• Health and Vision coverage: date records must show that you are authorized and were paid to work with a minimum of 25 hours for the most current 2 consecutive months.

No, you will not be enrolled automatically.

New eligible IPs will automatically get enrollment packets from SFHP.

If you need an application because you are not enrolling for the first time (or did not automatically receive an application), you can contact PA:

• 415-243-4477 and ask for an application to be email to you.
• Email info@sfihsspa.org and request one to be email to you.

Applications are available in English, Chinese, Spanish, Russian, Tagalog, and Vietnamese.

Only the person covered by the insurance can choose the right doctor for them. If you need help selecting a doctor: refer to Provider directory or visit SFHP's "Find a Provider" website to filter doctors by location, language, and specialty: https://www.sfhp.org/programs/healthy-workers/find-a-provider/

Yes, our monthly deadline is the 12th of each month.

Once you have met the eligibility requirements, it may take up to 60 days for your coverage to begin.

When you are enrolled, you will receive an ID card from the insurance company welcoming you to the plan. You should wait until you receive these packets to obtain services.

No, this is an Employee only coverage.

Contact SFHP if you have not received your ID card within 60 days of submitting your application to check the status.

Yes, you can change clinics anytime or asked for a replacement card. Just contact San Francisco Health Plan and a representative will change your clinic and will mail you a new ID card or replacement card.

An insurance premium is the amount of money an individual pay for an insurance policy.

The premium contributions will be deducted from your second paycheck each month.

Health and Vision - $3/month

Open enrollment season is a period of time when IP may elect or change the benefit options for their Dental plan.

November 1st to December 12th.

• Change plan you are enrolled in.
• Add a dependent
• Re-enroll for Voluntary termination.

No. You do not have to wait until Open Enrollment, but you must re-enroll by filing out the application(s) again.

No. For medical insurance with SFHP you can (re-)enroll at any time during the year. There is only one plan option, and you cannot add dependents.

In order to be eligible, data records must show that you are authorized and were paid to work 25 or more hours a month for six months. You will continue to be eligible as long as you continue to work at least 25 hours a month.

The Public Authority offers two good options for dental benefits. The EPO plan allows you to pick from a large network of dentists. This plan covers 80% or more of the cost of most services. The LDP100 plan provides services through a smaller group of dentists with no co-payment for most services. See the attached Comparison of Benefits and decide which is the best plan based on your needs.

Review the enclosed Comparison of Benefits and choose your plan. Complete and sign the Enrollment Form and send it to the IHSS Public Authority in the enclosed envelope.

Your completed and signed Enrollment Form must be received by the IHSS Public Authority on or before the twelfth of any month to be effective the first of the following month.

You will receive an ID packet from LIBERTY welcoming you to the plan. You should wait until you receive this packet to obtain dental services.

You are required to pay a monthly premium contribution. The amount you contribute is dependent on the plan you enroll in:

• LDP100 Plan: Employee Only - $1 per month
• LDP100 Plan: Employee + 1 dependent - $2 per month
• LDP100 Plan: Employee + 2 or more dependents - $3 per month
• EPO Plan: Employee Only - $2 per month

In addition to your monthly fees, you may be required to pay a share of the cost for some of the services you receive. See the attached Comparison of Benefits for any additional co-payments that might be required.

If you elect to have dental coverage, the premium contribution will be deducted from your paycheck each month.

Dependent coverage is only available under the LDP100 plan. There is an additional monthly cost for dependent coverage. For a premium cost of $2 per month you may add one dependent to be covered by the LDP100 plan.

For a premium cost of $3 per month you may add 2 or more dependents to be covered by the LDP100 plan. You may not add dependents to the EPO plan.

• Legal spouse. You must submit a copy of a county or state issued marriage certificate to be able to enroll your spouse.
• Domestic Partners and their children. A domestic partnership is established when persons meeting the criteria specified by California Family Code section 297 file either a Declaration of Domestic Partnership (Form NP/SF DP-1) or a Confidential Declaration of Domestic Partnership (Form NP/SF DP-1A) with the California Secretary of State. A copy of the declaration and a Certificate of Registration of Domestic Partnership will be returned to the partners after the declaration is filed. You must submit the Certificate of Registration of Domestic Partnership with your enrollment form to be able to enroll your domestic partner.
• Children up to the age of 26. You must submit a copy of a birth certificate, proof of adoption, foster care agreement or guardianship court order to be able to enroll your child.
• Dependent children over the age of 26 with disabilities who are dependent upon you for support and are not able to support themselves due to physical or mental disability. You must submit IRS qualifying documents or SSI qualifying documents to be able to enroll your disabled child over the age of 26. Medical statements or legal documents can be considered.

