Jeffrey Wade
Open Enrollment for CalPERS health insurance plans typically takes place each fall, with the 2024 Open Enrollment period ending on October 11, 2024. Changes made during this period took effect on January 1, 2025. The 2025 Open Enrollment dates are September 15 to October 10, with changes taking effect on January 1, 2026. During Open Enrollment, members can switch plans and make changes to their dental and vision plans.
| Characteristics | Values |
|---|---|
| Open Enrollment Dates for 2025 | September 15 to October 10 |
| Open Enrollment for | State of California and California State University (CSU) sponsored dental and vision plans |
| Changes Effective Date | January 1, 2026 |
| ID Cards | Mailed mid-December 2024 |
| ID Cards Not Received by | January 1, 2025 |
| Contact for Basic Plan | Included Health |
| Contact for Medicare | Blue Shield |
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What You'll Learn
Open enrollment for retirees
For the 2024 open enrollment period, which ended on October 11, 2024, changes took effect on January 1, 2025. The 2025 open enrollment period is from September 15 to October 10, 2025, and any changes made during this period will take effect on January 1, 2026.
It is important to note that retirees need to review their pay warrants to ensure that the health plan premium deduction was made when changing health plans, enrolling for the first time, or making changes to dependents. Additionally, retirees who are enrolled in a PERS Gold or Platinum health plan and do not receive their ID card by January 1 of the year following open enrollment should contact Included Health.
CalPERS is working to provide members with more affordable health plan choices and ensure equitable, high-quality healthcare. Members will be informed of any health plan or premium changes prior to open enrollment.
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Switching plans during open enrollment
Open Enrollment for CalPERS health insurance plans is an opportunity for active members to make changes to their health plans. The open enrollment period for 2024 ended on October 11, 2024, with changes taking effect from January 1, 2025. The 2025 open enrollment period is from September 15 to October 10, 2025. During this time, members can switch their health insurance plans, but it is important to note that certain changes cannot be made outside of this period.
If you are enrolled in a plan that will no longer be available in the upcoming year, it is important to select a new plan during Open Enrollment. If you do not make a selection, CalPERS will automatically enroll you in a comparable plan. During Open Enrollment, you have the option to switch to a new health plan, including a CalPERS-sponsored Medicare health plan if you are eligible for Medicare. You will receive notifications about this transition a few months before your 65th birthday.
It is important to note that if your medical group ends its contract with your current health plan, or if there are changes to memoranda of understanding, bargaining unit agreements, or employer contribution amounts, these do not qualify as events that allow you to change plans outside of Open Enrollment. However, if you experience a qualifying life event, such as retirement or a dependent aging out of your health plan, you may have the opportunity to make changes outside of Open Enrollment through a special enrollment period (SEP).
If you switch health plans during Open Enrollment, you will receive new ID cards from your new health plan provider, not from CalPERS. These ID cards will typically be mailed in mid-December, and you should receive them by January 1. If you do not receive your new ID card by then, contact your health plan provider directly to request additional cards.
To explore your options during Open Enrollment, active members can review the Annual Health Plan Changes, which provide details on health plans, service areas, and benefit design changes for the upcoming year. Additionally, CalPERS offers a wide range of behavioral health and wellness programs, with specific information available on the website.
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Maintaining coverage during leave of absence
Open enrollment for State of California and California State University (CSU)-sponsored dental and vision plans is from September 15 to October 10, 2025.
Maintaining coverage during a leave of absence
A leave of absence is a period of time when you have authorisation from your employer to be absent from some or all of your duties, for example, maternity or paternity leave, temporary disability, or a sabbatical. During this time, you may be able to purchase service credit.
If you want to keep your health coverage during a leave of absence, you must contact your personnel office to enroll under direct pay. You will then be responsible for making the monthly premium payments directly to your health plan. If you do not elect direct pay, you must cancel your CalPERS health coverage.
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. 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.
- You are awaiting approval of disability or service retirement.
- You are awaiting approval of Non-Industrial Disability Insurance (NDI) benefits.
You may only elect direct pay through the end of the qualifying control period. If you do not choose this option while off-pay status, your health benefits will be cancelled. You can re-enroll when you return to pay status if your earnings are sufficient to cover your share of the monthly premium.
