FAQs - Health Care Reform

Health Insurance Exchange/Covered California

If my CalPERS employer doesn't contract with CalPERS for health, can my employer contract with the Exchange?

If your employer contracts with CalPERS for retirement but not for health benefits, and your employer has less than 50 full-time employees, then your employer may contract with Covered California for health benefits.

If "yes" to above, can I authorize CalPERS to take deductions from my check to pay directly to the Exchange (Direct Authorization)?

No. CalPERS cannot take deductions for Covered California payments.

Can I opt out of CalPERS and go to the Exchange?

You may choose to opt out of your employer-sponsored health benefits to purchase health benefits as an individual through Covered California. If you purchase benefits through Covered California when you have affordable employer-sponsored health benefits available, you will almost certainly lose your employer health contribution. In addition, you most likely will not qualify for premium tax subsidies or cost-sharing reductions.

Will I receive my employer's contributions if I choose the Exchange?

You should check with your employer, but if you choose Covered California, you most likely will lose your employer health contribution and pay the full cost of coverage.

Will I receive Medicare reimbursement if I choose the Exchange?

Covered California does not offer Medicare plans. Please contact Covered California for information.

Can I have a CalPERS-covered health plan and one from the Exchange? Is it considered "dual coverage"? (Example: I have CalPERS through my employment and my spouse has health through the Exchange.)

You may be able to purchase coverage through Covered California but you likely would not qualify for tax credits or cost sharing-reductions. Please contact Covered California for information.

If "yes" to above, does that include Medicare plans?

Covered California does not offer Medicare plans.

If my employer does not contract for dental and vision, can I go to the California Health Exchange for my dental and vision coverage?

Please contact Covered California for information.

Dependent Coverage

I heard that CalPERS will be deleting spouses from members' health plans because of the Affordable Care Act (ACA). Is that true?

No. Although the ACA does not include a spouse in the definition of dependent, CalPERS currently allows a legally married spouse to be enrolled on a member's health plan. We do not plan to change that.

How does health care reform affect young adults?

As a result of the ACA, children of CalPERS health benefit subscribers, whether previously on their parents' plans or not, are eligible for health coverage up to age 26.

Does my child have to live with me, be unemployed, unmarried, or enrolled in college to qualify for the extended dependent coverage?

No. Your child can be covered up to age 26, regardless of his or her marital, student, housing or employment status.

My son got married and lost coverage. Can his wife and children be covered by my plan now too?

Under the ACA, coverage does not extend to your son’s wife or children.

Who is going to pay for this coverage?

The payment for extended dependent coverage costs is consistent with premium payments for other dependents.


To meet the "individual mandate" requirement, I have to prove my family and I had health insurance when I file our 2014 tax return. My tax preparer told me I will receive proof of insurance from my health plan. Is this true?

In general, beginning in 2014, individuals must have qualifying health care coverage, qualify for a health coverage exemption, or make a shared responsibility payment with their tax return. Called minimum essential coverage by the IRS, the reporting of qualifying coverage by a group health plan is optional for the 2014 tax year. It will be required beginning with the 2015 tax year. Members being asked by their tax preparer for form 1095-B from their group health plan to prove qualifying coverage should discuss other ways to attest they had coverage for the 2014 tax year. Please see IRS Publication 5187 for more information.

This information is provided for general assistance purposes only and should not be construed as tax advice.

I have heard that I will be taxed on the value of employer-provided health coverage for any adult child on my plan from age 23 up to 26. Is this true?

Federal and State tax laws exempt this employer-provided health coverage from taxation.

I have heard that the ACA requires my employer to include the value of applicable employer-sponsored group health coverage on my W-2 starting in taxable years beginning after December 31, 2011. Is this a taxable benefit?

Under the ACA, the value of employer-sponsored group health coverage will appear on employees’ W-2 forms for information purposes. Federal and State laws exempt this value from taxation.

Does health care reform require my Form 1099 to include the value of applicable employer-sponsored group health coverage?

No. The ACA only requires this information to be included on W-2 forms.

Lifetime Limits

Do PERS Select or PERS Choice plans still have lifetime limits?

No. To comply with the ACA, CalPERS removed the $2 million lifetime maximum from the PERS Choice Preferred Provider Organization (PPO) plan and the PERS Select PPO plan.


The Social Security Administration (SSA) recently informed me that I will be subject to a Part D income-related monthly adjustment amount. Will CalPERS reimburse me for this charge?

The adjustment is a surcharge assessed by the SSA, based on income, and is above and beyond standard Part D premium rates already built into your CalPERS plan. There is no provision in State law that provides for reimbursement of Part D premiums. Please contact the SSA at (800) 772-1213 or the Centers for Medicare and Medicaid Services at (800) 633-4227 with your questions.

General Consumer Information

Where can I find more details about changes in dental and vision benefits?

If you are an employee of a State or contracting public agency, you should contact your employer about dental and vision coverage. If you retired from a contracting public agency, you should contact your last employer. If you are a State retiree, contact the California Department of Human Resources (CalHR) with questions about dental benefits and Vision Service Plan (VSP) with questions about vision benefits. For CalHR and VSP contact information, refer to the CalHR website.

Dated: 02-06-2015