Open Enrollment for Employers

• Is the UC Health System available through Blue Shield Access+ HMO and EPO?
  • All six universities in the University of California (UC) Health System are available through Blue Shield Access+ HMO and Blue Shield EPO. We are working to update our health plan search tool to reflect this information.
    • UC Davis
    • UC Irvine
    • UC Los Angeles
    • UC Riverside
    • UC San Diego
    • UC San Francisco
• Has Blue Shield of California Access+ HMO expansion into Monterey County been approved?
  • Yes. It is approved by Department of Managed Health Care (DMHC) approval. The Annual Health Plan Changes webpage has been updated.
• Do members need to do anything if they want to keep their current health plan?
  • No action is required if they want to keep their current health plan.
• How can members confirm which health plans accept their provider/medical group? How do members know if the primary doctor, specialist, or group they prefer are covered by a specific health plan?
  • The Health Plan Search by ZIP Code on our website and Search Health Plans tool in myCalPERS allow members to enter the name of a doctor, specialist, or medical group to find out which health plans they are available through. Members are always encouraged to confirm doctor and medical group availability directly with the carrier or doctor before making a change.
• What health plans offer health and wellness programs and other benefits? What kinds of benefits are offered like gym memberships, nutrition classes, behavioral health, etc.?
  • All of our health plans offer health and wellness programs along with other benefits, including comprehensive behavioral health services. The benefits may include gym memberships, health and nutrition classes, wellness coaching, discounts on several wellness activities and memberships, individual and group therapy, and more. Programs vary by health plan. Encourage your employees to learn more by visiting Health & Wellness Programs by Health Plan.
• How can members compare differences between health plans?
  • The Health Plan Search by ZIP Code on our website and Search Health Plans tool in myCalPERS allow members to compare benefits and premiums between health plans, and filter the results by differences for quick results. For more details on covered services, review each health plan’s Evidence of Coverage document in Forms & Publications.
• Where are publications and Evidence of Coverage (EOC) documents found?
  • EOCs, which outline the costs and benefits of each plan for that specific year, are found in Forms & Publications.
• How will employers be notified of the health enrollment file erroring out if demographics do not match what’s in myCalPERS?
  • You’ll be notified of demographic errors in a response file placed in the secure file transfer protocol (SFTP) folder where you submitted your enrollment file. This response file will specify which transactions encountered errors and provide details on the demographic issues that caused them.
• When will the CalHR benefits calculator be updated to include 2026 information?
  • For our state members - CalHR's benefits calculator is currently up to date with 2026 information.
• If our agency decides to use our own online platform for employees to submit Open Enrollment elections, do we still have to require employees to submit a paper HBD-12 form?
  • If your agency decides to use your own platform to submit Open Enrollment elections, you do not need to require employees to submit a paper HBD-12  form (PDF); however, you need to collect all the information contained on the form and be able to provide the information upon audit request. All of this information is contained in Circular Letter 600-010-19 (PDF) from February 25, 2019.
• Why isn’t a provider/medical group contract termination a qualifying event to change health plans?
  • Changes to medical groups and contract terminations occur often and throughout the course of the year. These are not qualifying events to change health plans. Most of the time contract negotiations are successful in negotiating a new contract and the services are maintained. While we understand the confusion and anxiety created by these events, as a purchaser of health care, CalPERS can’t guarantee you will be able to indefinitely continue your relationship with your provider, if your provider or health plan ends their contract.
    
