Open enrollment: annual opportunity to change HMOs

Government employees across the state will have the option beginning Monday of changing their health-care plan as part of an annual event known as open-enrollment. The window of opportunity, which will stay open for more than three weeks, closes Oct. 10.

The largest government purchaser of health-care coverage is the California Public Employees Retirement System, which serves some 1.3 million government workers, retirees and their families. CalPERS has put together a major outreach program to alert its members of the health-care options. Premiums to take effect in January 2009 will rise an average of 4.8 percent – the smallest increase in a decade – for basic HMO and PPO plans, CalPERS says.

From year to year, there is not a great deal of movement from HMO to HMO, CalPERS notes. But much of the activity in open enrollment stems from new employees coming into the system.

“There is not a lot of change other than new employees coming into the plans. With regards to movement between the plans, that change is minimal,” said CalPERS’ health-benefits chief Gregory Franklin. CalPERS negotiates rates and coverage with its health-care providers, posts the rates in September, then lifts the open-enrollment window. “There is a cycle that we go through. Really, it is about member choice.”

CalPERS offers the following advice to its health-plan members and applicants.
Depending on where you live or work, CalPERS offers active employees and retirees one or more types of health plans, which may include:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Exclusive Provider Organization (EPO) (for members in Colusa, Mendocino and Sierra counties.)
CalPERS’ board of administration reviews health-plan contracts annually to determine the specific health plans available, as well as covered benefits, monthly health premiums, and co-payments.

Whether you are working or retired, your employer or former employer may make monthly contributions toward your health premiums. The amount of this contribution varies. The cost of your premium may depend on your employer or your former employer’s contribution, the length of your employment, and the health plan you choose. Active employees should contact their employer, State retirees should contact CalPERS, and contracting public agency retirees should contact their former employer for the monthly contribution amounts.

Some notes on eligibility:

• State employees and annuitants and contracting public agencies may sign up for the CalPERS Health Program. To be eligible, you must meet the eligibility requirements for an employee, retiree/annuitant, or family member.
• Eligibility is based on tenure and time base of your qualifying appointment. You must have a permanent appointment and must work at least half-time. Appointments classified as “Limited Term” must have a duration of more than six months.
• A state Permanent-Intermittent (PI) employee may enroll if he or she has received credit for a minimum of 480 paid hours at the end of a “control period.”

A control period means the six-month period from Jan. 1 through June 30 or July 1 through Dec. 31. Government employees: You cannot become eligible in the middle of the control period even if the minimum hours are met early. To continue to qualify for coverage, you must be credited with at least 480 paid hours at the end of each control period or at least 960 hours in two consecutive control periods (current and prior). Checkpoints to determine whether the hours have been met are June 30 and Dec. 31.
If you are a retiree, you are eligible to enroll in a CalPERS health plan if:

• The retirement date is within 120 days of separation from employment, and you were eligible for health benefits upon separation.
• You have, or will, receive a monthly retirement allowance.
• You retire from the state, California State University (CSU), or a contracting public agency (an agency that currently contracts with CalPERS for health benefits)
• You are the spouse or registered domestic partner, or an economically or disabled dependent of a member, or the dependent of a member up to the age of 23.
Certain state or contracting public agency employees and family members are not eligible for CalPERS health benefits. They include:
• Those working less than half-time (certain California State University employees and some public agencies have contracted for employees working less than half-time to qualify for health benefits).
• Those whose appointment lasts less than six months and one day.
• Those whose job classification is “Limited-Term Intermittent” (seasonal or temporary)
• Those classified as “Permanent-Intermittent” who do not meet the hour requirements within the control period.
• Those whose employer does not have a contract or has terminated its contract with CalPERS.

For more information on CalPERS’ health-plan options and benefits, call 1-888-225-7377), or write P.O. Box 942714, Sacramento, CA 94229-2714.

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