Evidence of Coverage

Your CSEA Chapter 262 has heard all of you asking when we would be able to provide you with comprehensive details about the health coverage available under the Self-Insured Schools of California (SISC) benefit plans. This coverage is found in what is called “Evidence of Coverage.” The EOC is a description of services covered by the plan.  The EOC is not a comprehensive list of costs associated with those services.  The EOC is not a cost sheet.

CSEA 262 and the District have negotiated a budgeted amount for a family plan, and a means for reducing or eliminating out-of-pocket costs to members. If the Tentative Agreement is ratified, then CSEA 262 will negotiate with the District and SISC the most favorable plan structure within that budget. It is similar to buying a car. You have a certain amount of money, and you add the options you can afford with that money. Will you get every option possible? Probably not, but you will get all you can within your budget.

Evidence of Coverage (EOC) describes benefits, limitations, and exclusions to a health benefit plan. The EOC tells you exactly what services are covered by the plan. Each plan has its own EOC document. These EOC documents are provided to you so you can evaluate the coverages offered by SISC in comparison to your current plan to make an informed decision as to whether to ratify the Tentative Agreement reached June 12.

Please note CSEA 262 has NOT NEGOTIATED the costs or any plan structure and cannot do so until the Tentative Agreement reached June 12 is ratified by the membership and has been adopted by the Mt. SAC Board of Trustees. The purpose of these documents is to help you understand what benefits are available in the plans so you can decide whether to accept or reject the Tentative Agreement.

Note: These EOC documents are named to compare CalPERS with SISC plans and may not reflect the actual name of the EOC document. The EOC documents are for comparison only.

If your current CalPERS plan is…

  1. Anthem HMO Select

  2. Anthem Traditional

  3. Blue Shield Access Plus+

  4. Health Net Salud Y Mas

  5. Health Net Smartcare

  6. Kaiser

  7. United Healthcare

  8. PERS Care

  9. PERS Choice

  10. PERS Select

There are two additional Kaiser plans that are not comparable to existing plans but may be available to us from SISC that we want to make available to you for evaluation. Remember these Kaiser plans are only samples of coverage and not necessarily what will be available to us should we vote to move to SISC during the ratification vote.