If, as the saying goes, the future begins in California, then health coverage for postdocs across the country may be in for some real improvement.

On 1 January 2005, after years of preparation, and a full year behind the initially announced start date, the University of California (UC) inaugurated its much-heralded unified health plan for the estimated 6000 postdocs in the 10-campus system. For the first time ever, all UC postdocs, regardless of their funding source, have access to the same comprehensive group health insurance. Nine of the campuses came under the new plan on New Year's Day and the tenth, the University of California-San Francisco (UCSF), will do so on 1 July 2005. The Lawrence-Berkeley Lab may also join, according to Steve Johnson of the benefits firm Garnett-Powers & Associates, which arranged for the insurance.

Ends longstanding inequity

With an estimated 10% of the nation's postdocs, UC is the "first system in the United States to recognize postdocs in this way," says Sam Castaneda, director of Berkeley's Visiting Scholars and Postdoctoral Affairs Program. The new plan ends the longstanding inequity, common in labs across the country, of colleagues who work at the same bench having access to different health coverage depending on who provides the money that supports their research.

At UC, postdocs hired on PI grants (known as employee postdocs) formerly received the same comprehensive health coverage as other UC staff and faculty members. Postdocs holding NIH and NSF fellowships (known as stipend postdocs) could not receive those benefits, however, because federal policy forbids universities to consider them employees. Nor did postdocs funded by private entities or foreign governments (know as paid direct postdocs) come under the employee plan. A hodgepodge of group plans on the various campuses covered some of these individuals, but others "had to go in the Yellow Pages" to buy very inferior individual policies, Castaneda says.

The new package is "a very good deal for the postdocs," says Mark Westlye, director of Graduate Student Advancement in the UC Office of the President, which oversaw the massive changeover. Coverage for each postdoc, and, if desired, for his or her spouse and children, now includes comprehensive medical insurance with a choice of a health maintenance organization (HMO) or a preferred provider organization (PPO); dental insurance, also with HMO or PPO options; and vision insurance under a PPO. All preexisting conditions are covered. The postdoc also receives $50,000 in life insurance coverage, free accidental death and dismemberment insurance, and free short-term disability insurance, "the only [such] free benefits in the entire UC system," according to Castaneda. Postdocs may also buy optional long-term disability insurance.

The university pays the entire premium for employee postdocs choosing HMO medical coverage; employee postdocs may elect to pay an additional fee for the costlier PPO coverage. Stipend and paid direct postdocs, whose costs are supposed to come out of the research allowance that accompanies the fellowship or the salary provided by the funder, must arrange for what UC terms "sharing of premium costs" between their research allowances and other funding sources, since research allowances are often insufficient to pay for insurance. In the majority of cases, departments are picking up the cost differential.

Employee postdocs working at UC before 1 January got to choose between remaining with their existing coverage and changing to the new plan, which will automatically enroll all new postdocs of every category who join UC from 1 January on. Stipend and private-pay postdocs on board before 1 January all moved to the new plan. UCSF doesn't join until 1 July because they "have an existing contract for insurance and they need it to expire," says Kyle Cunningham, coordinator of UCLA's Office of Postdoctoral and Visiting Scholar Services. A system-wide rule limits postdoc appointments to five years, so by 2010 everyone "grandfathered" under the old employee coverage will be gone and the new plan will cover all UC postdocs.

"Postdocs can move from project to project without losing their benefits," says Castaneda. Previously, the many individuals who switched among federal fellowships, private funding, and jobs with PIs, or between projects on different UC campuses, also had to switch--and sometimes lose--their health insurance. This discouraged "the best of the best from applying for their own grants. They wouldn't have benefits if they get the fellowship," says Johnson, who worked in the UC-Irvine benefits office before joining Garnett-Powers. The certainty that postdocs will always receive uniform, comprehensive health benefits gives UC a "recruiting tool," he adds.

Bureaucratic miracle workers

The rollout of the new plan is nothing less than a "miracle," Castaneda says, and one made possible by scores of staffers across the state who spent thousands of hours working out countless details. Every other Tuesday for the past two years, as many as fifty of these bureaucratic miracle workers attended a system-wide, two-hour-long conference call to discuss innumerable issues that arose in dozens of arcane administrative areas. Each campus had previously handled postdocs in its own way, so the task of devising uniform procedures that worked for everyone was immense and fraught with unexpected complications. The new system had to track the enrollment of people who had previously been unknown to university databases, collect premiums in differing amounts from a large number of individuals and campus entities, and reconcile everyone's billing and records.

Staffers in payroll offices, benefits departments, and computer services departments labored to develop new job codes, some of which violated longstanding UC procedures; to extensively revise software, some of it decades old; to establish a single enrollment and accounting setup despite very different local circumstances; and to find answers to some screwball questions. How, for example, could cashiers' offices accomplish the previously unheard-of task of accepting personal checks from direct paid postdocs to fund their insurance? Solving this array of problems brought forth "absolutely the most amazing group effort I've ever seen, [with] not a bad attitude in the group," Johnson says.

"We're scrambling to get everything in place," Cunningham told Next Wave in early December. "We didn't do anything but postdoc [insurance] work for the last two months," added Castaneda. At the four campuses with the largest numbers of postdocs, that "we" includes the two new staff members, one in payroll and one in benefits, that each campus hired specifically to deal with postdoc insurance. Finding the extra money to pay for both the benefits and the administration has been a challenge, especially since California's budget does not make this "the best timing to appeal to departments to come up with additional funds," Cunningham says. But because "deans are putting out strong recommendations," departments have generally come through.

Not only the postdocs but the individual universities and the UC system at large will benefit from the new plan, sources agree. For the first time, all postdocs on all campuses will appear in a single, system-wide database administered by the payroll department. Each person will have a discrete account number, allowing UC to know who is working where at any given time--basic administrative information that no one had previously collected. This offers a "very rich opportunity" to find out about postdocs and their needs, Johnson says.

Postdocs across the nation will also benefit from the UC experience, Johnson hopes. With the details of providing the same health coverage to all categories of postdocs already worked out, "Garnett-Powers & Associates will be working with the National Postdoctoral Association to implement this sort of program on a national basis," he said. In addition, the company hopes to offer universities across the nation "a turn-key operation" that would both provide the insurance and "let us do the front-end" work of enrollment and data collection. "We want to be able to say, 'You don't need anybody to staff the operation,'" which would particularly suit campuses whose postdocs number in the dozens, Johnson believes.

Whether the long-awaited California plan actually lives up to its advance billing--let alone improves the situation nationally-- will become clear in the coming months. "We have to anticipate some problems," during the rollout, Cunningham admits, though he expects them to be "on the technical side." But, said Castaneda in December, "This is a wonderful, wonderful thing because it's finally going to happen."

Beryl Lieff Benderly writes from Washington, D.C.