Making Changes to Your Benefits

Changes can be made to your benefits within 

30 days of a qualifying event or during Open Enrollment every Fall. 

To submit your change forms, 

fax 415-386-1074, 

mail 2130 Fulton St, LM 339, SF, CA 94117, 

drop off in person at Lone Mountain 339, 

unless online submission is noted below. 

• Switch between Anthem Blue Cross & Kaiser Permanente: 
  • Switch from Anthem to Kaiser: Drop Anthem Blue Cross and enroll in Kaiser Permanente as explained in sections below.
  • Switch from Kaiser to Anthem: Drop Kaiser Permanente and enroll in Anthem Blue Cross as explained in sections below.
• Switch between Medical Waiver and USF Health Coverage: 
  • Switch from Medical Waiver to Kaiser/Anthem: Revoke waiver and enroll in Kaiser Permanente or Anthem Blue Cross as explained in sections below. 
  • Switch from Kaiser/Anthem to Medical Waiver: Waiver USF Health Coverage and and drop Kaiser Permanente or Anthem Blue Cross as explained in sections below.
• Employee Enroll in Anthem Blue Cross: Submit form with only these sections completed: 
  • Applicant's Personal Information (except Hire date, Employer Name, Job Title, Class, Dept. no., Email Address);
  • Employee and Family Information (except HMO ONLY, Current MD, Dental Net);
  • Other Coverage for All Enrolling Employees and Dependents (except C); 
  • Medicare Section (only if answered yes to Other Coverage question D); 
  • Prior Coverage for PPO Plans Only; 
  • Please Read Carefully - Signature Required.
• Employee Drop Anthem Blue Cross: Submit form with only these sections completed: 
  • Applicant's Personal Information (except Hire date, Employer Name, Job Title, Class, Dept. no., Email Address);
  • Declination (except B, C, D);
  • Please Read Carefully - Signature Required.
• Employee Enroll in Kaiser Permanente: Submit form with only these sections completed: 
  • B. Employee (except Work Phone, Home Phone, E-mail, Ethnicity, Preferred Language);
  • C. Family;
  • D. Kaiser Foundation Health Plan Arbitration Agreement.
• Employee Drop Kaiser Permanente: Submit form with only these sections completed: 
  • Write "Drop Coverage" clearly at the top of the form;
  • B. Employee (except Work Phone, Home Phone, E-mail, Ethnicity, Preferred Language);
  • D. Kaiser Foundation Health Plan Arbitration Agreement.
• Employee Waive USF Health Coverage: Submit copy of proof of insurance and Medical Waiver with only these sections completed: 
  • Employee Name;
  • USF ID Number;
  • Box 1: I hereby waive my choice of health plan...;
  • Signature;
  • Date.
• Employee Revoke waiver of USF Health Coverage: Enroll in Kaiser Permanents or Anthem Blue Cross as explained in previous sections and submit Medical Waiver with only these sections completed: 
  • Employee Name;
  • USF ID Number;
  • Box 2: I hereby revoke my waiver of the USF health plan;
  • Signature;
  • Date.
• Employee Enroll in Delta Dental: Submit form with only these sections completed: 
  • A. Enrollee (except Date Employed, Action Requested, Please enroll me in the following, Marital Status, Do you have dependent children, Does your spouse have a dental plan, Employee Classification, COBRA Enrollment);
  • C. Dependents;
  • D. Signature.
• Employee Drop Delta Dental: Submit form with only these sections completed: 
  • Write "Drop Coverage" clearly at the top of the form;
  • A. Enrollee (except Date Employed, Action Requested, Please enroll me in the following, Marital Status, Do you have dependent children, Does your spouse have a dental plan, Employee Classification, COBRA Enrollment);
  • C. Dependents;
  • D. Signature.
• Employee Enroll in VSP: Submit form with only these sections completed: 
  • Check "Enroll" 
  • A. Subscriber Information (except Date Employed, Marital Status);
  • C. Dependents;
  • Subscriber Signature.
• Employee Drop VSP: Submit form with only these sections completed: 
  • Check "Cancel Coverage" 
  • A. Subscriber Information (except Date Employed, Marital Status);
  • C. Dependents;
  • Subscriber Signature.
• Add dependents to health coverage: Enrollment in each provider, as explained above, and proof of relationship are required to add dependents to health coverages. For more information regarding qualified dependents and the documentation required, click here.
  • Enroll child under age 19: Enroll in coverages as explained in previous sections and submit copy of birth certificate, adoption papers or court document certifying custody.                              
  • Enroll child age 19-26: Enroll in coverages as explained in previous sections, submit certification form that dependent has no other access to health coverage and submit copy of birth certificate, adoption papers or court document certifying custody. 
  • Enroll child age 26 and older: Enroll in coverages as explained in previous sections, submit proof of condition making the dependent incapable of self-sustaining employment by reason of mental or physical handicap and submit copy of birth certificate, adoption papers or court document certifying custody. 
  • Enroll spouse: Enroll in coverages as explained in previous sections and submit copy of marriage certificate. 
  • Enroll Registered Domestic Partner as Legally Domiciled Adult (LDA): Enroll in coverages as explained in previous sections and submit copy of California Domestic Partner registration. 
• Remove dependents from health coverage: 
  • Anthem Blue Cross: Drop Anthem Blue Cross as explained in previous section;
  • Kaiser Permanente: Drop Kaiser Permanente as explained in previous section - except do not write "Drop Coverage" on form and complete section C Family;
  • Delta Dental: Drop Delta Dental as explained in previous section - except do not write "Drop Coverage" on form and complete section B Change to Existing Enrollment;
  • VSP: Drop VSP as explained in previous section - except check "Change Dependent Status: Drop" and complete section B Change Existing Enrollment Forms.

