1. Visiting Scholar Benefit Plan
 University of California
Berkeley
Visiting Scholar Benefit Plan
(UCBVSBP)
Effective December 1, 2010

2. UCBVSBP
The University of California, Berkeley (UCB) has partnered with Garnett-Powers & Associates to administer the Visiting Scholar Benefit Plan (UCBVSBP)
December 1, 2010 is the effective date whereby all domestic and international Visiting Scholars and Visiting Student Researchers must be provide proof of adequate health insurance coverage
The UCBVSP is available to both domestic and international Visiting Scholars and Visiting Student Researchers at UCB who are affiliates of the Visiting Scholar and Postdoc Affairs (VSPA) Program
The UCBVSBP fully meets the U.S. State Department
Exchange Scholar requirements for J-1 scholars and their J-2 dependents

3. UCBVSBP Healthcare Options PPO
Plan A
Plan B
Plan C
Benefits
UnitedHealthcare
In-Network
UnitedHealthCare
Out-of-Network
IMG
Standard Plan
Platinum Plan
Plan Type
PPO
Overall Plan Maximum
There is no overall maximum dollar limit on the policy
Visiting Scholar - $500,000 period of coverage
Dependent - $100,000 period of coverage
Visiting Scholar - $1,000,000 period of coverage
Plan Deductible
$250 per Insured Person, Per Policy Year
$500 per Insured Person, Per Policy Year
$500 per Illness/Injury
PPO Provider: $25 per Illness/ Injury
Non-PPO Provider: $50 per Illness/ Injury
Out-of-Pocket Maximum
$4,500 per Insured Person and $9,000 for all Insured Families Per Policy Year
$9,000 per Insured Person and $18,000 for all Insured Families Per Policy Year
No Out-of-Pocket Maximum
Coinsurance
Visiting Scholar pays 20% of Preferred Allowance
Visiting Scholar pays 40% of Usual and Customary Charges
PPO Provider: Visiting Scholar pays 0% of eligible expenses
Non-PPO Provider: Visiting Scholar pays 20% of eligible expenses up to $1,000, then the plan pays 100% thereafter
Prescription Drugs
$20 Copay for Tier 1
$40 Copay for Tier 2
$80 Copay for Tier 3
No Benefits
Visiting Scholar Pays 50% of actual charges
Up to annual maximum of $1,500
$20 Copay for Generic
$40 Copay for Brand
$80 Copay for Non-Brand
Up to the annual maximum of $3,000

4. UCBVSBP Healthcare Options PPO
Plan A
Plan B
Plan C
Benefits
UnitedHealthcare
In-Network
Out-of-Network
IMG
Standard Plan
Platinum Plan
Maternity
Paid as any other illness
No Coverage
Conception must occur during period of coverage
Routine Newborn Care
$750 maximum per period of coverage
Emergency Medical Evacuation
No Limit
$50,000 lifetime maximum
$500,000 lifetime maximum
Repatriation of Remains
$25,000 maximum
$50,000 maximum
Pre-Existing Conditions
Pre-existing conditions are covered with no waiting period
Pre-existing conditions are covered after 12 months of continuous coverage
Pre-existing conditions are covered after 6 months of continuous coverage
Emergency Room
$100 Copay per visit (waived if admitted) + Visiting Scholar pays 20% of preferred allowance
$100 Deductible per visit + Visiting Scholar pays 20% Usual and Customary Charges
$250 Deductible

5. UCBVSBP Healthcare Options PPO
Plan A
Plan B
Plan C
Benefits
UnitedHealthcare
In-Network
Out-of-Network
IMG
Standard Plan
Platinum Plan
Hospitalization
Visiting Scholar pays 20% of Preferred Allowance
Visiting Scholar pays 40% of Usual and Customary Charges
$500 per Illness/Injury
Usual and Customary Charges
PPO Provider: $25 per Illness/ Injury
Mental & Nervous Disorders
$50 Copay with $500 lifetime maximum
Eligibility
U.S. Citizens, Non-U.S. Citizens & Dual Citizens
Non-U.S. Citizens only
Preventive Care Services including Immunizations
Provided at No Cost
No Benefits
Well Exams covered at 100% (annual max of $500)
Immunizations covered at 100% (annual max of $250)

6. UCBVSBP Rates*
Plan Options
Insurance Plan
Visiting Scholar
Additional Premium for Spouse or Domestic Partner
Additional Premium for One Child
Additional Premium for Two or more Children
Additional Premium for Spouse & Two or more Children
Plan A
UnitedHealthcare
$322
$644
$966
Plan B
IMG Standard Plan
Age Rated:
19-23 years old
24-30 years old
31-40 years old
41-50 years old
51-64 years old
$69
$77
$122
$187
$242
$238
$260
$345
$356
$66
For every child dependent, the premium is an extra $66
N/A
Plan C
IMG Platinum Plan
$151
$172
$294
$480
$641
$575
$635
$845
$873
$134
For every child dependent, the premium is an extra $134
* Rates are effective September 1, 2016 through August 31, 2017

