Eligibility & Enrollment
An employee may elect to enroll in or continue health coverage upon retirement. Employees eligible for retirement must meet all of the following requirements to be eligible for enrollment in the CalPERS Health Benefit Program as a retiree:
- Retire within 120 days from the date of separation from employment.
- Receive a monthly retirement allowance.
- Be eligible for health enrollment on the date of separation.
- Must have retired from the State, California State University (CSU), or an agency that currently contracts with CalPERS for health benefits for their specific bargaining unit.
An enrolled member’s health benefits will continue into retirement if their separation date from employment and retirement date are within 30 days of each other:
If the member’s separation date and retirement date are more than 30 days from each other, the member will need to request to enroll into retiree health benefits within 60 days of the retirement date.
If the member’s separation date and retirement date are more than 120 days from each other, the member will not be eligible for health benefits into retirement.
If the member does not want health benefits to continue into retirement, the member has the option to cancel their coverage by:
- Submitting a Health Benefits Plan Enrollment form to the employer (if still active)
- Declining CalPERS health coverage on either CalPERS Service Retirement Election Application or on CalPERS Disability Retirement Election Application
- Writing or calling CalPERS to request to cancel health coverage (if retired)
An eligible retiree may elect health coverage at the time of separation for retirement or any time after retirement with a qualifying life event.
Since the onset of the COVID-19 pandemic, some of the rules surrounding your health enrollment and coverage may have changed.
Passed on May 5, 2020, the COVID-19 Relief Rule aims to provide health coverage relief. For CalPERS members like you, this may mean extended health enrollment periods and/or coverage.
Specifically, the 60-day limitations for Special Enrollment Periods and COBRA elections are being waived during the national emergency period for those qualifying events that occurred after March 1, 2020.
The Rule will be in effect from March 1, 2020 until 60 days after the announced end of the national emergency. Upon the announced end of the national emergency, the timelines will revert to the applicable timelines associated with each qualifying event.
Special Enrollment Periods
Typically, a special enrollment period (SEP) is a 60-day period for members to notify CalPERS of a specific qualifying event.
The COVID-19 Relief Rule is focused on the following SEP qualifying events:
- New enrollment due to loss of other coverage;
- Adding a dependent due to marriage, birth, adoption, or placement for adoption; and
- Loss of coverage under a state Children’s Health Insurance Program (CHIP) or Medicaid for employees and their dependents who are eligible to receive premium assistance under those programs.
The 60-day limitations for SEPs are being waived during the national emergency period for those qualifying events that occurred after March 1, 2020.
Note: This Rule does not impact other types of enrollments, including, but not limited to, Parent Child Relationships, Dependent Eligibility Verifications, Disabled Dependent Enrollments, and health plan change requests. These enrollment types are not covered under HIPAA, therefore they are not subject to the COVID-19 Relief Rule.
Typically, you have a 60-day window to elect continued health coverage through COBRA. The COVID-19 Relief Rule extends relief past the normal time frames, allowing individual COBRA enrollment rights throughout the national emergency. However, your COBRA enrollment must be continuous from the date your coverage ended.
Your specific health plan administers collection of COBRA premiums. Normal COBRA rules define timely payment as premiums paid within 30 days after the due date or within such longer period as applies to or under the plan.
The COVID-19 Relief Rule aims to prevent individual health cancellations due to late or non-payment and has extended the timely collection of COBRA premiums to 90 days after the national emergency is declared over.
- Special Enrollment Periods: members have the option to enroll and/or add a dependent on a current or retroactive basis.
- COBRA enrollments require continuous coverage. The effective date would be retroactive to the cancellation date.
If CalPERS determines you are unable to produce a marriage certificate or domestic partnership registration due to extenuating circumstances, you may execute and submit a signed and notarized CalPERS Affidavit of Marriage/Domestic Partnership (PDF). Additionally, if you are unable to obtain a government-issued birth certificate for a dependent child due to COVID-19, you may provide a hospital birth record to facilitate the enrollment and provide the government-issued birth certificate once it is available.
Extensions for Benefit Claims and Appeals
The COVID-19 Relief Rule extended the filing time frames through 60 days after the announced end of the national emergency:
- Claims for benefit payment (generally limited to 15 months from the date of service, prior to the COVID-19 Relief Rule)
- Health plan appeal (generally limited to 180 days from the date of the adverse benefit decision)
- External independent medical review (generally limited to four months from the date the health plan issued its appeal denial)
Governor Gavin Newsom also issued an executive order, extending CalPERS Administrative Review (AR) and Administrative Hearing (AH) requests by an additional 60 days.
- Administrative Review – Members have 90 days from the date of the health plan or external review adverse appeal decision to file a request (generally limited to 30 days prior to the executive order).
- Administrative Hearing – Members have 90 days from the date of the CalPERS AR decision to file a request (generally limited to 30 days prior to the executive order).
Health Enrollment Questions
For assistance with your enrollment request or questions about the COVID-19 Relief Rule, you may call the CalPERS Contact Center at 888 CalPERS (or 888-225-7377).
Once you retire, CalPERS becomes your health benefits officer. You can make changes during Open Enrollment, add a new dependent, or delete a dependent for certain life events. There are several ways you can make changes to your health plan.
- Complete the Health Benefits Plan Enrollment for Retirees (PDF) and mail or fax it to CalPERS.
- Contact us at 888 CalPERS (or 888-225-7377).
- Log in to myCalPERS.
Any health plan changes made during Open Enrollment become effective the following January 1.
If you choose to decline or cancel enrollment for yourself or your dependents, you'll have to wait for 90-days or until the next Open Enrollment period to enroll again — unless you have a qualifying life event.
Qualifying life events, such as having a baby or adopting a child, getting married or divorced, or losing other health coverage, allow you to make changes to your health plan outside of the Open Enrollment period.
- Adding a dependent child who is not your adopted, step, or recognized natural child requires an Affidavit of Parent-Child Relationship (PDF).
- Adding a registered domestic partner requires a copy of the approved Declaration of Domestic Partnership.
- Adding a spouse requires a copy of your marriage license.
For more information about additional enrollment opportunities, read the Health Program Guide (HBD 120) (PDF, 1.69 MB).
To make changes to your dental plan, refer to the table below. Your contact will differ based on where you retired from and whether your inquiry is related to enrollment or benefits.
|If you retired from:||Then your dental plan enrollment contact is:||And you dental benefits administrator is:|
|State||CalPERS - Call 888 CalPERS (or 888-225-7377)||CalHR|
|California State University (CSU)||CalPERS - Call 888 CalPERS (or 888-225-7377)||CSU Retirement Benefits|
|Public Agency||Your personnel office||Your personnel office|
The State Retiree Vision Program is offered through Vision Service Plan (VSP). To make changes to your vision plan, refer to the table below.
|If you retired from:||Then your vision plan enrollment contact is:||And you vision benefits administrator is:|
|State||VSP - Call (800) 877-7195||CalHR|
|California State University (CSU)||VSP - Call (800) 400-4569 or visit VSP for CSU Retirees||CSU Retirement Benefits|
|Public Agency||Your personnel office||Your personnel office|