Flexible Spending

• Enroll in Flexible Spending Account for 2012: Submit online application as detailed below. To skip enrollment in a Healthcare or Dependent Daycare account, simply "waive" that account instead of noting a contribution amount.
  • I am a First Time User (consult here to create this enrollment login, which is separate from account maintenance);
  • Open Enrollment (click "Begin the Enrollment Process");
  • Employee Info *NOTE: Information from Banner completes many fields. Others, such as Marital Status, Smoking Status and Medicare Status, have no bearing on eligibility or enrollment;
  • Dependent Info (SKIP section as dependent information is not pertinent to this enrollment); 
  • Healthcare FSA;
  • Dependent Daycare FSA *NOTE: Childcare Subsidy recipients should note the total contribution amount (Childcare Subsidy plus any personal contribution) in the "Employee Only" contribution section. USF will contribute the amount confirmed in the Childcare Subsidy confirmation email. To apply for the Childcare Subsidy, apply as explained in the section below. 
  • Review (click "Finish" to submit your application) *NOTE: You can review your elections throughout Open Enrollment under the tab "Life Events". To edit your elections throughout Open Enrollment, complete the steps of this process again. A confirmation email will not be sent from USF Human Resources for your Flexible Spending Account elections. 
• Apply for USF Childcare Subsidy: Complete all sections of online application. Once you have received a confirmation email, enroll in a Flexible Spending Account for 2012 as explained in previous section.

Life Insurance

• Enroll in Optional Life Insurance Coverage: Submit form with only these sections completed: 
  • Employee Section;
  • Term Life Insurance;
  • Accident Insurance;
  • Beneficiary; 
  • Acceptance/Declination; 
  • Medical Questionnaire Questions A-K;
  • Life Plan Designs;
  • Agreements;
  • Employee's Signature;
  • Month/Day/Year. 

Retirement

• Opt-Out of the automatic TIAA-CREF 403(b) 3% Contribution (deadline March 31, 2012): Beginning January 1, 2012, employees who are currently contributing less than 3% into a 403(b) account with TIAA-CREF, Fidelity or Valic will be automatically enrolled in a TIAA-CREF 403(b) with a pre-tax contribution made from each paycheck. 
• If you would like to opt-out of this automatic enrollment, please submit this form. 
• If you are currently contributing less than 3% into a 403(b) account, you will be automatically enrolled with TIAA-CREF for the difference between 3% and your contribution level. 
• If you are currently contributing 3% or more into a 403(b) account, your current election will continue and you will not be automatically enrolled. There is no need to complete the Opt-Out Form since you will not be automatically enrolled in anything.  

Commuter Benefit

• Enroll in Commuter Benefit through Clipper Card: Submit completed form and an invitation will be emailed to you. For more information about Clipper Direct, please refer to our Clipper Direct webpage. 

Tuition Remission

• Apply for Tuition Remission: Submit completed application. For more information regarding the Tuition Remission benefit, consult the website. 

Don't see the change you'd like to make listed above? Changes are possible throughout the year and you can contact a Benefits' Staff member for more information.