Eligibility & Enrollment
Eligibility is not based on your job classification. To be eligible for the CalPERS Health Program, you must:
- Be appointed to a job that will last at least six months and one day
- Work at least half time
- Work for an employer who has contracted with CalPERS to administer their health benefits program
The Affordable Care Act has new provisions which expand the eligibility criteria for certain variable hour employees. Contact your employer for additional information.
Permanent-intermittent state employees are eligible for health benefits after working 480 hours during one of two control periods:
- January 1 through June 30 (effective enrollment date of August 1)
- July 1 through December 31 (effective enrollment date of February 1)
You cannot attain eligibility in the middle of a control period, even if you met the minimum hours at the beginning of the period. To become eligible, you must receive credit for a minimum of 480 paid hours at the end of a control period.
To continue your eligibility, you must either:
- Be credited with at least 480 paid hours at the end of each control period
- Have at least 960 hours in two consecutive control periods (current and prior)
June 30 and December 31 are the checkpoints we use to determine whether you've satisfied the hour requirements.
To be eligible to enroll, you must:
- Have an appointment that is six months or greater
- Work at least half time
Check with your personnel office for more information.
You can continue your health coverage during a temporary leave of absence by completing a Direct Payment Authorization (PDF) to pay the entire monthly premium directly to your health plan.
You're eligible for the direct payment option if you:
- Are a state permanent-intermittent employee eligible for health benefits but in a non-pay status
- Are awaiting approval of disability or service retirement
- Are awaiting approval of Non-Industrial Disability Insurance (NDI) benefits
- Are suspended from your job
- Institute legal proceedings appealing a dismissal from service
- Take a leave of absence without pay
- Take temporary disability leave and do not use sick leave or vacation
You may elect direct pay only through the end of the qualifying control period.
If you do not elect the direct payment option while off pay status, your health benefits will be cancelled. You can re-enroll when you return to pay status if your earnings are sufficient to cover your share of the monthly premium.
When you take a leave of absence for military duty, you may continue coverage by making direct payments to your health plan. Your employer does not contribute to your health premium nor do you pay any administrative costs. Your CalPERS health coverage will resume the day you return to pay status.
If you leave your job for reasons other than retirement, your health coverage will continue through the month you leave and the following month if you have sufficient earnings to cover your share of the premium. If you elect to cancel your coverage before you leave your job, your benefits will not continue and you will not be eligible for COBRA Continuation Coverage.
If you reinstate and your break in service is:
- Less than one full pay period - Coverage will be continuous. Be sure to notify your personnel office if the deductions on your paycheck stub do not resume.
- More than one full pay period - You must re-enroll. You will go back into the health plan you were previously enrolled in and you may not change plans until the next Open Enrollment Period.
If your employer contracts for the CalPERS Health Program, you may be eligible to enroll in or continue health coverage into retirement if you:
- Retire within 120 days of your separation date with your employer
- Receive a monthly retirement allowance
- Are eligible for health enrollment on the date of your separation
If you are enrolled in a CalPERS health plan at the time you stop working and your retirement date is:
Within 30 days
Your coverage will continue into retirement without a break.
Between 30-120 days
You're eligible to re-enroll when you retire.
Contact us within 60 days of your retirement date or wait for the next Open Enrollment Period.
More than 120 days
You may not be eligible for coverage.
If you don't want your health insurance to continue into retirement, check the appropriate box on your retirement application indicating you do not want health benefits in retirement. You may also visit your personnel office prior to retirement and request to cancel your health insurance.
If you're eligible for the CalPERS Health Program, you have 60 calendar days from your appointment date to request enrollment. Below are other opportunities to enroll at a later date if you decline or cancel enrollment, or experience a qualifying life event.
Learn how to Enroll Family Members.
Open Enrollment takes place every fall. Changes made during Open Enrollment take effect the following January 1.
During Open Enrollment, you can:
- Add dependents to your health coverage
- Change your CalPERS health plan
- Delete dependents from your health coverage
- Discontinue your existing CalPERS health coverage
- Enroll in a CalPERS health plan if you do not currently have CalPERS health coverage
You can enroll yourself and eligible family members in a CalPERS health plan before the next Open Enrollment Period when you experience certain life events.
Special enrollment opportunities are available for:
- An eligible spouse, domestic partner, or minor child requiring health coverage because of a court order
- New children by birth or adoption, or placement of adoption
- New family members due to marriage or domestic partnership registration
- Those whose health plan was canceled due to an involuntary loss of coverage (you must provide proof your coverage ended)
You must submit your request within 60 days following the life event.
For more information about special enrollment opportunities, read the Health Program Guide (HBD 120) (PDF, 1.26 MB).
If you decline or cancel enrollment for yourself or your dependents and do not qualify for special enrollment, you or your dependents will have limited opportunities to enroll in the future. You may enroll during the next CalPERS Open Enrollment Period or at any time with within a 90-day waiting period. The earliest effective date of enrollment will be the first of the month following the 90-day waiting period or the January 1 after the Open Enrollment Period.
- Birth or Adoption
- Domestic Partnership
- Enroll Family Members
- Guide to Understanding Your Health Plan Statement (PDF)
- Marriage or Divorce
Forms & Publications
Frequently Asked Questions
- Am I eligible to enroll in a health plan?
As an active employee, you must work at least half-time and your appointment must last at least six months and one day. Your employer must contract with CalPERS to administer their health benefits program. Contact us at 888 CalPERS (or 888-225-7377) if you have questions about your eligibility.
- If I want to enroll in a health plan, do I select a primary care physician (PCP) or medical group?
You should select a PCP or medical group before you enroll in the health plan. Make sure the doctor you want is accepting new patients and participates in the plan you want. If you don't select a PCP, the health plan will choose one for you. To change your PCP, contact your plan as soon as possible.
Retirees should include this information on their written request or the Health Benefits Plan Enrollment for Retirees Form (PDF).
- If I'm not currently enrolled in a health plan and would like to enroll, what should I do?
If you're eligible and did not enroll in a health plan during the first 60 calendar days of your appointment date, you can enroll in a health plan during Open Enrollment. Your health plan coverage will become effective the following January 1.
- What should I do if I want to enroll my eligible family members, who are not currently enrolled, into a health plan?
You may enroll eligible family members during Open Enrollment. The number of family members you add does not change the premium amount once you have added two or more dependents.
- When should I call my health plan directly?
Contact your health plan for any aspects of your coverage, including: covered services; deductibles, maximums, and co-payments; limitations and exclusions of your coverage; Evidence of Coverage publications; individual conversion policies; member identification cards; service area boundaries (covered ZIP Codes); and verification of provider participation in the plan.
- Will CalPERS offer a low-cost/high-deductible health plan option like those offered in health care exchanges under ACA?
CalPERS does not offer a "bronze" plan, which under ACA is, in general, the lowest-cost qualified health care plan offered through the exchanges. It requires the consumer pay approximately 40 percent and the health plan pay 60 percent of health care costs.