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)
For specific member information, including eligibility and enrollment, plans and rates, Medicare, and long-term care, refer to Active Members Health Benefits.
To contract for health and retirement benefits, visit Contracts.
For guides and information on health policies and procedures, including enrollment, retroactive health premium reimbursements, types of transactions, enrollment reason codes, dates, and implementing the Affordable Care Act, see Health Procedures.
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.
- 2016 Health Benefits ZIP Codes for Contracting Agencies HMO Report for PA/Schools (PDF)
- 2016 Health Benefits ZIP Codes for Contracting Agencies PPO Report for PA/Schools (PDF)
- 2016 Health Benefits ZIP Codes for State/CSU Report (PDF)
- 2015 Health Benefits ZIP Codes for Contracting Agencies HMO Report for PA/Schools (PDF)
- 2015 Health Benefits ZIP Codes for Contracting Agencies PPO Report for PA/Schools (PDF)
- 2015 Health Benefits ZIP Codes for State/CSU Report (PDF)
The provisions of the Affordable Care Act (ACA) have various effective dates. As your health benefits purchaser, we ensure our health plans comply with all relevant provisions of the ACA and provide information to our contracting agencies and schools.
The ACA affects CalPERS program areas, members, employers, stakeholders, and systems in various ways. Some of the changes to CalPERS health plans due to ACA include:
- Coverage for dependent children up to age 26
- No-cost preventive services
- Participation in the Early Retiree Reinsurance Program
- Prohibition on rescissions
- Removing lifetime dollar limits and restrictions on annual limits
Most provisions of the ACA that affect our plans are seamless to members. You can learn more about how the ACA impacts our program by reviewing our Circular Letters or the Affordable Care Act Requirements.
Administrative Fee for Fiscal Year 2015-16
Effective July 1, 2015, the CalPERS Board of Administration set the PEMHCA administrative fee to 0.32 percent. The administrative fee is calculated on total active and total retired health premiums each month.
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 the CalPERS Health Marketing Unit or call (916) 795-1233.
If your agency already has a CalPERS health contract and would like to make changes to its monthly employer health contribution, email the CalPERS Health Contracts Unit.
- Affordable Care Act (ACA)
- Circular Letters
- Health Plan Chooser
- Health Plan Search by ZIP Code
- Long-Term Care
- Open Enrollment
- Plans & Rates
Forms & Publications
- 2016 Health Benefit Summary (PDF)
- Health Benefit Plan Enrollment Form (HBD-12) (PDF)
- Health Plan Chooser Poster (PDF)
- Health Program Enrollment Summary (PDF)
- Health Program Guide (PDF)
Frequently Asked Questions
- Do CalPERS health plans meet the minimum essential coverage requirement and provide minimum value?
All health plans offered by CalPERS meet the minimum essential coverage requirement. A health plan meets the minimum value standard if it is designed to pay at least 60 percent of medical costs while the individual pays the other 40 percent; CalPERS plans are in the 80 to 90 percent minimum value range.
- Will CalPERS help us find a health plan for our less than half-time employees?
Neither ACA nor PEMHCA requires health coverage for less than half-time employees. CalPERS cannot assist you with finding health coverage for this group.
- Will the Exchange be available to early retirees (under age 65) or active employees only?
The Exchange is available to individuals under age 65.