Summary Plan Documents
Insured Plans
| Name of Plan | Plan Number | Plan Year Ends | Insurer | Policy Number | Format |
Santa Clara University
Group Medical Care Plan | 501 | 12/31 | Blue Cross HMO | 175028H001 | PDF |
Santa Clara University
Group Medical Care Plan | 501 | 12/31 | Blue Cross PPO
(HIA)
| 175028 | PDF |
Santa Clara University
Group Medical Care Plan | 501 | 12/31 | Blue Cross PPO
(HSA)
| 175028 | PDF |
Santa Clara University
Group Medical Care Plan | 501 | 12/31 | Blue Cross PPO
(Traditional)
| 175028M007 | PDF |
Santa Clara University
Group Medical Care Plan | 501 | 12/31 | Kaiser Foundation
Health Plan (non-union) | 979 | PDF |
Santa Clara University
Delta Dental PPO Plan | 501 | 12/31 | Delta Dental | 4224-0005 | PDF |
Santa Clara University
Group Medical and Dental Care Plan | 501 | 12/31/05 | Vision Service Plan | 12081648 | PDF |
Santa Clara University
Welfare Benefit Plan | 501 | 12/31 | United Behavioral Health | N/A | PDF |
Santa Clara University
Long-Term Disability Plan | 501 | 12/31 | Met Life | 104767-1-G | PDF |
Santa Clara University
Employee Term Life, Accidental Death and Dismemberment and Dependents Term Life coverage... | 501 | 12/31 | Met Life | 104767-1-G | PDF |
Pension Plans
| Name of Plan | Plan Number | Plan Year Ends | Type of Plan | Format |
Santa Clara University
Tax-Deferred Annuity Plan - 403(b) | 001 | 12/31 | Tax-Deferred Annuity | PDF
|
Santa Clara University
Defined Contribution Retirement Plan - 401(a) | 002 | 12/31 | Defined Contribution | PDF |
ERISA Information
Your plan has been established under the guidelines of ERISA (Employee Retirement Income Security Act of 1974). ERISA requires that certain disclosures be made to plan participants. The following provides this information.
Plan Sponsor
President & Board of Trustees Santa Clara College
dba Santa Clara University
Santa Clara, CA 95053
Plan Administrator
Human Resources
Agent for Service of Legal Process
Human Resources,
Santa Clara University,
Santa Clara, CA 95053
Employer Identification Number
94-1156617
Source of Funding
The plans are funded by both employee and Santa Clara University contributions. Contributions required of employees are determined by Santa Clara University and are subject to periodic change.
Review of Legal Documents
If you wish to review or obtain copies of the legal documents for these plans, you may do so by contacting the plan administrator. In addition, you may request a copy of Form 5500, which Santa Clara University files with the Department of Labor each year. This form describes the financial condition of each plan. If you wish to correspond with a government agency regarding these plans, you should refer to the employer identification number and plan number.
