PLEASE NOTE: The links on this page open in a new window & the majority are PDFs.
Benefit Resource Center Flyer for Employees
Eligibility Information
To be eligible to enroll in your employer’s benefit plans, you must be a full time W-2 employee working 30 or more hours a week for the company and satisfy the new hire probation period.
Please refer to the Probation Calendar below and contact the person responsible at your employer for your company benefits. Also refer to the enrollment guidelines in the next section.
Benefit Waiting Period 1st of the month after 30 days
Enrollment Guidelines
Please read the Enrollment Guidelines to learn when you can come on the plan, add dependents and make other changes.
Health Plan Enrollment Guidelines
Premium Charts
Shown monthly
For Cal COBRA add 10% to table
Compliance Corner
Notices and Disclosures
Glossary of Health Coverage Terms
COBRA Center
Your Group is Subject to Cal COBRA
The Initial Notice should be provided to the employee AND spouse (if covered) within 90 days of becoming covered. One notice to the home is allowed if both live at the same address but it must be addressed to both parties.
Please contact your employer for more information.
Help & Support
| PLAN DEPARTMENTS | PHONE MEMBER SERVICES | PLAN/POLICY # |
|---|---|---|
| Blue Shield HMO Member Services | 1-888-319-5999 1-855-664-5577 (Trio Members) |
W0013228 |
| Blue Shield Life | W0013228 | |
| Wayco Insurance Services, Inc. (Broker) | 1-951-699-6000 x10 | john@wayco.com |
Cafeteria Plan
Your Cafeteria “Section 125” Pre-Tax Premium plan allows payroll deductions to be taken “off the top line” before taxes are calculated ~ saving from 25% to 40% depending on your personal tax bracket.
Example of Cafeteria Plan Savings
Medical Plan
| BENEFIT SUMMARIES | FORMS LIBRARY | WEB SITE LINKS |
|---|---|---|
| Blue Shield HMO Platinum A+ – CA Matrix Federal SBC (Summary of Benefits) are available from carrier website. |
New Member Enrollment Form | Blue Shield Website |
| Pediatric Dental & Vision FAQ (Included for children under age 19) |
Existing Member Subscriber Change Form | |
| EOC – Platinum HMO 25+ | Termination Form (Employer use) |
Life Insurance
| BENEFIT SUMMARIES | FORMS LIBRARY | WEB SITE LINKS |
|---|---|---|
| Life Insurance Summary | Use same forms as in the Medical Plan section. | Same as Medical section above. |
| Beneficiary Change Form |
Dental Plan
| BENEFIT SUMMARIES | FORMS LIBRARY | WEB SITE LINKS |
|---|---|---|
| BSC Dental HMO Plan Summary Matrix | Use Blue Shield forms in Medical Section above. | Blue Shield Website |
| Blue Shield DHMO Evidence of Coverage |
Vision Plan
| BENEFIT SUMMARIES | FORMS LIBRARY | WEB SITE LINKS |
|---|---|---|
| Blue Shield Vision Plan | Use Blue Shield forms in Medical Section above. | Blue Shield Website |
| MES Vision Information Card | ||
| Eye Care & Wellness Tips |