    It’s also important to note that the California Department of Managed Health Care requires health plans to have sufficient providers available in each health plan’s network at all times to provide services to all members.
  • If a new contract isn’t negotiated successfully, and you’re in a course of treatment, you are able to request continuity of care to complete your treatment with your provider. Once the treatment is complete, you’ll receive services with an in-network available provider. However, members who are not satisfied with their access to health care services can appeal to CalPERS in writing. These will be evaluated on a case by-case basis.
• How often and when during the year can a provider/medical group negotiate their health plan contract? Can members be notified prior to Open Enrollment to make an informed decision?
  • Most provider/medical groups are multi-year contracts, typically lasting three years, but the negotiations can take place anytime of the year. And the timing sometimes coincides with Open Enrollment. Unfortunately, CalPERS can’t notify members when health plans are negotiating with providers at any time of year until the outcomes are decided. The CalPERS policy (PDF) is to allow the health plans and provider to continue negotiations and work toward resolution together, without our intervention. To do otherwise might result in higher premiums for you. We closely follow the progress of negotiations and will act appropriately to assure you have health care coverage if it appears a contract termination will occur.
• Can members change health plans when they move? What are the permitting events in which members can change their health plan outside of Open Enrollment?
  • Yes, moving is a qualifying event to change a health plan. Other qualifying events include retirement and Medicare eligibility. For any of these qualifying events, members have 60 days from the qualifying event date to request a health plan change. For more information, visit life events to learn how certain events impact coverage or benefits.
• If a member's child is disabled, what paperwork is needed to add that child after 26 years of age?
  • Disabled children are to be enrolled at the time of the initial enrollment or are to be continued on the member’s enrollment from before age 26 to be eligible for our health program. The required paperwork is our Disabled Dependent Member Questionnaire and Medical Report (HBD-34) (PDF). We also have an Authorization to Disclose Protected Health Information form (BDS-35) (PDF) to authorize the doctor to release the information. This form isn’t required, and your doctor might have a different authorization form they would like you to complete. CalPERS doesn’t need any authorization forms back. The Disabled Dependent Member Questionnaire and Medical Report (HBD-34) (PDF) has a portion for the member to complete and a portion for the doctor to complete. The doctor must send the completed form back to CalPERS directly from the doctor’s office by fax or mail. All of the instructions are on the HBD-34 form and the forms can be found in Forms & Publications.
• Is it possible to add a parent as a dependent for health insurance due to loss of coverage? Who is eligible to be a dependent for health coverage?
  • Parents are not eligible for employer sponsored health plans. Eligible dependents include spouses, registered domestic partners, children, adopted children, stepchildren and domestic partner’s children. Another person's child under age 26 may be eligible for coverage if a parent-child relationship exists. An Affidavit of Parent-Child Relationship (PDF) must be filed prior to enrollment and be updated upon request. Certified disabled dependent children, aged 26 and older are also eligible. More information regarding who is eligible can be found on the Enroll Family Members page.
• I am retiring in October, and I understand I am covered under my same plan which will transition to a Medicare plan December 1. But if I want to change my health plan, does it have to be effective January 1, 2026, for Open Enrollment?
  • Medicare eligibility and retirement are qualifying events to change your health plan. Under this scenario you can change your health plan effective December 1 with a qualifying event of retirement or Medicare eligibility. Some members change health plans due to retirement and later become Medicare eligible and change plans again as both are qualifying events. More information can be found on our Medicare (Retirees) webpage.
• Do members have health insurance when temporarily traveling outside of the United States? What does it cover?
  • Yes, members temporarily traveling outside the U.S., can receive urgent or emergency medical care. They may need to pay up front and submit a claim to their health plan for reimbursement. Members should check their EOC for specific information, phone numbers, or websites prior to traveling. For more information, explore our PERSpective article: Know Your Health Care Coverage Before You Go.
• If a member changes health plans, how do they select a new primary care physician (PCP)? Will their medical records and prescriptions be transferred over to the new provider?
  • If a member changes health plans, they need to review the plan's in-network provider list online and can select a new in-network PCP there. Another option is to call the health plan's member service line and ask for assistance in selecting a new in-network PCP. Medical records can be transferred by requesting them from the previous provider, which often requires a medical release form. For prescriptions, members will want to coordinate with the new PCP and pharmacy for transfers. Members are encouraged to first verify medication coverage under the new plan and schedule initial appointments with the new PCP.
• Do pre-existing conditions affect health coverage or ability to change plans?
  • No. CalPERS health plans comply with federal and state laws, including the Affordable Care Act (ACA). Under the ACA, health insurance providers cannot deny coverage or charge higher premiums based on pre-existing health conditions. CalPERS health plans provide guaranteed coverage to eligible members regardless of their health status or pre-existing conditions.
• Value-Based Insurance Design, (VBID): What are all the activities that can reduce the PERS GOLD deductible, and where can I find the list of these activities? Where do I complete a smoking attestation?
  • Starting in 2026, the smoking attestation credit will no longer apply to the PERS Gold in-patient deductible. In 2026, more vaccine options and expanded screening choices to promote healthy habits and support overall well-being have been added. All the activities that can reduce your PERS Gold Basic Plan’s deductible can be found at calpers.ca.gov/VBID.
• Is the Included Health provider search tool on their website and app more up to date? And is the registration requirement to use the search tool removed for Open Enrollment?
  • The Included Health search tool is routinely updated; however, its results may differ from the Blue Shield provider results because the Included Health tool uses the member’s information to produce in-network, high-quality provider results, but not necessarily all the available providers. Members seeking a more comprehensive provider list can visit the Blue Shield website. Registration with Included Health is required to use the provider search tool, including during Open Enrollment.
• Will members be able to access the formulary, find which drugs are covered and the cost, during Open Enrollment so that they can make an informed decision?
  • Both the Basic and Medicare formularies will be available for members to access on the CVS Caremark: Pharmacy Benefits webpage, during Open Enrollment. The formulary will provide the tiering for each drug and those tiers determine the copayments. Tiering information can be found in our Health Benefit Summary.
• Will members continue to have automatic mail order prescriptions?
  • Yes. The mail order pharmacy will change, but mail order delivery will continue to be an option. Most mail order prescriptions will transfer automatically. CVS will notify you prior to the transition if action is needed.
• Will members be able to get 90-day prescriptions at the pharmacy instead of mail order?
  • Yes, Basic plan members will be able to get a 90-day supply of many medications through retail in-network pharmacies as well as the mail order pharmacy. This was always the case for Medicare members. For more information, visit the CVS Caremark: Pharmacy Benefits webpage.
• Will members still be able to use OptumRx?
  • No, members in an affected plan will switch to CVS effective January 1, 2026.

Starting January 1, 2026, CVS Caremark will be the pharmacy benefits manager (PBM) for certain CalPERS health plans.

