Medical Plan Changes After Open Enrollment

Although Open Enrollment has ended, employees can change to a different medical plan beginning January 7, 2014, through March 31, 2014. This is a special change window for 2014 only and will not apply in any subsequent year.

Employees will see their 2014 medical plan selection on the At Your Service website starting January 7, 2014, and will receive Identification Cards most likely on January 1, 2014.

How to change medical plans

Campus faculty and staff should submit a UPAY 850 Enrollment Form to the Central Benefits Office no later than Monday, March 31, 2014, to enroll in a different medical plan.

Section 1 – enter your personal information

Section 3 – in "Change" column select “Other”

Section 3 - in comments write “Change after Open Enrollment" and whether or not a medical or drug service has been used in 2014

“Medical or drug services used on (date)”


“No medical or drug services have been used in 2014"

Section 4 - select the medical plan you want to enroll in for 2014

Section 7 -  enter the information for all eligible family members you want enrolled in the medical plan. If you are enrolling in Health Net Blue & Gold HMO, enter the Primary Care Physician (PCP) for each family member. PCP information is not required for any of the other plans. 

Section 8 - sign and date the form

Campus employees should send the UPAY 850 form to the Central Benefits Office

  1. By mail: Wilshire Center, Suite 200, Benefits Unit
    Campus Mail Code: 146548
  2. Via FAX: (310) 794-0835

Effective date of new medical plan

The effective date of the new plan will depend on whether or not you or your enrolled family members have had medical and/or prescription drug services prior to submitting the UPAY 850 form. If you or a family member use services, the rules and costs of the plan you are in at the time of the service will be applied to the service.

For example, if in January you are in UC Care and see a Tier 2 physician, the cost for those services will be applied to the deductible and 20% coinsurance. If you submit a UPAY 850 to change plans after you receive services, the earliest you can be in the new plan is February 1.

Use the following chart to determine the effective date for your new medical plan. The UPAY 850 enrollment form must be received by the Benefits Office on or before March 31, 2014.


Medical and/or Drug ServicesEffective Date of New Plan
No services in 2014January 1, 2014
Medical and/or drug services received in January 2014 onlyFebruary 1, 2014
Medical and/or drug services received in February 2014March 1, 2014
Medical and/or drug services received in March 2014April 1, 2014

It will take 30 to 60 days for the insurance carrier to update their membership system and mail ID cards.

Payroll adjustments for new monthly premiums

Your January paycheck will have the deduction for the medical plan you defaulted in or selected during Open Enrollment. It will take 30 to 60 days for the medical plan deductions to be adjusted after the medical plan has been changed in the Payroll System by the Benefits Office.


Information about the medical plans can be found in Related Information.

If you have other questions, please contact:

  1. Campus Faculty and Staff should call (310) 794-0830
  2. Health System employees should call (310) 794-0500
  3. Retirees (whose medical coverage is thru UC retirement system) should call RASC at 1-800-888-8267