Who is Eligible for Employee Benefits?
- All Certificated employees, working 51% or more, and their dependents
- All Classified employees working 7 hours or more, and their dependents
Eligible dependents include:
- Spouse of employee (Marriage Certificate is required)
- Domestic Partner (State Registration Certificate is required)
- Child of an enrolled employee or domestic partner under 26 years of age:
- Natural child - (Birth Certificate is required for enrollment)
- Adopted child - (Final Adoption Papers are required for enrollment)
- Step child - (Birth Certificate is required for enrollment)
- Child of an eligible, covered domestic partner - (Birth Certificate is required for enrollment)
- Unmarried child under legal guardianship - A dependent child under a court ordered legal guardianship of the employee is eligible for coverage, provided they meet all other eligibility requirements. Please note: eligibility ends on the date of expiration of the court awarded guardianship or upon the 18th birthday of the child, whichever comes first. (Legal Guardianship Papers are required)
- Permanently disabled child(ren)
- A permanently disabled dependent who is married will lose their coverage at age 26
- A permanently disabled dependent who is single will continue to be covered past age 26 until he or she marries or is no longer certified as permanently disabled.
When You May Enroll
Eligible employees may enroll at the following times:
- As an eligible new hire
- When a current employee has an increase in hours making them eligible for benefits
- Each year during annual open enrollment
- Within 30 days of a qualifying event
As a new hire, the effective date of coverage is provided to you by the Human Resources Department.
Changes to Enrollment
Each year, there will be an annual open enrollment period where you can make new benefit elections for the following plan year. Once you make your benefit elections, you cannot change plans; however you may add or remove a dependent if you experience a qualifying event. Examples of qualifying events include, but are not limited to the following:
- Marriage, divorce or annulment
- Birth or adoption of a child
- A qualified medical child support order
- Death of a spouse or child
- A change in your dependent’s eligibility status
- Loss of coverage from another health plan
Who is SISC?
The Palm Springs Teachers Association (PSTA) elected Self-Insured Schools of CAlifornia as the administrator for the medical plans, which includes medical, mental health, an employee assistance program and prescription drug coverage.
Being a member of SISC brings you many different partners in the healthcare industry. As a result, you may see many different products and provider names associated with your benefits, but it’s important to note they are your partner through SISC.
How can I find a Blue Shield Provider?
Step 1: Go to www.blueshieldca.com Log in if you are registered or enter your plan information.
If you have an HMO, select Access+ HMO for the Plan and SubPlan.
If you have a PPO Plan, select Blue Shield of California PPO Network (no subplan is needed.)
Step 2: Select the kind of provider that you need. You can select either Doctors or Facilities if you are on a PPO plan.
If you have an HMO plan, you can select Doctor's, Facilities, and Pharmacies.
You can also use the advanced features to filter your search.
How do I find a Kaiser provider?
Finding a provider for your Kaiser plan is very simple:
Step 1: Go to kp.org/newmember
Step 2: Click on “Choose a Doctor"
Step 3: Browse doctor profiles, see what languages they speak, their education and what their interests are.
At kp.org/newmember, you are also able to register on the website. This will allow you to securely email your doctor’s office, refill most prescriptions, schedule routine appointments, and more.
How do I find a Mental Health Provider?
Mental health services for Blue Shield members is provided through MHSA Participating Providers and is available through the Mental Health Services Administrator (MHSA) network. To find an approved caregiver, you will follow the instructions above but you will select Mental Health Caregiver on the doctor type or specialty.
A pop-up window will appear and you will select Search or Visit the MSHA Network option.
Follow the prompts under "Begin Your Search" and select the BSC MHSA, then click on "Non Medicare Providers" and enter your zip code.
You will be provided with the network caregivers that meet your criteria.
Please note: If you are a PPO Plan member, your coverage is through your Blue Shield Medical Plan and your caregiver/doctor will need to contact HealthComp at (800) 442-7247 for verification.
If you are an HMO member, Blue Shield of California has contracted with an MHSA to underwrite and deliver all Mental Health Services through a unique network of Mental Health Participating Providers. All Non-Emergency Mental Health Services, except for Access+ Specialist visits, must be arranged through the MHSA. Members do not need to arrange for Mental Health Services through their Personal Physician.
How do I find a Provider while traveling?
To locate a provider, go to blueshieldca.com/findprovider and select the Providers Outside of California link under Traveling. This takes you to the BlueCard Doctor and Hospital Finder on the BlueCArd Program's website. Or, you can call BlueCard Access at (800) 810-BLUE (2583), seven days a week, 24 hours a day.
As a Blue Shield member, you have access to coverage through the BlueCard® Program, no matter where you live or travel. Providers in more than 200 countries belong to the BlueCard Worldwide® Network, and 85% of providers in the United States belong to BlueCard's national network. Note that you will need to get prior authorization for certain services, including inpatient surgeries, hospital stays, and outpatient surgeries.
For Blue Shield PPO members
If you're a member of a PPO plan you may use the BlueCard Program for access to covered benefits, except dental and vision care, and prescription drugs.
For Blue Shield HMO members
HMO plan members have coverage for emergency and urgent care services, or authorized medical follow-up care, when they are out of their HMO service area. In case of a life-threatening emergency, call 911.
if you are in the U.S., or go immediately to the nearest medical facility, and then get the necessary authorization when it's possible for you to do so.
How do I get prescriptions through my Blue Shield PPO Plan?
SISC provides Navitus for prescription drug needs for each Subscriber and their eligible dependents enrolled in a SISC Plan.
If you ever misplace your card or would like to order additional cards for family members, please call SISC's Member Services.