If you enroll in the LDP100 plan you can choose a dentist from the provider network provided in the enrollment packet. If you do not choose a dentist at the time you enroll, a dentist will be selected for you based on your home zip code and language preference. If you wish to change to another contracted dentist, you may do so by the 20th day of any month for the change to be effective the first day of the following month. If you choose the EPO plan you do not need to choose a primary care provider, but when you go to a dentist you should check the provider list to make sure your chosen dentist is an in-network doctor. If you need assistance with choosing a provider for either the LDP100 plan or EPO plan please contact LIBERTY Dental Plan at 1-888-703-6999. LDP100 providers can also be found by visiting www.libertydentalplan.com. EPO providers can also be found by visiting www.firstdentalhealth.com. Click on "For Members", then on "Find a Dentist", and when filling out the information on the next page, be sure to set it to "EPO" by "Select a Network". If you go to an out-of-network doctor, you may have a higher out-of-pocket expense.

You may change plans only during the annual open enrollment period. Open enrollment will take place in November and December of each year and is effective January 1st of the following year.

Yes, you can voluntarily dis-enroll from the dental benefit plan at any time by providing written notice to the Public Authority. If your disenrollment is received by the twelfth of the month, dental coverage and premium withholding will end the first of the following month.

If you voluntarily decide to terminate your dental coverage, you will not be allowed to re-enroll for dental benefits until the next Open Enrollment period. To re-enroll, you must also meet eligibility requirements, that is, have worked a minimum of 25 hours per month for the six previous months.

The dental benefit plan you select will continue as long as you are providing IHSS home care services. If you work less than 25 hours for two or more months you will lose eligibility for dental benefits.

If you lose your benefits, you must re-qualify by working a minimum of 25 hours per month for six consecutive months. Once this criteria has been met, you may re-apply.

Federal law requires that all workers have the right to purchase their group coverage for a specific period of time after employment ends. You will be responsible to pay the full amount of premium to continue under this coverage. This law is called COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985). Once your eligibility ends, you will have 60 days to elect coverage with no lapse in coverage.

• San Francisco IHSS Public Authority, Benefits Coordinator, Betty Hon, at 415-593-8125, www.sfihsspa.org.
• About the benefits/procedures covered? LIBERTY Dental Plan at 1-888-703-6999.
• About which providers I can see? LIBERTY Dental Plan at 1-888-703-6999.
• You can text your question to 415-593-8125. Please allow time for a response.
  • By sending a text, you have agreed that your phone number will be used for SMS message notifications sent by the San Francisco IHSS Public Authority. Message and data rates may apply.

If you need to change your information, you must contact IPAC at 415-557-6200, Located at 2 Gough street, SF, CA 94103. You will need to provide documentation for changes.

Providers can mail the L564 form to SF IHSS PA at 832 Folsom street, 9TH floor, SF, CA 94107. The form will be mailed back within 2 business days upon received.

The benefit plans you select will continue as long as you are providing IHSS services in San Francisco. If you work less than 25 hours for two or more months consecutively, you will lose eligibility for all benefits. A warning letter will be sent to you a month before termination date.

Yes, you can request to cancel health benefits by filling out a cancellation request form. If Public Authority received the form by the 12th of the month, your insurance will be cancelled effective the first day of the next month. If you canceled Health insurance, you can reapply anytime.

If you should have a period of lower than 25 hours in any month, you will receive a warning letter, however if you are paid 25 hours or more the following month your benefits will not be affected. You will lose your benefits if you are paid less than 25 hours in three consecutive months.

Remember: Your eligibility could be at jeopardy if you do not turn in your timesheets on time! We base your eligibility on paid hours data and the check issue date, not the hours worked. Please submit your timesheets as soon as the pay period ends.

If you worked and received paid for a minimum of 25 hours before insurance terminates, you must contact the number in the warning letter within 30 days from termination date for reinstatement.

If you no longer work in San Francisco, you will lose your insurance and you will need to apply with the county you are currently working. A warning letter will be sent to you a month before termination date.

Your insurance company San Francisco Health Plan will mail out the 1095B form around March of each year.

If you lose your benefit, you must re-enroll. Once the criteria(s) are met, you may re-apply again.

Yes, you will be offered COBRA when insurance terminates. We have WageWorks as our COBRA administrator. You will automatically receive a COBRA packet with a given election period of 60 days to choose whether or not to continue with same coverage.

San Francisco IHSS Public Authority, Benefits Coordinator, Betty Hom at 415-593-8125

• SFHP Healthy Workers at 415-547-7800
• VSP (Vision Service Plan) at 1-800-877-7195
• WageWorks Cobra at 1-888-678-4881