Santa Clara University

Human Resorces

Frequently Asked Questions

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General Questions
What is SCU's benefits philosophy and guiding principles?

The University's strategic plan calls for us to "implement a comprehensive compensation strategy that is affordable within the University's resources, addresses the problem of housing costs, and is sufficiently competitive to attract and retain excellent faculty and staff."

SCU offers comprehensive health care and insurance benefits designed to promote and sustain good health for you and your family, help cushion financial obligations associated with illness or death, and assist in building a retirement income.

The following principles guide us in developing and providing health care options to faculty and staff:

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Which employees are eligible for benefits?

All regular employees of the University working minimum of 20 hours per week is eligible for healthcare coverage provided by the University. Eligible family members, whose eligibility has been defined by the University's contract with the provider, may be covered by these plans provided the employee pays the required contribution.

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How many hours per week are required to be eligible for benefits?

All regular employees of the University working at least 20 hours a week are eligible for healthcare coverage provided by the University. Eligible family members, whose eligibility has been defined by the University's contract with the provider, may be covered by these plans provided the employee pays the required contribution.

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Where can I find information on SCU benefits?

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Overview of Benefits Committee
What is the Benefits Committee and what is its purpose/charge?

The Benefits Committee will be a free-standing committee, reporting to the Administration and Finance Vice-President. Its mandate will be to meet with representatives of and advise the Department of Human Resources and facilitate communication between the Department of Human Resources and the SCU community concerning benefit issues.

The University Coordinating Committee will appoint four members: two from faculty and two from staff. Faculty and Staff appointments will run for 3 years except where necessary to maintain staggered terms. Members must be benefits eligible. The criteria used by the UCC in selecting committee members will include willingness to study issues in order to reach informed conclusions; openness to the collaboration necessary to reach balanced solutions; the ability to consider a wide range of, at times competing, interests fairly; and the desire both to disseminate information about the committee's work to the SCU community, and to collect feedback and ideas from the SCU community to bring to the committee. Changes in the size or composition (for example, faculty versus staff) of the membership will be made jointly by the UCC and the Administration and Finance Vice-President.

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Who are the faculty and staff representatives on the Benefits Committee?

Terms are from July to the following June.

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What issues have the Benefits Committee been focusing on this year?

Health care costs, on average, are doubling every 7.3 years. Given this, the Benefits Committee focused its efforts on exploring options that will allow the University and its employees to share in the costs to balance.

How has SCU and the Benefits Committee undertaken a review of benefits?

During the past year, the Benefits Committee has met with Dave Cannon, the University-retained insurance broker (Barney & Barney), on a monthly basis to prepare for the Annual Health and Welfare Benefits Renewal process in late August 2013. The Benefits Committee meets to discuss different areas of SCU’s benefits programs. The time invested includes learning more about SCU’s health plans and other trends in the health care industry, health education and consumer-driven plans, keeping abreast of current literature and government legislation, including the new health care reform bill, and understanding employee benefits programs offered by other institutional cohorts.

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The Need For Change
Why are benefit plan changes necessary?

Rising health care costs are far outpacing inflationary figures and stripping available University financial resources. Increasing at about 10 percent each year, health care is the fastest growing cost driver in the University budget. The University must explore options that might help mitigate some of these costs.

In such difficult economic times, why must employees pay more for health care?

Without change, the University will diminish its ability to carry out its strategic initiatives of the University’s mission. The University is committed to hiring and retaining excellent faculty and staff through offering a competitive benefits package. However, in order to do so, the University must be able to financially meet these obligations and may need for the employees to share more in these costs to be able to maintain its current benefits programs.

How much does the University spend on benefits for faculty and staff?

Benefits for faculty and staff cost approximately $44M.

Each year, the Vice President of Administration and Finance presents information on the budget to faculty and staff in March at the Budget Forum. The information presented can be found in the Fiscal Year 2014 Budget Forum Presentation (PDF 423KB).

How does this relate to the total SCU budget?

Faculty and staff salaries and benefits account for approximately 50% (175M) of the University operating budget of $333M. This information can be found in the Fiscal Year 2014 Budget Forum Presentation (PDF 423KB).

What strategies is the Benefits Committee employing to moderate costs?

As a part of the on-going discussions between the Benefits Committee and the broker, the Committee is working to safeguard the health care plans and has identified four fundamental ways to address this widening challenge:

Typically the committee recommends a combination or a blend of the four fundamental components when recommending annual health insurance plans and rates.

What is the time frame for any changes?

Any changes will be effective with the new Plan Year, January 1, 2014. Exact contribution amounts for SCU’s health plans will be available once annual rates are set. This information will be available prior to Open Enrollment (mid-through November 2013). Health plan descriptions and rates also will be published in Open Enrollment material in October when faculty and staff choose their benefits for the following calendar year, January 1, 2014.

Health Care Costs
How much do I currently pay for health care?
Do I have a choice of health plans?
How much will faculty and staff members contribute toward health coverage?
What can individual faculty and staff members do to help reduce or control our health care expenses?

It is important for faculty and staff to take an active role in reviewing their benefit offerings during the open enrollment period each year. This time allows for employees to adjust and reconsider their choices and coverage to meet their changing needs.

