San Francisco Unified School District

Eligible San Francisco Unified School District (SFUSD) employees may enroll themselves and their eligible family members in an SFHSS administered medical plan. Enrollment must take place within 30 days of the start work date, no later than 30 days after a qualifying event, or during the annual Open Enrollment period, which takes place each year during the month of October.

*IMPORTANT UPDATE* We are aware that some SFUSD members may have had their health coverage terminated in error due ongoing system issues. SFHSS is working closely with SFUSD administration to address these issues. If you believe your health coverage was terminated in error, please call SFHSS immediately at (628) 652-4700 and press option 1 for benefits questions, then press option 3 for dedicated SFUSD support.

The following are eligible to participate in the San Francisco Health Service System as members:

• All regularly scheduled provisional or temporary exempt employees of the SFUSD whose normal scheduled work week at date of hire is not less than 20 hours.
• All other employees of the SFUSD, including “as needed” intermittent or substitute temporary/temporary exempt employees, who have worked at least 20 hours a week in a consecutive 12-month period may be eligible under the Affordable Care Act.
• All members of the San Francisco Board of Education boards during their time in service to the SFUSD.
• All other employees who are deemed 'full-time employees' under the shared responsibility provision of the federal Patient Protection and Affordability Care Act (Section 4980H).

SFHSS offers a variety of medical plan options to allow you to select the plan that provides the right coverage at the right cost for you and your covered family members to remain healthy and productive. SFHSS offers four Health Maintenance Organization (HMO) plans and one Preferred Provider Organization (PPO) plan.

Health Maintenance Organization (HMO)

An HMO is a medical plan that offers benefits through a network of participating physicians, hospitals and other healthcare providers working closely together to help coordinate your care. You select a Primary Care Physician (PCP) who will coordinate all non-emergency care and services including access to certain specialists, programs and treatments that are in the same medical group or network. You must live or work in a ZIP code serviced by the plan to enroll. Under these plans, there is no plan year deductible before accessing your benefits. Most services are available for a fixed

Preferred Provider Organization (PPO)

A PPO is a medical plan that provides access to a network of health care providers (doctors, hospitals, labs, pharmacies, etc.) known as preferred providers. You pay less when you to seek services from preferred providers. However, the plan allows you the option of seeing non-preferred providers, but requires you to pay a higher percentage of the bill. Generally, when compared to HMO medical plans, PPOs usually result in higher out-of-pocket costs and a deductible will apply to many services. Instead of having a fixed co-pay for medical services, your cost share may vary as a percentage of what the provider charges, known as a “coinsurance”. You will need to pay your plan year deductible prior to paying your coinsurance for the applicable service.

SFUSD employees can choose from Health Net CanopyCare HMO, Blue Shield of California Access+ HMO, Blue Shield of California Trio HMO, Kaiser Permanente HMO or Blue Shield of California PPO health plans.

Please note that Health Net CanopyCare HMO, Blue Shield of California HMO and Kaiser Permanente HMO require enrollees to live or work in a zip code serviced by their plan. Blue Shield of California PPO does not have service area requirements.

All SFUSD members and their dependents who are enrolled in an SFHSS medical plan are automatically enrolled in VSP's Basic Plan at no additional cost. We also offer an enhanced plan called the VSP Premier Plan at an additional cost based on the number of members enrolled in coverage.

If you do not enroll in a medical plan, you and your dependents cannot access VSP Vision Care benefits.

Eligible SFUSD employees may qualify for additional benefits, such as dental coverage and flexible spending accounts, which are administered by the SFUSD Benefits Team.  For more information, please visit the SFUSD Employee Intranet at https://www.sfusd.edu/employees/employee-services/benefits-insurance-information or submit a help/inquiry ticket at eis.sfusd.edu