Los Angeles County + USC Medical Center
Benefits & Forms
- Membership Form
- Domestic Partnership Application (both same-sex and opposite-sex partners are eligible) – To add a partner, download an application and return a notarized copy, along with all requested documentation, to the Plan office. You must also complete an Update Form below.
- Update Form – To add new dependents to your plan. Requests to add dependents must be received within 30 days of qualifying event (birth/adoption or marriage), and you must attach requested documentation.
- Opt-Out Form – Please fill out this form if you would like to remove yourself and/or your dependent(s) from the CIR Benefits Plan.
Davis Vision benefits:
- Your Fashion Plan benefits
- Eye Exam brochure
- Virtual Try-on Tool
- Member ID Card
- Davis Vision website
- Davis Vision app
- Handling eye injuries in the workplace
- Supplemental Major Medical Claim Form – Now available through the Member Portal: CLICK HERE
- Supplemental Dental Benefit Claim Form – Now available through the Member Portal: CLICK HERE
Connect to a counselor for free support services: 1-800-386-7055 (available 24 hours a day, 7 days a week).
Visit ibhworklife.com and login to “For Employees & Members” (password: wlm70101).
Questions? Email: firstname.lastname@example.org.
For purposes of our disability benefits, “disabled” means you can no longer perform the duties of your occupation due to accidental bodily injury, sickness, or a related medical condition, including pregnancy or childbirth. You must also be under the care of a licensed provider as defined by the state in which you work.
- Disabled Health Premium Reimbursement
- Short-Term Disability (STD) Benefits Claim Form
- Coverage begins on the eighth (8th) day of your disability. The maximum benefit payable is 70% of your weekly salary, up to $875 per week, for up to 26 weeks. See the Summary Plan Description (SPD) for more details.
- If you are going out on a disability leave, contact your employer as soon as possible.
- Long-Term Disability (LTD) Benefits Claim Form
- The LTD plan pays you $3500 per month. LTD benefits typically start if you are still disabled after 26 continuous weeks. For detailed information on Long-Term Disability see the Guardian Certificate.
- Rivetti Financial Disability Coverage
- As a resident, you are eligible to apply for Specialty Specific disability insurance at discounted rates. There is also no medical screening required to qualify. You are only eligible for this plan during your residency, so act now and don’t wait.
- Professional Educational Benefit (PEB) Claim Form – Now available through the Member Portal: CLICK HERE – reimburses costs associated with books, board exams, medical licensure fees, dues, subscription, journals and mobile electronic medical devices. Items that can be used for both personal/non-work purposes AND work/training purposes are NOT eligible for reimbursement, such as:
- Calling and/or Service Plans
- Desktop Cameras
- Data Service Plans
- eBook Readers
- Software (e.g., Excel, Word, PowerPoint)
- Upgrade Fees
- Opportunity to learn a new language with Rosetta Stone
Rivetti Financial offers Student Loan Consultations to CIR members at a discounted rate:
- Receive individualized advice regarding your student loans
- Complete analysis of your federal and private loans
- Analysis of different repayment plans (Standard, IBR, PAYE, REPAYE)
- Assistance selecting appropriate repayment plan
- Projections of future payments and forgiveness
- Eligibility for Public Service Loan Forgiveness (PSLF)
- Refinancing suitability analysis
- Introductions to competitive refinancing lenders
How to sign up:
- Verify your CIR membership to receive the discount code
- Go to the registration form
- Complete the registration form and upload your documents
- Schedule a date and time
- Pay the discounted consulting fee
Once the registration is complete, we will analyze your loans and request any additional information or documents from you if necessary. We will call you on the day and time of your consultation to conduct a review of your student loans with you.
Consultations are conducted either by phone or through computer screen sharing if you are a visual learner (similar to a webinar).
What is COBRA continuation coverage?
COBRA continuation coverage allows you to choose to continue and pay for group health benefits provided by CIR for up to 18 months after your termination date.
Who is eligible?
You and your dependents covered under the Plan on the day before you terminated from your employer.
You will receive a COBRA notice mailed to the address we have on file. This notice has important information about your rights related to continued health care coverage in the House Staff Benefits Plan.
COBRA Election forms:
Your COBRA Election includes Vision and Supplemental Major Medical and Dental. Please select the Election form (also includes the COBRA Credit Card Authorization Form) that applies to you:
You have up to 31 days from your date of termination to apply for continued disability coverage with Rivetti:
Currently, the application cycle is closed and will reopen in late summer/early fall of 2019.
Looking to Improve Patient Care? LAC+USC and Harbor-UCLA has one of the oldest and largest Patient Care Funds, with LA County contributing $1,210,000 and $980,000 respectively.
LA Gap Insurance
As you start your residency program with LAC + USC Medical Center, please be aware that there is a 90-day waiting period after you start your employment before your employer-sponsored healthcare coverage begins.
