Eligibility & Enrollment (Retiree)

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.

COBRA

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.

Effective Dates

• 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.

Supporting Documentation

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).

We’re committed to ensuring that health care is equitable and individualized for all members, regardless of race, ethnicity, language, sexual orientation or gender identity. By completing your Health Demographic Profile in myCalPERS, you’re helping us to better understand our members and work towards better health outcomes for all.

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).