7. Medical Evacuation & Repatriation Coverage
The UCBVSBP plan includes includes medical evacuation and repatriation of remains benefits that meet the U.S. State Department requirements
International J-1 scholars and their J-2 dependents do not need to purchase supplemental coverage to meet their J Visa requirements

8. UCBVSBP Administrative Process
Department staff prepares an affiliate application in the VSPA Gateway
VSPA Program confirms approval of affiliate application
VSPA sends notification of eligibility to GPA for new and extended appointments
Department creates a Human Capital Management (HCM) Contingent Worker Job Organizational Instance .NOTE: Staff can create record up to 3 months in advance of appointment
Cal Numerical ID is generated
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9. UCBVSBP Administrative Process
Affiliate has 31 days from appointment date to visit the GPA website and enroll in VSBP or opt out of the plan
When enrollment form is completed and premiums are paid, GPA will notify the scholar. The insurance company will provide an insurance ID card
If waiving or opting out: Affiliate must provide proof of comparable coverage to GPA for verification. Upon approval, GPA will notify the affiliate, department staff and VSPA Program that health insurance requirement has been satisfied

10. UCBVSBP Administrative Process
VSPA creates a Person of Interest (POI) record in HCM, which activates the HCM Contingent Worker Job Organizational Instance
If the affiliate’s insurance does not meet the waiver requirements, or if the affiliate drops coverage early, GPA will notify department staff of the deficiency
If the requirements are not satisfied by the affiliate, GPA will inform the VSPA Program and the POI record will be deactivated, resulting in loss of campus services

11. VSPA Affiliate Enrollment Process
Affiliate must enroll online through Garnett-Powers & Associates’ UCVSBP website:
Affiliates must follow the enrollment process carefully. To get started, the affiliate clicks on the ‘Enrollment’ link and prints (or reads) the ‘Enrollment/Payment Instructions.’ These instructions are written to guide the affiliate’s completion of the enrollment form. Once the affiliate has filled out the form, the affiliate should print the completed form for record-keeping purposes.
IMPORTANT: Failure to adhere to the recommended enrollment process may result in a long delay in becoming active in the insurance carrier’s system

12. VSPA Affiliate Enrollment Process
Affiliate must provide a current and correct address because all correspondence between GPA and the affiliate will transacted by  including confirmation of enrollment and quarterly invoices for subsequent quarterly enrollment.
Enrollment is not complete until GPA receives:
1) confirmation of eligibility from the campus, and
2) initial payment
Health insurance ID cards will be mailed to the affiliate’s U.S. mailing address listed on the enrollment form 7 to 10 business days after the enrollment process is complete
If the affiliate would like to make changes to enrollment in the future, the affiliate must click ‘Making Changes to Your Enrollment’ link and print (or read) the ‘Instructions on Making Changes’ link for detailed instructions.

13. VSPA Affiliate Payment Process
Upon completion of the enrollment form, the affiliate is directed to ‘Submit and Create Printable Enrollment Form’. A reminder that payment is due immediately is issued.
Payment is due for the current quarter (or portion as determined by the affiliate’s insurance start date) at initial enrollment (whole months only  no pro-rated amounts when enrolling after the first of the month)
When the affiliate clicks on the ‘Calculate Premium’ button, the system automatically ‘populates’ both the initial premium owed for the first quarter and premium owed for subsequent quarter(s) on the payment coupon at the bottom of the enrollment form. The affiliate should print this document for record-keeping purposes.

14. VSPA Affiliate Payment Process
The affiliate can pay by debit or credit card or with a check. If the affiliate is paying by check, the affiliate should return the payment coupon with a check to Garnett-Powers & Associates.
After the initial premium has been paid, the GPA billing department will send the affiliate an electronic invoice for subsequent billing(s) prior to the expiration date of the insurance policy. If affiliate’s appointment ends before the end of any quarter, affiliate will only be billed the premium through the end of the last month of appointment.

15. Family Member Eligibility*
Family member categories (including J-2 dependents) are the following:
Spouse
Domestic partner
Same-sex domestic partner
Opposite-sex domestic partner only if one partner is over age 62
Unmarried natural or adopted children to age 19 or to age 23 if a full-time student who is not self-supporting
NOTE: Other family members (e.g., parents, nieces or nephews) are NOT eligible
*See Eligibility and Definitions sections in policy brochure

16. Information Sources www.garnett-powers.com/vs/ucb 888-441-3719
Website: Garnett-Powers’ UCBVSBP website:
Toll Free Phone: Garnett-Powers’ UCBVSBP customer service number:
Address: Garnett-Powers’ address: