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As open enrollment begins, government workers face an array of health care choices

The open enrollment “window” – the five-week period during the year when government employees can sign up for new health care coverage or change their existing HMO – begins today, Sept. 10, and will continue through Oct. 16.

Most of California’s 240,000 state employees don’t switch their health-care providers. But some do, and for those who are considering the option, the California Public Employees’ Retirement System has put together an extensive packet of information to help them through the process.

CalPERS, the second largest purchaser of health care after the federal government, provides benefits to nearly 1.3 million state and local public employees, retirees and their families.

The 2010 Health Program Guide and other documents related to open enrollment and health care are available through CalPERS’ web site, www.calpers.ca.gov.

This week, we’ll provide some basic information about the health care programs and the timelines for enrollment. In the coming weeks, we’ll provide more detailed information.

If your initial timeframe expires, you may enroll during the next Open Enrollment period, or use a special or late enrollment opportunity. All health plan changes made during this year’s open enrollment will become effective on Jan. 1, 2010.

Here’s a brief description of the enrollment options.

Government employees: You have 60 days from the date of your initial appointment to enroll yourself or yourself and all eligible family members in a health plan. Permanent Intermittent employees have 60 days from the end of the qualifying control period to enroll.  If you are a new enrollee or are requesting a change due to a qualifying event, the effective date is the first day of the month following the date your Health Benefits Officer receives the Health Benefits Plan Enrollment form (for active members) or the Health Benefits Plan Enrollment for Retirees form.

Retirees: If you are currently enrolled in a CalPERS health plan and want to continue your enrollment into retirement, your employer will notify CalPERS, and your coverage will continue into your retirement. As you transition from employment to retirement, be sure to inform CalPERS if you or your dependents have Medicare coverage.

Spouse: You may add your spouse to your health plan within 60 days of your marriage. You are required to provide a copy of the marriage certificate and the spouse’s Social Security Number and Medicare card (if applicable). Your spouse’s coverage will become effective the first day of the month following the date your Health Benefits Officer receives the Health Benefits Plan Enrollment form (for active members) or the Health Benefits Plan Enrollment for Retirees form.

Registered domestic partner: You may add your registered domestic partner to your health plan within 60 days of registration of the domestic partnership. If you add your domestic partner within 60 days of the registration of the partnership, the coverage will become effective the first day of the month following the date your Health Benefits Officer receives the Health Benefits Plan Enrollment form (for active members) or the Health Benefits Plan Enrollment for Retirees form.

You may register your domestic partner through the California Secretary of State’s Office. Upon registration, that office will provide you with a Declaration of Domestic Partnership. To add your registered domestic partner to your health plan, you are required to submit a copy of the approved Declaration of Domestic Partnership, and the domestic partner’s Social Security number and Medicare card (if applicable).

Same-sex domestic partnerships between persons who are both at least age 18 and certain opposite sex domestic partnerships (one partner must be 62 years of age or older and the other partner at least 18 years of age) are eligible to register with the Secretary of State. For more information about domestic partnership registration, visit the Secretary of State’s Web site.

Children: Natural-born children, adopted children, domestic partnership children, and stepchildren who are under age 23 and have never been married may be added to your health plan, as follows:

–Newborn children can be added within 60 days of birth. Coverage is effective from the date of birth. Newly-adopted children can be added within 60 days of physical custody. Coverage is effective from the date physical custody is obtained.  

–Stepchildren or domestic partnership children under age 23 who have never been married can be added within 60 days after the date of your marriage or registration of your domestic partnership. The coverage will become effective the first day of the month following the date your Health Benefits Officer receives the Health Benefits Plan Enrollment form (for active members) or the Health Benefits Plan Enrollment for Retirees form.

Disabled children over 23: A child over age 23 who has never been married and is incapable of self-support because of a mental or physical condition that existed prior to age 23 and continuously since age 23 may be included when you first enroll. This enrollment is subject to CalPERS approval.

Prior to enrollment of a disabled child over age of 23, you must submit a Member Questionnaire for the CalPERS Disabled Dependent Benefit form, and your doctor must complete and submit a Medical Report for the CalPERS Disabled Dependent Benefit form for CalPERS approval. You must update these forms periodically upon request.

Economically dependent children: Other children may be eligible if they are under age 23, have never been married, and a parent-child relationship exists. Generally, a parent-child relationship exists when you have been granted legal custody or joint legal custody of the child, the child resides with you (generally in the absence of the natural or adoptive parents) and is economically dependent upon you. You have 60 days from the date you obtained custody of the child to enroll him or her on your health plan.

Prior to the enrollment of another person’s child, you must submit an Affidavit of Eligibility for Economically Dependent Children form.

This form must include the date you obtained custody of the child or the child became your economic dependent.  You may be asked to provide supporting documentation such as court records, tax returns, or proof of school registration. Coverage will become effective the first day of the month following the date your Health Benefits Officer receives the Health Benefits Plan Enrollment form (for active members) or the Health Benefits Plan Enrollment for Retirees form. You will be asked to recertify this information each year.

Survivor of a retired annuitant: If a CalPERS annuitant satisfied the requirement to retire within 120 days of separation, a surviving beneficiary who is receiving a monthly survivor check may be eligible to enroll within 60 days of the annuitant’s death.

If you are a registered domestic partner who is a surviving beneficiary of a deceased employee or annuitant, on or after January 1, 2002, and you are receiving a monthly survivor check, you are eligible to continue coverage. To do so, you must either be currently enrolled or enroll within 60 days of your domestic partner’s death, during a future Open Enrollment period, or at a later time due to a qualifying event.

A survivor cannot add any new dependents.  Only the eligible dependents who were enrolled at the time of an annuitant’s death or those who were eligible to enroll at the time of the annuitant’s death qualify for benefits.

Enrolling Family Members at a Later Time: When you enroll, you must enroll yourself or yo
urself and all eligible family members. However, you may enroll the following family members either at that time or at a later date. Children age 18 to 22 who have never been married, eligible children who are not in your custody, or dependents in the military, when they return to civilian life.
Split enrollments: Married employees/domestic partners or retirees can enroll separately. However, when these individuals enroll in a CalPERS health plan in their own right, one parent must carry all children and dependents on one health plan. Parents cannot split enrollment of children and dependents. CalPERS will retroactively cancel split enrollments. You may be responsible for all costs incurred from the date the split enrollment began.

Enrolling in Two CalPERS Health Plans: Dual CalPERS coverage occurs when you are enrolled in a CalPERS health plan as both a member and a dependent or as a dependent on two enrollments.  This duplication of coverage is against the law. When dual CalPERS coverage is discovered, the enrollment that caused the dual coverage will be retroactively canceled. You may be responsible for all costs incurred from the date the dual coverage began.  However, members may enroll in both a CalPERS health plan and a health plan provided through another employer. For example, a spouse may enroll in a State or contracting agency employee’s CalPERS plan and in the plan from his or her private employer.  In this case, the two plans will coordinate benefits.


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