If you leave your job for reasons other than retirement, 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 elect to cancel your coverage before you leave your job, your benefits will not continue, and you will not be eligible for COBRA Continuation Coverage.
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Online health enrollment changes
CalPERS members can make online health enrollment changes through their myCalPERS account. Active members can visit the Online Health Enrollment for Active Members webpage to learn more about how to make changes, while retired members can visit the Online Health Enrollment for Retirees webpage.
Members can also compare plans to determine which one best suits their needs by referring to the CalPERS Health Benefit Summary. This summary can be useful for those who are currently in a Basic plan and turning 65, as they might need to enroll in a CalPERS Medicare health plan.
It is important to note that open enrollment takes place each fall, and any changes made during this period will take effect on January 1 of the following year. For example, the 2025 Open Enrollment dates are September 15 to October 10, and changes made during this period will take effect on January 1, 2026.
During open enrollment, members can switch plans, add or delete dependents, and make other necessary changes. However, it is important to remember that changing plans outside of open enrollment may be restricted and dependent on certain conditions, such as a qualifying life event.
Additionally, CalPERS offers a direct payment option for members who wish to continue their health coverage during a temporary leave of absence. By completing a Direct Payment Authorization, members can pay the entire monthly premium directly to their health plan and maintain their coverage.
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CalPERS Medicare health plan
CalPERS is a health benefits program for active and retired state and California State University (CSU) employees. It offers a range of health plans, including a CalPERS Medicare health plan.
If you are an active member and want to transition from a CalPERS Basic health plan to a CalPERS Medicare health plan, you are encouraged to enrol in Medicare Parts A and B before or within 30 days of retirement. This allows for a smooth transition, as CalPERS will receive notification of your enrolment electronically and can automatically transfer you into a CalPERS Medicare health benefits plan. If you enrol more than 30 days before retirement, you may need to provide supporting documentation. If your CalPERS Basic health plan has a corresponding Medicare health plan, you will automatically transition to that plan. If not, you will be transferred to UnitedHealthcare (HMO) or, if that is not available in your area, to PERS Platinum (PPO).
If you are already enrolled in a CalPERS Basic health plan and are approaching your 65th birthday, you will receive notifications about transitioning to Medicare a few months in advance. You will have a seven-month initial enrolment period to sign up for Medicare Parts A and/or B, beginning three months before you turn 65 and ending three months after your birthday. If you are still working and have employer group health coverage, you may defer your enrolment in Medicare Part B. However, you must provide proof of your active employer group health plan to CalPERS to maintain your Basic health plan coverage.
If you are a retiree and you and/or your dependent are over 65 and eligible for premium-free Medicare Part A and premium-based Medicare Part B, CalPERS requires you to enrol in both Part A and Part B and then transfer into a CalPERS Medicare health benefits plan to continue your health coverage. If you are Medicare-eligible, receiving retirement health benefits, and not enrolled in a CalPERS Medicare health benefits plan, you need to enrol in a CalPERS Medicare health benefits plan to continue your health coverage through the CalPERS Health Program.
If you enrol in Medicare Part A while still working, your current CalPERS Health Plan will continue to be the primary payer of your insurance claims, while Medicare Part A will be the secondary payer. This means that Medicare will pay up to their allowable amount of costs not covered by your CalPERS health insurance, potentially reducing your out-of-pocket costs. However, Part A only covers inpatient care in a hospital, skilled nursing care, hospice, and some home health services. Therefore, you may want to consider delaying Medicare Part A if you contribute to a Health Savings Account (HSA) or if you will have to pay a premium to enrol.
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Frequently asked questions
September 15 to October 10, 2025.
January 1 of the following year. For example, changes made during the 2025 Open Enrollment will take effect on January 1, 2026.
Contact Included Health if you are in a Basic plan. If you are in Medicare, contact Blue Shield.
Yes, you can make changes to your dental and vision plans outside of open enrollment by accessing Dental & Vision Benefits for more information.
You should select a new plan during Open Enrollment; otherwise, you will be automatically enrolled in a comparable plan.