The key to reigning in escalating health care costs is a strong focus on prevention, early intervention and wellness. If you haven't already done so, schedule your annual physical and make sure you and your family members are getting the preventive care exams you need. Utilizing primary care physicians or urgent care facilities before an emergency room visit (if treatment is not an emergency) reduces your overall costs. In addition, FDA approved generic medications instead of brand name drugs can also provide enormous savings.

Can you tell me how the new health care reform legislation will impact my benefits?

The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act were signed into law in March, 2010. As a result of the new legislation, effective June 1, 2010, the maximum coverage age for dependent children changed from age 24 to age 26, and student status was no longer required as a condition for eligibility for coverage.

Both Kaiser and Blue Cross sent out notifications to those employees and their families who may have been impacted by this change.

Is there any place I can go to find information/resources about these topics?

Yes. The Department of Health and Human Services will continue to issue detailed guidance on the new Patient Protection and Affordable Care and Health Care and Education Reconciliation Acts. We will continue monitoring this guidance to determine how the new laws affect Santa Clara University's Plans and look forward to sharing more information with you. In the meantime, you may search the Library of Congress website at http://thomas.loc.gov/ for the most recent versions of bills that have been signed into law or see the following sites for more information:

Summary of New Acts

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Understanding Benefits Terms
What is a Health Maintenance Organization (HMO)?

An HMO is a group of providers associated with or contracted by a medical insurance administrator. These providers include physicians, hospitals, pharmacies and laboratories. All non-emergency treatment must be received by one of these providers.

Which HMO's are available at Santa Clara University?

Kaiser Permanente and Blue Cross.

What type of HMO is Kaiser?

Kaiser is an HMO which owns its medical facilities and employs its own providers (i.e. physicians, nurses, lab technicians etc.) Kaiser offers full-service facilities which includes a hospital, physician's offices, pharmacy and lab. The closest full facility to SCU is about 15 minutes from campus.

What type of HMO is Blue Cross?

Blue Cross is an administrator that has contracted with private practicing physicians, medical groups, hospitals, pharmacies and laboratories. A physician you are currently using may be part of the Blue Cross network. For the most current provider network listing, visit Blue Cross' website at www.anthem.com/ca.

What is a Primary Care Physician (PCP)?

A Primary Care Physician is your primary doctor. This doctor coordinates all of your care. Therefore, specialty care must be referred by your PCP. A PCP is defined as an internist, general practitioner, family practitioner and pediatrician.

When do I choose my PCP?

With Blue Cross you must choose a PCP at the time you enroll in the medical plan. You may change your PCP at any time by contacting Blue Cross through their website or by calling the Member Services department. Kaiser does not require the selection of a PCP at the time of enrollment.

When Can a Specialist's Services be Obtained?

Specialist care must be referred by your PCP. Exceptions: Blue Cross and Kaiser allow self referral to a contracted OB/GYN for all women's health related symptoms and treatment, including the annual well woman exam. Both Blue Cross and Kaiser allow self referral to a contracted chiropractor.

Does Blue Cross require that the Specialist be contracted with the same medical group as the PCP?

Yes. Please check with your PCP for details.

Are there any limitations to the plans available based on where I live?

Most of the plans have a designated service area in which you must reside to be eligible for the plan. Check with the insurance carrier for service area restrictions.

What is a Preferred Provider Organization (PPO)?

A delivery system where providers are under contract to a carrier to provide care at a discount for a fixed fee, and the health provider provides incentives to patients to use the contracting providers. Employees can reduce their annual deductible, and the portion of the medical bill they pay, by selecting providers from a specific network of physicians and or facilities.

What does Network mean?

The doctors, clinics, hospitals and other medical providers that a carrier contracts with to provide health care to its covered persons at discounted rates.

What does "In-network" mean?

When the participants choose to receive care from providers who participate in a network under the plan, this is considered receiving care "in-network." Some plans have a "gatekeeper" who must authorize all care to have that care covered at in-network levels under the plan.

What is an Individual deductible?

The dollar amount or "deductible" that an employee must pay for covered services before the insurance pays.

What is a Lifetime Maximum?

The maximum amount the plan will pay toward a member's coverage during the employee's lifetime.

What is an Out-of-pocket maximum?

The maximum amount that a covered person must pay for medical expenses covered under the plan. It is the sum of deductibles, co-payments or coinsurance. Some charges do not count toward this maximum.

What is reasonable and customary?

The amount customarily charged for the service by physicians in the area and the reasonable cost of services for a given patient after medical review of the services.

What is a co-pay?

Co-pays are the amounts you pay toward health services when you visit the doctor or physical therapist, for example, or fill a prescription at the pharmacy.

What are premiums and co-premiums?

The premium is the total amount paid each month to the insurance company for the cost of your health insurance. The University covers most of this cost. The co-premium (also called employee contribution) is the amount you contribute each month toward the cost of the health insurance plan you select during Open Enrollment. In most cases, your co-premium is deducted on a pre-tax basis from your paycheck.

Click here for a complete glossary of frequently used health insurance terms »

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