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.
Open Enrollment
- Open Enrollment 2019 ended on October 4.
- The deadline for processing all Open Enrollment transactions was November 1.
- Changes made during Open Enrollment 2019 take effect January 1, 2020.
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
The following Cognos reports provide a listing of ZIP codes for HMO and PPO plans that are available in each county by health plan. Health plan codes for reporting and enrollment purposes are also included.
- Health ZIP Code Yes-No Report-HMO for PA-School
- Health ZIP Code Yes-No Report-PPO for PA-Schools
- Health ZIP Code Yes-No Report-State-CSU
To access the Cognos reports, log in to my|CalPERS and select the Reports link within the Common Tasks left-side navigation menu.
For instructions on generating any Cognos report, refer to the my|CalPERS Employer Reports (Cognos) (PDF) student guide.
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.
Videos
Benefit Programs
Resources
- Affordable Care Act (ACA)
- Circular Letters
- Dependent Eligibility Verification
- Health Plan Search by ZIP Code
- Long-Term Care
- Open Enrollment
- Plans & Rates
Forms & Publications
- 2019 Health Benefit Summary (PDF)
- Health Benefit Plan Enrollment Form (HBD-12) (PDF)
- Health Program Enrollment Summary (PDF)
- Health Program Guide (PDF)
- Medicare Enrollment 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.