Open Enrollment Benefits Worksheet - Adobe Sign
Employees with the last names A - L
Employees with the last names M - Z
Medical, Dental and/or FlexCash Changes. Complete this worksheet if you would like
to:
· Enroll, cancel or make changes to your medical, dental and/or FlexCash option (requires
additional form)
· Add/delete eligible dependents
FlexCash Form - Adobe Sign
Employees with the last names A - L
Employees with the last names M - Z
Enroll or cancel Flexcash - if enrolling, proof of non-CSU insurance is required.
Open Enrollment Flexible Spending Account form for HCRA and/or DCRA - Adobe Sign
Click here to enroll or re-enroll in a Flexible Spending Account.
VSP Vision:
Click Here to enroll or dis-enroll in VSP Premier
CSU Health Plans:
CSU Health Plan 2024 Rates
HMO—Health Maintenance Organization. Requires you to receive care through a network of providers. You must select a
primary care physician, who is responsible for coordinating your health care, including
referrals to specialists.
PPO—Preferred Provider Organization. Lets you choose from a network of preferred providers. A primary care physician
is not required and no referrals are necessary for other in-network providers. You
pay more to use an out-of-network provider.
Health Plans Online (Evidence of Coverage)
Health Plan by Zip Code Coverage
Delta Dental (PPO) and Delta Care USA (HMO)
No changes to these employer-paid plans.
Vision Basic Plan and Vision Premier Plan
Employees will enjoy new plan enhancements such as higher frame and lenses allowance,
ultraviolet (UV) protection and VSP Primary Eyecare Plan which includes, for members
with diabetes, it offers retinal screenings and additional exams.
There are also services available to members with glaucoma or age-related macular
degeneration, and the treatment and diagnosis of eye conditions like pink eye, vision
loss and cataracts, at no additional cost or premium increase.
Health Care Reimbursement Account Plan
This plan allows you to set aside a portion of your pay on a pretax basis to reimburse
yourself for eligible health, dental and vision care expenses for you, your spouse/registered
domestic partner and eligible dependent(s). You may contribute up to $3,050 for the
2024 plan year through payroll deduction. Enrollment in the Health Care Reimbursement
Account (HCRA) is required each year along with your designated contribution amounts.
The 2024 monthly minimum is $20.00 and the maximum is $254.16. ASIFlex is the claims administrator for this plan.
HCRA Brochure
Dependent Care Reimbursement Account Plan
The Dependent Care Reimbursement Account plan (DCRA) allows you to set aside a portion
of your pay on a pretax basis to reimburse yourself for childcare expenses for your
eligible dependent child(ren) under the age of 13. Additionally, if you have an older
dependent who lives with you and requires assistance with day-to-day living and is
listed as a dependent on your annual tax return, you can claim these eligible expenses
through your DCRA. You may contribute up to $5,000 each plan year ($2,500 if married,
filing a separate tax return) through payroll deduction. Neither contributions nor
reimbursements are taxed. Enrollment in the DCRA is required each year along with
your designated contribution amounts. The 2024 monthly minimum is $20.00 and the maximum
amount is $416.66. ASIFlex is the claims administrator for this plan.
DCRA Brochure
The Open Enrollment period also provides you with the opportunity to enroll or cancel
in the following voluntary plans.
ARAG Legal Plan: The California State University is excited to announce that effective January 1,
2024 we are partnering with ARAG® to offer legal insurance to our employees. ARAG
will offer you greater legal protection at a lower price than our current vendor. The ARAG legal insurance benefit will cost $16.95 per month and continue to come out of your paycheck via payroll deduction.
The ARAG legal insurance benefit will replace the MetLife legal plan as of January 1, 2024. Current MetLife legal plan participants do not need to do anything further to receive
legal protection under the ARAG plan in 2024; you will be automatically enrolled in
the new plan via payroll deduction. On January 1st, you will receive a welcome email
from ARAG with your Member ID and steps to get started.
If you are currently in the MetLife Legal plan and do not wish to be automatically enrolled in the new ARAG plan, please contact ARAG Customer Care
at 800-247-4184 or service@ARAGlegal.com before the end of Open Enrollment on October 13, 2023 at 5pm and provide policy ID number 19061csu.
You can learn more about ARAG by visiting their website at ARAGlegal.com/CSU, and
entering ACCESS CODE 19061csu or by calling Customer Care at 800-247-4184 and mentioning
ACCESS CODE 19061csu.
Get to Know ARAG Flyer
Legal Insurance from ARAG Flyer
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California Casulty Auto, Home and Renters Insurance: The Chancellor’s Office offers all its employees auto and homeowner’s insurance
through California Casualty. This employee-paid voluntary plan allows employees to
make payments through payroll deduction. Employees can save an average of over $500
and receive unique benefits like: free/waived deductible if your vehicle is hit/vandalized
on campus, identity theft protection, 12-month rate lock guarantee, no charge personal
property coverage up to $500 and payroll deduction available at no cost to active
employees or monthly E-Z Pay Plans with skip payment options. Employees can enroll
at any time. For more insurance information, safety resources or to get a quote, visit
calcas.com/csu or call (866) 680-5142.
California Casulty Flyer
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Fidelity - CSU 403(b) Supplemental Retirement Plan (SRP): California State University 403(b) Supplemental Retirement Plan (SRP) is a voluntary
employer sponsored retirement savings account that is meant to supplement CalPERS
pension and Social Security income in retirement. The benefit allows employees to
put extra income aside for retirement in a tax deferred retirement savings account
where the money can be invested. Fidelity Investments is the administrator/record
keeper for this plan. To learn more about Fidelity please visit their website.
CSU 403b SRP Plan Flyer
Enrollment Guide
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Nationwide Pet Insurance: Nationwide is offering two benefit options for your pets. This insurance can cover
your pet’s accidents, illness and even preventive care and wellness services. Plans
are available for dogs, cats, birds, small mammals and exotics (such as reptiles).
To learn more about this plan and/or to enroll, visit their website at www.petinsurance.com/calstate
or call (877) 738-7874.
Nationwide Pet Insurance Flyer
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The Standard Insurance: The Standard offers a variety of insurances including:
You can learn more about The Standard by visiting their website at www.standard.com/mybenefits/csu or call 800-378-5745.
The Standard Open Enrollment Offering Flyer