Jane Dotson
California Public Employees' Retirement System (CalPERS) offers 12 health plans to its members, including basic and Medicare health plan options in all of California's 58 counties. CalPERS members can make health plan changes during the open enrollment period held each fall. To be eligible for CalPERS health insurance, certain conditions must be met, such as retiring within 120 days of the employer separation date, and the employer must contract for the CalPERS Health Program. CalPERS also offers limited health plan options for members living out of state and allows retirees to remain enrolled in certain situations, such as when their retirement allowance doesn't cover their full share of the monthly health premium.
| Characteristics | Values |
|---|---|
| Number of health plans offered | 12 |
| Enrollment period | Each fall |
| Continuation of coverage into retirement | If retiree retires within 120 days of their separation date |
| Eligibility | If employer contracts for the CalPERS Health Program |
| Dental and Vision Benefits | Available |
| Enrollment for retirees | Online through myCalPERS |
| Enrollment for agencies with existing human capital management systems | Through an electronic Health Enrollment File in XML format |
| Health plan options | Basic and Medicare |
| Health plan premiums | Competitively priced, varying across three regions in California |
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What You'll Learn
CalPERS health insurance eligibility
If you are still working and have employer group health coverage, you may defer your enrollment in Medicare Part B. You must provide proof of your active employer group health plan to CalPERS to maintain your Basic health plan coverage. If you are Medicare-eligible and are receiving retirement health benefits but are not enrolled in a CalPERS Medicare health benefits plan, you need to enroll in a CalPERS Medicare health benefit plan to continue your health coverage.
You can continue your health coverage during a temporary leave of absence by completing a Direct Payment Authorization (CalPERS-1008) to pay the entire monthly premium directly to your health plan. You are eligible for the direct payment option if you are a state permanent-intermittent employee eligible for health benefits but are in a non-pay status, are awaiting approval of disability or service retirement, or are awaiting approval of Non-Industrial Disability Insurance (NDI) benefits.
Dependent Eligibility Verification is the process of re-verifying the eligibility of your spouse, domestic partner, children, or other dependents enrolled in health and/or dental benefits. It is required by the California Code of Regulations and happens every three years.
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Enrolling in CalPERS
To be eligible for the CalPERS Health Program, you must be appointed to a job that will last at least six months and one day. Eligibility isn't based on your job classification. Permanent-intermittent state employees are eligible for health benefits after working 480 hours during one of two control periods: January 1 through June 30 (effective enrollment date of August 1) or July 1 through December 31 (effective enrollment date of February 1).
If your employer contracts for the CalPERS Health Program, you may be eligible to enrol in or continue health coverage into retirement. You must retire within 120 days of your separation date with your employer and be eligible for health enrolment on the date of separation. You must also receive a monthly retirement allowance and have retired from the State, California State University (CSU), or an agency that currently contracts with CalPERS for health benefits for their specific bargaining unit.
If you are 65 or older, retired, and eligible for premium-free Medicare Part A, you must enrol in a CalPERS Medicare health plan and also enrol and pay for Medicare Part B. You will have the option to choose a new health plan. If you do not choose one, CalPERS will enrol you in your current health carrier's Medicare plan or one that is available to you if your current health carrier does not offer a CalPERS-sponsored Medicare health plan.
If you are taking a temporary leave of absence, you can continue your health coverage by completing a Direct Payment Authorisation (CalPERS-1008) to pay the entire monthly premium directly to your health plan. You are eligible for the direct payment option if you are a state permanent-intermittent employee eligible for health benefits but in a non-pay status, or if you are awaiting approval of disability or service retirement.
If you are no longer working for your employer, your health coverage will continue through the month you leave and the following month if you have sufficient earnings to cover your share of the premium. If you leave your job for reasons other than retirement, your health coverage will resume the day you return to pay status.
