Open Enrollment for Employers

Below are answers to frequently asked questions we received during the year.

• What’s the health eligibility ZIP code rule? Can employees choose a plan that’s available in the ZIP code area they live in, or where their employer is located?

  Employees can use their residential ZIP code or their employer’s ZIP code for health eligibility, which would allow them to choose a plan from the respective service area.

• Can subscribers add or delete dependents and cancel coverage only during Open Enrollment?

  Subscribers can only add dependents to their health plan during annual Open Enrollment or with a qualifying event.

  Subscribers can delete dependents or cancel coverage any time during the year. For more information visit the Eligibility and Enrollment page.

• Where can I find more information regarding Online Health Enrollments?

  Find employer information on the Online Health Enrollments for Active Employees page.

  Refer your employees to the Online Health Enrollment for Active Members page for information on how to make changes to their health plan using myCalPERS.

• Will Health Net Salud y Más exit CalPERS in 2024?

  No, it will remain as an offering to CalPERS members.

• How will members in Preferred Provider Organization (PPO) plans know if they’re using a preferred lab provider for routine lab tests to waive the coinsurance?

  Quest Diagnostic and LabCorp are the two lab providers covered at 100%. If a member lives within the PERS Platinum or PERS Gold service area but must travel more than 15 miles from their home or work to the nearest Quest Diagnostic or LabCorp facility, reimbursement for in-network laboratories will be covered at 100%. To receive this level of reimbursement, members should complete the Laboratory Location Exception form and email it to Anthem at CalPERSLabException@anthem.com.

• If a member’s dependent is switched to Consolidated Omnibus Budget Reconciliation Act (COBRA) health coverage, are they able to choose a different health plan other than the subscriber?

  When a dependent is switched to COBRA health coverage, they become a subscriber in their own right, therefore they can choose any health plan available in their service area.

  For more information regarding COBRA health coverage, review the COBRA page.

• If a member is enrolled in a health plan that will offer the pharmacy mail-order program for home delivery for non-specialty maintenance medications, will they have to opt out of this program to use a retail pharmacy for prescriptions?

  Yes, members will need to call Optum to Opt-out to continue to receive their non-specialty maintenance medications at the retail brick and mortar pharmacy.

• For PERS Gold and PERS Platinum plans, will members have to reach the in-network and out-of-network deductibles separately?

  Yes, there are two separate deductible buckets (in-network or out-of-network) that the member would have to meet.

Open Enrollment Health Fair requests closed on September 1. Virtual and onsite Open Enrollment events started September 5 and will go through October 13.

If you submitted a request, each health plan received a notification and they'll contact you directly. If you haven’t been contacted, connect with the health plans.

Tips for Virtual or Onsite Open Enrollment Health Fairs

• Create or use existing external/internal websites that'll house all virtual resources.
  • Market the website(s) and resources to your employees through email and mail.
• Email weekly Open Enrollment reminders to your employees.

Gifts & Literature Policy

To comply with CalPERS guidelines, the following items are prohibited from being distributed at any health fair or Open Enrollment function, or any health fair held for the sole purpose of initial enrollment, regardless of date:

• gifts (such as pens, cups, clothing, food, etc.)
• prizes for raffles or drawings
• game prizes
• giveaways

Any literature provided to members at these three types of events must be limited to educational information about the Health Plans. This policy applies only to the Health Plans, not agencies hosting Open Enrollment fairs.

During Open Enrollment, your employees can:

• Change their CalPERS health plan
• Add eligible dependents
• Remove dependents
• Cancel their existing CalPERS health coverage
• Enroll in a CalPERS health plan if they don't currently have coverage

If an employee isn't making changes to their coverage, no action is needed.

With your approval, employees make Open Enrollment changes online through their myCalPERS account instead of submitting a hard copy form to you. Encourage your employees to make changes via their myCalPERS if you participate in online enrollments. Visit Online Health Enrollments to learn more.

Open Enrollment resources available to you and your employees

• myCalPERS — Beginning September 11, your employees can view their 2023 Health Plan Statement and 2023 Open Enrollment Newsletter (PDF) in their myCalPERS account. Encourage your employees to use the Search Health Plans tool to shop health plans.
• Open Enrollment for Active Members — Learn what is shared with your employees throughout Open Enrollment.
• Online Health Enrollments for Active Employees — Find information on how employees can make health enrollment changes through their myCalPERS account.
• Your Guide to Choosing a Health Plan (PDF) – Encourage your employees to use this guide to see what factors they should consider when shopping for a health plan that best fits their needs.
• Health & Wellness Programs by Health Plan — Explore wellness events and resources offered by our health plans to improve health and well-being. Many of these resources are free and at either low-cost or no-cost.
• Active Member Plans and Rates — View a full listing of 2024 health plans and monthly and Consolidated Omnibus Budget Reconciliation Act (COBRA) premium rates. Access Evidence of Coverage and Summary of Benefits publications.
• Health Plan Statement — Open Enrollment packets, which includes a Health Plan Statement, will be mailed on September 11, 2023 for those who indicated a mailing preference of U.S. mail by July 1, 2023. Use A Guide to Understanding Your Health Plan Statement to assist with understanding the information provided on the Health Plan Statement.
• Open Enrollment Flyer — Use the following email template to distribute the 2023 Open Enrollment Flyer (PDF) to your employees as a reminder to review their health benefits information through their myCalPERS account.

  Subject: CalPERS 2023 Open Enrollment

  Open Enrollment starts Monday, September 18 and ends Friday, October 13. Log in to your myCalPERS account to access Open Enrollment information and resources. Use the Search Health Plans tool to shop health plans. You may be able to switch to a lower cost plan and still keep your doctors or specialists.

