Choosing–and changing–the health plan

Current active employees and retirees may change their health plans or add eligible family members. There are four times at which to do this.

One is during CalPERS’ Open Enrollment period, which occurs every fall. The changes become effective the following January 1. During this time, you may add eligible family members.

The second is if you move. You must change plans if you move out of your health plan’s service area. You may select any plan available in the ZIP Code where you live or work. Until you make the change, your previous plan may limit coverage to emergency or urgent care only. When you move or change employment, you may submit your health plan change request 31 calendar days before the move, but no later than 60 days after the move. The effective date of the change will be the first of the month following receipt of your request.

The third is when you retire. You may change health plans within 60 days of your retirement date. You may select any plan within your residential ZIP Code area. Retirees cannot use the address of the contracting agency or school employer from which they retired to establish ZIP Code eligibility unless it is a non-CalPERS covered employer. The effective date of the change will be the first of the month following receipt of your request.

And finally, it’s when you qualify for Medicare. When you first become eligible for Medicare, you have 60 days to request to change health plans. If you are Medicare-eligible, you must enroll in a CalPERS-sponsored Medicare health plan. Your plan change will be effective on the first day of the month after you request the change.

For enrollment purposes, the terms “family member” and “dependent” are used interchangeably. Both refer to your spouse or registered domestic partner, and eligible children under age 23. Eligible family members must be enrolled when you initially sign up for a CalPERS health plan or they can be added as described below.

It is against the law to enroll ineligible family members. If you do so, you may have to pay all costs incurred by the ineligible person from the date the coverage began.

Your spouse can be added to your health plan within 60 days of your marriage date or during any Open Enrollment period. To add a new spouse, you must provide a copy of your marriage certificate, and your spouse’s Social Security number and Medicare card (if applicable). Your spouse’s coverage will become effective the first of the month following the date your Personnel Office or Health Benefits Officer receives your completed Health Benefits Plan Enrollment form (HBD-12).

Your registered domestic partner may be added to your health plan within 60 days of the registration of domestic partnership or during any Open Enrollment period. When added within 60 days of registration of the partnership, the coverage will become effective the first of the month following the date your Personnel Office or Health Benefits Officer receives your completed Health Benefits Plan Enrollment form (HBD-12).

Registered domestic partnerships are authorized through the California Secretary of State’s Office. Upon registration, the office provides a Declaration of Domestic Partnership. 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. When applying for health plan coverage, the enrollee must provide a copy of the approved Declaration of Domestic Partnership and the domestic partner’s Social Security number.

Also, your natural-born children, adopted children, and stepchildren who are under age 23 and have never been married can be added to your health plan, as outlined below: