement applies to the following plans:

  • UC Care
  • UC Health Savings
  • CORE
  • UC Blue & Gold HMO
  • UC High Option Supplement to Medicare
  • UC Medicare PPO
  • UC Medicare PPO without Prescription Drugs

By providing your written or electronic signature, it is understood and you agree that any dispute as to medical malpractice — that is, as to whether any medical services rendered under the contract were unnecessary or unauthorized or were improperly, negligently or incompetently rendered — will be determined by submission to arbitration as provided by California law and not by a lawsuit or resort to court process, except as California law provides for judicial review of arbitration proceedings. Both parties to the contract, by entering into it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury and instead are accepting the use of arbitration.

This arbitration agreement applies to ONLY the Kaiser Foundation Health
Plan.

With regard to enrollment in a Kaiser Foundation Health Plan (KFHP), I understand that (except for Small Claims Court cases, claims subject to a Medicare appeals procedure or the ERISA claims procedure regulation, and any other claims that cannot be subject to binding arbitration under governing law) any dispute between myself, my heirs, relatives, or other associated parties on the one hand and Kaiser Foundation Health Plan, Inc., any contracted health care providers, administrators, or other associated parties on the other hand, for alleged violation of any duty arising out of or related to membership in KFHP, including any claim for medical or hospital malpractice (a claim that medical services were unnecessary or unauthorized or were improperly, negligently, or incompetently rendered), for premises liability, or relating to the coverage for, or delivery of, services or items, irrespective of legal theory, must be decided by binding arbitration under California law and not by lawsuit or resort to court process, except as applicable law provides for judicial review of arbitration proceedings. I agree to give up our right to a jury trial and accept the use of binding arbitration. I understand that the full arbitration provision is contained in the Evidence of Coverage.

For more information

For more information about each plan’s arbitration provision please see the appropriate plan booklet or call the plan.

Additional terms and conditions applicable to all plans

Except where specifically noted below, the following terms and conditions apply to the health and welfare benefit plans provided to benefits-eligible employees, retirees and family members, including medical, dental, vision, life, disability, accident, critical illness, hospital indemnity, accidental death and dismemberment, flexible spending accounts, identity theft protection, legal, pet, family care resources and adoption assistance plans.

  1. By making an election with your written or electronic signature you are authorizing UC to take deductions from your earnings (employees)/monthly Retirement Plan income (retirees)/designated bank account (direct payment retirees) to cover your contributions toward the monthly costs (if any) for the plans you have chosen for yourself and your eligible family members. You are also authorizing UC to transmit your enrollment demographic data to the plans and associated service vendors in which you are enrolled.
  2. You are subject to all terms and conditions of the UC-sponsored plans in which you are enrolled as stated in the plan booklets and the University of California Group Insurance Regulations.
  3. By enrolling individuals as your family members you are certifying that those individuals are eligible for coverage based on the definitions and rules specified in the University of California Group Insurance Regulations and described in UC health and welfare plan eligibility publications. You are also certifying under penalty of perjury that all the information you provide regarding the individuals you enroll is true to the best of your knowledge.
  4. If you enroll individuals as your family members you must provide, upon request, documentation verifying that those individuals are eligible for coverage. The carrier may also require documentation verifying eligibility. Verification documentation includes, but is not limited to, marriage or birth certificates, domestic partner verification, adoption papers, tax records and the like.
  5. If your enrolled family member loses eligibility for UC-sponsored coverage (for example because of divorce or loss of eligible child status) you must notify UC by de-enrolling that individual. If you wish to make a permitted change in your health or flexible spending account coverage you must notify UC within 31 days of the eligibility loss event; for purposes of COBRA, eligibility loss notice must be provided to UC within 60 days of the family member’s loss of coverage. However, regardless of the timing of notice to UC, coverage for the ineligible family member will end on the last day of the month in which the eligibility loss event occurs (subject to any continued coverage option available and elected).
  6. Making false statements about satisfying eligibility criteria, failing to timely notify UC of a family member’s loss of eligibility, or failing to provide verification documentation when requested may lead to de-enrollment of the affected individuals. Employees/retirees may also be subject to disciplinary action and de-enrollment from health benefits and may be responsible for any cost of benefits provided and UC-paid premiums due to misuse of plan.
  7. Under current state and federal tax laws, the value of the contribution UC makes toward the cost of health coverage provided to domestic partners and certain other family members who are not “your dependents” under state and federal tax rules may be considered imputed income that will be subject to income taxes, FICA (Social Security and Medicare), and any other required payroll taxes. (Coverage provided to California registered domestic partners is not subject to imputed income for California state tax purposes.)
  8. If you specifically ask UC representatives to intercede on your behalf with your insurance plan, University representatives will request the minimum health information required to assist you with your problem. If more health information is needed to solve your problem, in compliance with state and federal privacy laws, you may be required to sign an authorization allowing UC to provide the health plan with relevant health information or authorizing the health plan to release such information to the UC representative.
  9. Provided all electronic and form transactions have been completed properly and submitted timely, actions you take during Open Enrollment will be effective the following January 1 unless otherwise stated.