California Community Colleges Part-Time Faculty Health Insurance Reimbursement Claim Form 2023-24

Education Code sections 87860 through 87868 establish the Part-Time Faculty Health Insurance Program to encourage community college districts to offer health insurance for part-time faculty. For this program the following definitions apply:

Part-Time Faculty are those with assignments equal to or greater than 40 percent of a full-time assignment.
Multidistrict part-time faculty are those with total teaching assignments at two or more community college districts equal to or greater than 40 percent of a full-time assignment.

For more information, see the Part-Time Faculty Health Insurance program webpage. This reimbursement claim must be submitted no later than June 1, 2024. Revised claims must be submitted no later than November 30, 2024.

1. District: *This question is required.

2. Number of district part-time faculty participants: *This question is required. This question requires a valid number format.

3. Number of multidistrict part-time faculty reimbursement program participants: *This question is required. This question requires a valid number format.

4. District share of health insurance premiums paid for district part-time faculty:
Note: Do not include cost of multidistrict part-time faculty reimbursements that are reported in question six below. *This question is required. This question requires a valid currency format.

5. Part-time faculty share of health insurance premiums: *This question is required. This question requires a valid currency format.

6. District cost of health insurance premium reimbursement to multidistrict part-time faculty: *This question is required. This question requires a valid currency format.

Districts can receive reimbursement for up to 100% of the total cost of health insurance premiums paid for part-time faculty, multidistrict part-time faculty, and their dependents if they meet the four requirements below. Please mark Yes or No for each requirement:

7. Do you offer health insurance coverage to all part-time faculty who work 40% or more of a full-time load? *This question is required.

8. Do you offer part-time faculty the same health insurance benefits provided to the full-time faculty at the community college district? *This question is required.

9. Do you limit individual premiums paid by part-time faculty to no more than the actual individual premium paid by full-time faculty in that district? *This question is required.

10. Do you offer a health insurance reimbursement plan to all multidistrict part-time faculty who work a combined load of 40% or more at two or more districts? *This question is required.