The debate rages over which employer group offers the best health care benefits, but one group that always seems to come out at or near the top of that debate is the state. The California Employees' Retirement System, the nation's largest public pension fund, provides information on health coverage to hundreds of thousands of government workers and retirees.
CalPERS itself is the third-largest purchaser of health care in the nation, providing benefits to more than 1.2 million public employees, retirees and their families. The program covers state employees by law, and local public agencies and school employers can contract to have CalPERS provide health benefits to their employees – regardless of whether they contract for the retirement program.
The pension fund has three types of health plans: Preferred Provider Organizations, or PPOs; Health Maintenance Organizations, known as HMOs; and Exclusive Provider Organizations, or EPOs. The latter are limited to members in certain California counties.
More than two-thirds of CalPERS members are enrolled in HMO plans, which offer a standard benefit design. All HMO, PPO and EPO plans offer separate Medicare supplemental plans for those members eligible for Medicare.
Health plans offered, covered benefits, monthly rates, and co-payments are determined by the CalPERS board, which reviews health plan contracts annually.
Employers make a contribution toward the member's monthly premiums, with members covering the difference between the employer's contribution and the actual premium amount. The employer contribution rate is normally established through collective bargaining agreements.
You can find more detailed information on benefits on CalPERS' Web site, www.calpers.ca.gov.
CalPERS also offers long-term care benefits. The CalPERS Long-Term Care Program is the largest self-funded program of its kind and is designed specifically for California public employees, retirees and their extended family members.
All California public employees and retirees, and their spouses, parents, parents-in-law and adult siblings are eligible for the CalPERS Long-Term Care Program. Those eligible to apply must be between the ages of 18 and 79. This includes members of CalPERS, teachers and other school employees, University of California, and California State University employees and retirees, county and city employees and retirees, judges, legislators and all other California public employees and retirees. Members of the program can receive benefits anywhere in the nation.
A catastrophic accident or disability can occur at any age, and conventional health plans do not provide extended care. CalPERS offers three plan options – Comprehensive, Facilities Only and Partnership. Each plan option offers a variety of daily benefit and total coverage amounts and flexibility on how the benefits are used. Additional information can be found at CalPERS' Web site.