Eligibility

Eligibility isn't 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.

Temporary Leave

You can continue your health coverage during a temporary leave of absence by completing a Direct Payment Authorization (CalPERS-1008) (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.

Military Duty

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.

Leaving Your Job

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.

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’re enrolled in a CalPERS health plan at the time you stop working and your retirement date is:

Then:

Within 30 days

Your coverage will continue into retirement without a break.

Between 31-120 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.

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.

Enrollment

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. Use our Health Plan Search by ZIP Code tool to find plans available in your area. You can also log in to myCalPERS to use the Search Health Plans tool to research the plan coverage and benefits most important to you and your family.

Learn how to Enroll Family Members.

Dental & Vision

View Dental & Vision Benefits for details on how to make changes to your dental and vision plan.

Online Health Enrollment for Active Members

With your employer’s approval, you can submit many health enrollment changes online through your myCalPERS account. Visit Online Health Enrollment for Active Members for more information.

Special Enrollment Periods

A special enrollment period (SEP) is a 60-day period for members to notify CalPERS of a specific qualifying event.

  • New enrollment due to loss of other coverage
  • Adding a dependent due to marriage, birth, adoption, or placement for adoption
  • Loss of coverage

COBRA

You have a 60-day window to elect continued health coverage through COBRA.

Your specific health plan administers collection of COBRA premiums. COBRA rules define timely payment as premiums paid within 30 days after the due date or within such longer period as applies to or under the plan.

Effective Dates

  • Special Enrollment Periods: members have the option to enroll and/or add a dependent on a current basis.
  • COBRA enrollments require continuous coverage. The effective date would be retroactive to the cancellation date.

Supporting Documentation

If CalPERS determines you’re unable to produce a marriage certificate or domestic partnership registration due to extenuating circumstances, you may execute and submit a signed and notarized CalPERS Affidavit of Marriage/Domestic Partnership (PDF).

Health Enrollment Questions

We’re committed to ensuring that health care is equitable and individualized for all members, regardless of race, ethnicity, language, sexual orientation or gender identity. By completing your Health Demographic Profile in myCalPERS, you’re helping us to better understand our members and work towards better health outcomes for all.

Open Enrollment ended October 13. Changes made during 2023 Open Enrollment will take effect January 1, 2024.

Access your health information year-round, including Open Enrollment updates, by logging in to myCalPERS, or learn more by visiting our Using myCalPERS page.

You can enroll yourself and eligible family members in a CalPERS health plan before the next Open Enrollment 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).

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 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 Open Enrollment.

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