News

Enrollment opportunities–part II

In an earlier story, we covered a myriad of enrollment possibilities. But we barely scratched the surface. So let’s scratch a little deeper.

Married employees or retirees can enroll separately. However, when married employees are enrolled in a CalPERS health plan in their own right, one parent must carry all children and dependents on one plan. Children and dependents cannot be split between parents. When split enrollments are discovered, they will be retroactively canceled. You may be responsible for all costs incurred from the date the split enrollment began.

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 can be enrolled in both a CalPERS health plan and a health plan provided through another employer. For example, a spouse who is enrolled in a State or public agency employee’s CalPERS plan may also be enrolled in the plan provided by his or her private employer. In this case, the benefits provided by each plan will be coordinated between the two plans.

New employees and their dependents may initially enroll in a CalPERS health plan as indicated in the sections above. Additional enrollment options and guidelines are described below.

The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996. HIPAA provisions improve portability and continuity of health insurance coverage in the group insurance markets. HIPAA requirements for CalPERS took effect in January 1998. HIPAA changed enrollment policies and offers two provisions outside of the annual Open Enrollment period and the initial enrollment period for employees and family members to enroll in CalPERS health plans.

Special Enrollment refers to certain types of enrollment after your initial enrollment, but outside of the annual Open Enrollment period. You may need special enrollment if:


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