  Contact your personnel specialist or health benefits officer in human resources if you’re interested in making a health plan change or have any questions regarding Open Enrollment.

  Complete your Health Demographic Profile in myCalPERS, it takes less than two minutes to complete. Your response is confidential and secure and will help CalPERS better understand members and improve the quality of care and health outcomes for all. Dependents at least 18 years old can complete a profile at www.calpers.ca.gov/hdp.

  Attachment: 2023 Open Enrollment Flyer

• Publications — Guide your employees to view, download, or print publications that can be helpful during Open Enrollment:
  • 2024 Health Benefit Summary (PDF, 1.8 MB)
  • Health Program Guide (PDF)
  • Medicare Enrollment Guide (PDF)

Each year, we send letters to members affected by significant health plan changes to ensure they have the information they need to make informed decisions during Open Enrollment.

Below are examples of these letters; they look slightly different from the mailed letters due to accessibility requirements, but the content is the same. This year, we’re sending letters to the following groups in late August:

• Members impacted by a 9% or higher premium increase who have other HMO or EPO health plan options in their area^*
  • State Active (PDF)
  • Public Agency/School Active (PDF)
• Members impacted by a 9% or higher premium increase who don’t have other HMO or EPO health plan options in their area^*
  • State Active (PDF)
  • Public Agency/School Active (PDF)
• Members enrolled in a health plan that will no longer be offered starting January 1, 2024
  • State Active & Public Agency/School Active with an Expansion (PDF)
  • State Active & Public Agency/School Active with no Expansion (PDF)

To register for a class, log in to your myCalPERS business partner account, then select Education. Participate in the Health Business Rules class to increase your understanding of the following:

• Eligibility & enrollment requirements
• Health Plan options
• Health benefits into retirement
• Best ways to manage resources

The information below outlines roles and responsibilities for processing enrollment transactions for your employees.

Contracting public agencies, schools, and state agencies, along with their active employees, can make online health enrollment changes. When your employees use this functionality, you do not need to collect the HBD-12.

Use of the functionality is at the discretion of your agency and does not change your roles and responsibilities as outlined below.

Health Benefits Officer Role

As the designated health benefits officer or assistant health benefits officer, you're the authorized point of contact to process CalPERS health transactions and provide health eligibility and enrollment information to your employees.

To ensure successful ongoing CalPERS health benefits and communication, all employees should:

• Have a myCalPERS account.
• Maintain a current email address, health eligibility ZIP code, and communication preference.
• Submit supporting documentation needed to verify their dependents.
• Confirm their new health plan and monthly premium adjustments in their January 2024 paycheck.

Verify and Maintain Supporting Documentation

You have a fiduciary responsibility to manage the CalPERS Health Program by ensuring that only eligible employees and their dependents are covered. Employers are responsible for obtaining and maintaining records of all supporting documentation that determines the eligibility of enrolled dependents. At the time of enrollment – or anytime thereafter – you have the right to request additional supporting documentation needed to verify a dependent's eligibility.

To find a list of eligible dependent types and for additional information, refer to the Health Program Guide (PDF).

Submitting and Approving Transactions

All health enrollment transactions should be submitted through myCalPERS. If your employees are using online health enrollments self-service, you will need to review and approve those transactions in myCalPERS. Early submission and approval will ensure timely processing of health plan ID cards and proper payroll deductions. For more information on adding and updating health transactions view our myCalPERS Student Guides.

• The deadline for processing all Open Enrollment transactions is 11:59 p.m. (Pacific Time) on Friday, November 3, 2023.
• Your employees may choose to use their employer ZIP code as their health eligibility ZIP code when they first enroll in CalPERS health, upon a move, or during any Open Enrollment period.
• If you're unable to complete all Open Enrollment transactions before the processing deadline, contact us at 888 CalPERS (or 888-225-7377). Don't forward unprocessed Open Enrollment request forms to us.

COBRA

During Open Enrollment, you're responsible for submitting transactions for former employees or their dependents enrolled in COBRA continuation coverage who want to change or cancel health plans or add/delete eligible dependents.

Employees on Leave of Absence

You're also responsible for submitting transactions during Open Enrollment for employees on a leave of absence who want to change plans or add/delete dependents. Employees who do not change plans or add/delete dependents during Open Enrollment may do so within 60 days from the date they return to regular pay status.

Rescinding Transactions

You can rescind health transactions when the effective date of the transaction occurs in the future. For example, before the January 1, 2024 effective date, if an employee decides they no longer want to change health plans, you can rescind the transaction in myCalPERS.

Rescinded transactions must be updated before the December 2023 cutoff date. Open Enrollment transactions rescinded after the December 2023 cutoff date will be adjusted during a subsequent pay period.

State and CSU Agencies

Visit the Civil Service Benefits Cutoff Calendar to view the State Controller's Office (SCO) benefit cutoff dates.

Contracting Agencies and Schools

Refer to the 2023 Health Billing Cutoff Dates (PDF) table, attachment to Circular Letter 600-061-22 (PDF), 2023 Health Billing Cutoff Dates and Payment Information.

Review Health Premium Adjustments

If an employee's January 1, 2024 pay warrant does not reflect the proper premium payment of a health plan change, the premium payment will be adjusted during a subsequent pay period.

Advise the employee to discontinue using their prior plan after December 31, 2023. Verify that myCalPERS reflects the appropriate enrollment and advise the employee that the payroll discrepancy will be resolved.