Your employer-sponsored healthcare coverage will start at the beginning of September if you enroll during your orientation in June or July.
You can purchase healthcare coverage for the gap period
- If you purchase COBRA coverage from your former insurance carrier or a form of GAP coverage to cover yourself and/or your family during this 90-day waiting period, the CIR/SEIU House Staff Benefits Plan will reimburse you up to $500 for the 90-day window that you did not have LAC + USC Medical Center employer-sponsored healthcare coverage.
- In order to receive the reimbursement, you will need to fill out the LA GAP Insurance Claim Form and provide:
- A copy of the COBRA notice and proof of COBRA coverage payment, or
- The GAP policy statement, and a copy of the GAP policy payment receipt.
- Benefits-at-a-Glance – a comprehensive summary of available benefits.
- HIPAA Notice of Special Enrollment Rights
- LA County coverage frequently asked questions.
- WorkLife Matters Employee Assistance Program: overview, details, and website.
Mental Health Resources:
The Benefits Fund Office is pleased to announce the launch of our Member Portal!
Now accepting claims for the Professional Educational Benefit (PEB), Supplemental Major Medical, and Supplemental Dental, with more benefits coming soon.
Click on Submit Claim if you have already registered to the member portal. If not, please click on the register link and enroll:
Please note: the “View EOB” (Explanation of Benefits) option will be hidden for claims that were processed prior to going live with Member Portal registration.
How it Works:
Member Portal Instructions – First Time
Click the REGISTER button above to get started.
User Details – Enter the following criterions to register:
- Enter Member ID (starting with 900/901) or Last 4 of SSN
- Enter First Name, then Last Name
- Enter Date of Birth (slashes not necessary)
- Click Next
- System navigates to Create Your Password step
- Create New Password and Confirm Password
- Select terms and accept the terms and conditions
- Terms and Conditions box will appear
- Click Submit
- Click Next
- Click Send Authorization code button
- Sent to user registered primary email ID
- Enter code (did not receive code, check box to skip email verification)
- Click Finish
System will display confirmation message and navigate to login page. You will receive a welcome email to the registered email address on file.
Member Portal Instructions
Click the SUBMIT CLAIM button above to open the Member Portal. Then:
- Click on the Login (top right) -> The Member Portal Login section appears
- Enter User Name and Password (created during registration)
- Verification email will appear if skipped during registration
- Click send Authentication code
- Click “I already have a code”
- Enter code sent via registered email address
- No code, request new code
- Click Submit
- Enter code sent via registered email address
Communications details will appear if first time logging into Member Portal:
- Update address/contact information if required.
- Click Submit
- System updates address information on member record
To submit for reimbursements, please see steps below
- Top menu Click Benefits
- Select Reimbursement Type and Employer
- Read the claim submission rules and instructions then Click Continue
- System will display the Claim Form
- Enter all required information and attach proofs (supporting documents) as required
- Click Submit
- Reimbursement claim will be submitted to the Benefit Funds Office
- You will receive an email confirmation of your submission
- Claims are processed between 7 to 10 business days
Advantages of the Self-Serve Member Portal
- You will be able to easily update contact information as needed.
- The Member Portal streamlines the application process by automatically linking to your member and employer details so that you won’t have to enter them on each application. Based on the login information provided, the system will automatically load the applicable reimbursement claim forms.
- The proof needed for each expense submitted will be tied to the expense line itself. This will reduce the number of denials from the Fund Office for lack of proof-of-submission and decrease wait time for payments.
- The claims processing time will decrease. Checks will be mailed out faster than they have been under the old system.
- The rules and guidelines for the reimbursement type are listed on the form’s first page to help you understand what’s allowed and required.
- You will be able to easily submit claims through the browser on your desktop computer, cell phone, or tablet.
- You can take a picture from your device and upload it for proof of payment.
- Coming soon: “View Balance” – view payment information for your individual benefits.
- Coming soon: “My Messages” – communicate with the Benefits Office directly through the Member Portal.
Regional Vice Presidents & Delegates
Regional Vice Presidents
Monique Hedmann, Family Medicine, Harbor UCLA Medical Center
Mahima Iyengar, Med/Peds, Los Angeles County – USC Medical Center
William Aragon, Emergency Medicine
Patrick Isola, Anesthesiology
Sarah Soliman, Internal Medicine
Patrick Mcgillen, Surgery
Borna Shirvani, Anesthesiology
Briah Fischer, Obstetrics & Gynecology
Saif Azam, Radiology
Shea Nagle, Internal Medicine/Pediatrics
Mahima Iyengar, Medicine-Pediatrics
Alexander Sapin, Emergency Medicine
Corey Ambrose, Surgery
Ishani Premaratne, Plastic Surgery
Contact us: 1545 Wilshire Blvd., Suite 608, Los Angeles, CA 90017 | Morgan Currier: 213.435.4008, email@example.com.