We hosted a webinar on Thursday, September 18. The recording is available now, on YouTube.

As the designated health benefits officer or assistant health benefits officer, you're the authorized point of contact to process CalPERS health transactions and provide health eligibility and enrollment information to your employees. Encourage your employees to reach out to you directly for any questions or assistance related to Open Enrollment transactions.

To ensure successful ongoing CalPERS health benefits and communication, all employees should:

• Have a myCalPERS account.
• Maintain a current email address, health eligibility ZIP code, and communication preference.
• Submit supporting documentation needed to verify their dependents.
• Confirm their new health plan and monthly premium adjustments in their January 2026 paycheck.

You have a fiduciary responsibility to manage the CalPERS Health Program by ensuring that only eligible employees and their dependents are covered. Employers are responsible for obtaining and maintaining records of all supporting documentation that determines the eligibility of enrolled dependents. At the time of enrollment, or anytime thereafter, you have the right to request additional supporting documentation needed to verify a dependent's eligibility.

To find a list of eligible dependent types and for additional information, refer to the Health Program Guide (PDF).

All health enrollment transactions should be submitted through myCalPERS. If your employees are using online health enrollments self-service, you will need to review and approve those transactions in myCalPERS. Early submission and approval will ensure timely processing of health plan ID cards and proper payroll deductions. For more information on adding and updating health transactions view our myCalPERS Student Guides.

• The deadline for processing all Open Enrollment transactions is 11:59 p.m. (Pacific Time) on Friday, November 7, 2025.
• Your employees may choose to use their employer ZIP code as their health eligibility ZIP code when they first enroll in CalPERS health, upon a move, or during any Open Enrollment period.
• If you're unable to complete all Open Enrollment transactions before the processing deadline, contact us at 888 CalPERS (or 888-225-7377). Don't forward unprocessed Open Enrollment request forms to us.

During Open Enrollment, you're responsible for submitting transactions for former employees or their dependents enrolled in COBRA continuation coverage who want to change or cancel health plans or add/delete eligible dependents.

You're also responsible for submitting transactions during Open Enrollment for employees on a leave of absence who want to change plans or add/delete dependents. Employees who do not change plans or add/delete dependents during Open Enrollment may do so within 60 days from the date they return to regular pay status.

You can rescind health transactions when the effective date of the transaction occurs in the future. For example, before the January 1, 2026 effective date, if an employee decides they no longer want to change health plans, you can rescind the transaction in myCalPERS.

Rescinded transactions must be updated before the December 31, 2025, cutoff date. Open Enrollment transactions rescinded after the December 31, 2025, cutoff date will be adjusted during a subsequent pay period.

State and CSU Agencies

Visit Civil Service Benefits Cutoff Calendar to access the State Controller's Office (SCO) benefit cutoff dates.

Contracting Agencies and Schools

Refer to the 2025 Health Billing Cutoff Dates, Contracting School Districts and Public Agencies (PDF) attachment linked in Circular Letter 600-005-25 for 2025 health billing cutoff dates and payment information.

If an employee's January 1, 2026, pay warrant does not reflect the proper premium payment of a health plan change, the premium payment will likely be adjusted during a subsequent pay period.

Advise the employee they should've discontinued using their prior plan after December 31, 2025. Verify that myCalPERS reflects the appropriate enrollment and advise the employee that the payroll discrepancy will be resolved.

A dependent can be added without an SSN. However, the Affordable Care Act requires you to provide an SSN to be reported to the Internal Revenue Service (IRS) for health coverage information. If a spouse is pending a Social Security number, the spouse can be added by contacting CalPERS to process the enrollment.

Employees can use their residential ZIP code, or their employers’ ZIP code for health eligibility, which would allow them to choose a plan from the respective service area.

The new SBC and EOC documents will be available online at the Forms & Publications by September 15.

No. Members and their dependents must enroll in the same health plan.

You can request a copy of your agency’s resolution by sending a secure message through myCalPERS or calling us at 888 CalPERS (or 888-225-7377).

Active public agency and school members will not see their employer contribution in their myCalPERS account. However, retirees will see the contribution amount listed in their agency’s resolution. Agencies with several employee groups and/or optional resolutions, such as vesting, can view their employer contributions by selecting the appropriate group and contribution type (Active, Retiree, or Vesting).

You can learn more about Eligibility & Enrollment and DEV from our website. For additional employer health-related information, take our virtual Health Business Rules class. Visit Business Rules & myCalPERS Classes to register and learn about:

• Eligibility and enrollment requirements
• Health plan options
• Health benefits into retirement
• Best ways to manage resources

You can run Cognos reports to keep informed of all health enrollment changes your employees make.

myCalPERS generates on-demand reports using IBM Cognos software that queries your agency’s data. This allows you to run reports using criteria that you choose. To access Cognos reports, log in to myCalPERS for Employers & Business Partners and select the Reports link within the Common Tasks left-side navigation menu. Refer to the myCalPERS Employer Reports (Cognos) (PDF) student guide for additional information.

The table below lists three specific Cognos reports related to health benefits.