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Health Benefits

The Public Employees' Medical & Hospital Care Act (PEMHCA) governs the CalPERS Health Program, which enables you to provide a quality health benefits program to your employees while reducing financial risk. The program covers state employees by law. Local public agencies and school employers can contract to have CalPERS provide these benefits to their employees, regardless of whether they contract for our retirement program.

  • All plans offer separate Medicare health benefits for those members eligible for Medicare.
  • Catastrophic illnesses do not affect coverage or premium rates, which are negotiated on an annual basis.
  • Health coverage for employees continues into retirement.
  • We offer four types of health plans:
    • Association Plans (for members of specific employee organizations)
    • Exclusive Provider Organizations (EPOs)
    • Health Maintenance Organizations (HMOs)
    • Preferred Provider Organizations (PPOs)

Register for CalPERS Health Program Workshops to learn more.

2018 Open Enrollment Dates

  • Open Enrollment ended on October 5.
  • The deadline for processing all Open Enrollment transactions is 11:59 p.m. (Pacific Time) on November 2, 2018.
  • Changes made during Open Enrollment 2018 take effect January 1, 2019.

Health Resources

  • Health Benefits (Active Members) - Access member health information including eligibility and enrollment, plans and rates, Medicare, and long-term care.
  • Health Procedures - View guides and information on health policies and procedures including enrollment, retroactive health premium reimbursements, types of transactions, and enrollment reason codes.

Health Plan Codes & ZIP Codes

Find the list of ZIP codes for HMO and PPO plans available in each county by health plan. Health plan codes for reporting and enrollment purposes are also included.

2019

2018

Affordable Care Act

As your health benefits purchaser, CalPERS ensures our health plans comply with all relevant provisions of the Affordable Care Act (ACA) and provides information to our contracting agencies and schools. Employers have certain responsibilities to comply with the ACA and must become familiar with its requirements and effective dates, and make policy decisions based on individual needs and practices.

To learn more about the ACA, see Affordable Care Act (ACA) Guidance and review our Circular Letters.

Administrative Fee for Fiscal Year 2018-19

Effective July 1, 2018, the CalPERS Board of Administration set the PEMHCA administrative fee to 0.23 percent. The administrative fee is calculated on total active and total retired health premiums each month.

NOTE: The new administrative fee becomes law upon passage of the State of California budget for the Fiscal Year 2018-19. If the budget isn't passed until after the June Billing Cut-Off date, the new administrative fee will be reflected on the next health premium statement and on a prospective basis only. No retroactive adjustment will occur.

Contribution Formula

Contracting agencies are required to provide an employer health contribution toward the cost of the monthly premium for all eligible employees and annuitants. PEMHCA requires minimum contribution amounts and allows for various contribution methods. Contact us to discuss the options available to you.

If your agency is interested in participating in the CalPERS Health Benefits Program, email Health Program Consultation Services or call (916) 795-1233. To contract for health and retirement benefits, visit Contracts.

If your agency already has a CalPERS health resolution on file and you'd like to make changes to monthly employer health contributions, email the Health Resolutions and Compliance Unit.



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