Eligibility

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.

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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.

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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.

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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:

Then:

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.

Enrollment

You have 60 calendar days from the date of your initial appointment to enroll in a health plan. There 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. This year's Open Enrollment takes place September 14 - October 9.

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, 1.26MB).

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.



Health Benefits

Resources

Forms & Publications

Frequently Asked Questions

  • Am I eligible to enroll?

    You can enroll in the CalPERS Health Program if:

    • Are appointed to a job that will last at least six months and one day, and
    • Work at least half time, and
    • Work for an employer who has contracted with CalPERS to administer their health benefits program

    State permanent-intermittent employees can enroll if they meet credit requirements.

    To be eligible for health benefits after retirement, you must:

    • Meet the definition of an annuitant, and
    • Retire within 120 days of your separation date

    There are some exceptions to the rule for exempt state employees. Contact us if you have questions about your eligibility.

  • Can I change health plans?
    You can change health plans during the annual Open Enrollment period. Any changes you make will become effective the following January 1.
  • I want to enroll in an HMO plan. When 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 do not select a PCP, the health plan will choose one for you. If this happens and you want a different PCP, contact your plan as soon as possible to make the change.

    Active members should indicate their PCP selection on the Health Benefits Plan Enrollment Form (PDF). For help with completing the form, download the Health Benefits Plan Enrollment Instructions (PDF).

    Retired members should include this information on their written request or the Health Benefits Plan Enrollment for Retirees Form (PDF).

  • When can I enroll in a health benefits plan?

    If you're eligible for the CalPERS Health Program, you can enroll during the following time periods:

    • Annual Open Enrollment
    • The first 60 calendar days of your appointment date

    The number of dependents that you add does not change the premium amount once you have added two or more dependents.

  • When can I enroll my family members?

    You can enroll your eligible family members during the annual Open Enrollment. You also have the option to enroll only yourself, regardless of the status of your marriage or registered domestic partnership.