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

The information below will provide you highlights of 2019 health benefit changes, approved health plans, and monthly premium rates.

Health Plans, Monthly Premium Rates, & COBRA Information

The CalPERS Board of Administration approved the 2019 health plans and monthly premium rates in June 2018. Visit Plans & Rates to view a list of all health plans in the CalPERS Health Program along with the monthly premium rates, and information about Consolidated Omnibus Budget Reconciliation Act (COBRA) premium rates.

2019 Benefit Changes to Plans and/or Regions

Listed below are the health plan changes for 2019. For a full list of 2019 health premium rates and employer contributions, visit Plans & Rates. For questions regarding available networks or providers, employees may contact their health plan directly.

Plan Name Impacts Service Area Changes
Anthem HMO Select (Basic)

No longer offering UC Davis medical group.

Premiums will decrease by 6 percent.*

N/A
Anthem HMO Traditional Premiums will increase by 22 percent.* N/A
Blue Shield Access+ Premiums will increase by 6 percent.* Withdrawing from eight Bay Area counties for state and public agencies:
  • Alameda
  • Contra Costa
  • Marin
  • San Francisco
  • San Mateo
  • Santa Clara
  • Solano
  • Sonoma
Members will be automatically enrolled in Health Net SmartCare unless a different plan is chosen during Open Enrollment.
Health Net SmartCare Premiums will decrease by 7 percent.*

Withdrawing from the Sacramento Region for state and public agencies:

  • El Dorado
  • Placer
  • Sacramento
  • Yolo

Members will be automatically enrolled in UnitedHealthcare unless a different plan is chosen during Open Enrollment.

PERSCare (Basic & Combination Plans)

Co-payment for urgent care & specialist office visits will increase from $20 to $35.

Premiums will increase by 19 percent.*

N/A
PERS Choice (Basic & Combination Plans)

Co-payment for urgent care & specialist office visits will increase from $20 to $35.

Premiums will increase by 5 percent.*

N/A
PERS Select (Basic)

Changing to value-based insurance design (VBID). Personal Doctor visit co-payment will decrease to $10; all other co-payments will increase from $20 to $35.

Premiums will decrease by 25 percent.*

N/A
UnitedHealthcare (Basic & Combination Plans) Premiums will decrease by 1 percent.*

Withdrawing from:

  • Bay Area Region (public agencies only)
  • Other Northern Region (public agencies only)

Members will be automatically enrolled in Anthem Blue Cross Traditional HMO unless a different plan is chosen during Open Enrollment.

*Percentages are based on single-party state basic health premiums. For comparison purposes only.
 

Employer Contributions

State & CSU Active Employees — For information regarding employer contributions, review Rates & Employer Contributions.

State & CSU Retirees — For information regarding employer contributions, review Rates & Employer Contributions.

Public Agency & School Members — CalPERS informs Public Agency & School members that contributions vary by employer, and to contact their employer to find out how much they contribute toward the monthly premium rate.

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

Health Benefits Officer Role

As the designated Health Benefits Officer (HBO) or assistant HBO, you are 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 my|CalPERS account
  • Maintain a current email address, health eligibility ZIP code, and communication preference
  • Know how to access their Health Plan Statement in my|CalPERS beginning August 27, 2018
  • Submit Open Enrollment changes to you from September 10 - October 5, 2018 with the Health Benefit Plan Enrollment Form (Active) (HBD-12) (PDF) and the supporting documentation needed to verify their dependents
  • Confirm their new health plan and monthly premium adjustments in their January 2019 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).

Health Plan Comparison

Log in to my|CalPERS as a Business Partner to use Health Plan Comparison through the Premium Search tool. You can assist your employees with finding health plan options tailored to them and their eligible dependents.

All health enrollment transactions should be submitted through my|CalPERS. Early submission will ensure timely processing of health plan identification cards and proper payroll deductions. For more information on adding and updating health transactions view our my|CalPERS Student Guides

Submit Transactions

  • All Open Enrollment requests must be received between the Open Enrollment dates of September 10 - October 5, 2018.
  • The deadline for processing all Open Enrollment transactions is 11:59 p.m. (Pacific Time) on Friday, November 2, 2018.
  • 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 are unable to complete all Open Enrollment transactions before the processing deadline, contact CalPERS at 888 CalPERS (or 888-225-7377). Don't forward unprocessed Open Enrollment request forms to CalPERS.

COBRA

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

Employees on Leave of Absence

You may also submit 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.

Rescind Transactions

You can rescind health transactions when the effective date of the transaction occurs in the future. For example, before the January 1, 2019 effective date, if an employee decides they no longer want to change health plans, you can rescind the transaction in my|CalPERS.

Rescinded transactions must be updated before the December 2018 cut-off date. Open Enrollment transactions rescinded after the December 2018 cut-off date will be adjusted during a subsequent pay period.

Refer to the information below for cut-off dates:

State and CSU Agencies

Visit the Decentralized Payroll Calendar to view the State Controller's Office (SCO) benefit cut-off dates.

Contracting Agencies and Schools

Refer to the 2018 Health Billing Cut-Off Dates table, attachment to Circular Letter 600-002-18, 2018 Health Billing Cut-Off Dates and How Payments Are Applied.

Review Health Premium Adjustments

If an employee's January 1, 2019 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, 2018. Verify that my|CalPERS reflects the appropriate enrollment, and advise the employee that the payroll discrepancy will be resolved.