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CalPERS health plan options
For active members, CalPERS offers a range of health plans with varying rates and benefits. The specific health plan premium rates are adjusted based on regional pricing to reflect the actual cost of healthcare in a particular region. California is divided into two regions, with Region 1 covering the northern part of the state and Region 2 covering the southern part. Within these regions, CalPERS offers a variety of health plans to choose from, ensuring competitive and appropriate premiums for individuals based on their location.
During the annual Open Enrollment period in the fall, active members can make changes to their health plans, including enrolling in a new plan, adding or deleting eligible dependents, or cancelling coverage. It is important to note that CalPERS requires all family members to have the same health carrier when enrolling in a health plan.
For retirees, CalPERS offers customized health plans and rates. Retirees can remain enrolled in a CalPERS-sponsored health plan even if their retirement allowance does not cover their full share of the monthly health premium. Additionally, those who are Medicare-eligible must enroll in a CalPERS Medicare health benefits plan to continue their health coverage. Similar to active members, retirees can manage their enrollment, add or delete dependents, and make changes to their plans through the designated platforms.
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CalPERS health insurance and retirement
CalPERS (California Public Employees' Retirement System) is a benefits administrator for government employees in California, providing health and retirement benefits.
CalPERS health insurance is available to retirees, with certain eligibility requirements. Firstly, retirees must have retired from the State, California State University (CSU), or an agency that contracts with CalPERS for health benefits for their specific bargaining unit. Secondly, retirees must have received a monthly retirement allowance, and thirdly, they must have been eligible for health enrollment on the date of separation from employment. Lastly, the retirement date must be within 120 days of the date of separation from employment, or within 30 days to continue health benefits automatically.
CalPERS health insurance offers retirees a range of plans, including Basic and Medicare plans, with different contribution formulas. The Exclusive Provider Organization (EPO) plan, for example, offers the same services as an HMO plan but requires the use of the plan's network of preferred providers. There are also Combination Plans, where at least one family member is enrolled in a Medicare plan and another in a Basic health plan. CalPERS health insurance premiums are adjusted based on the region, to reflect the actual cost of healthcare in that specific area.
CalPERS also provides retirement benefits to eligible employees. To be eligible for retirement benefits, employees must meet certain requirements, including retiring within a specified time frame and being enrolled in a CalPERS-sponsored health plan. Upon retirement, CalPERS becomes the health benefits officer, and retirees can make changes to their plans through myCalPERS.
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CalPERS health insurance for dependents
CalPERS health insurance is available for eligible dependents of members. Dependents include a spouse, domestic partner, children, or other eligible family members.
Open Enrollment, which takes place annually in the fall, is when eligible members can add or delete dependents to their health plan. CalPERS requires all family members to have the same health carrier. There are 12 health plans offered by CalPERS, and members can make changes to their health plan during the Open Enrollment period.
There are two types of plans available: the Exclusive Provider Organization (EPO) plan and the Combination Plan. The EPO plan offers the same covered services as an HMO plan, but services must be sought from the plan's network of preferred providers. This includes physicians and specialists, which can be accessed without a referral. The EPO plan includes copayments for some services but has no deductible or claim forms. The Combination Plan means at least one family member is enrolled in a Medicare health plan, and at least one is enrolled in a Basic health plan through the same carrier.
Dependent Eligibility Verification is the process of re-verifying the eligibility of your dependent enrolled in health and/or dental benefits. This process is required by the California Code of Regulations and occurs every three years.
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Frequently asked questions
You can enrol in the CalPERS Health Program if your employer contracts for it and you meet the eligibility requirements. You must enrol within 60 calendar days of your appointment date.
You can continue your health coverage during a temporary leave of absence by completing a Direct Payment Authorisation (CalPERS-1008) to pay the entire monthly premium directly to your health plan.
Yes, retirees can remain enrolled in a CalPERS-sponsored health plan when their retirement allowance doesn't cover their full share of the monthly health premium. You can continue coverage into retirement if you retire within 120 days of your separation date.
