Retiree Plans & Rates
Retirees: Visit your health plan's website to learn how benefits, claims, and payment of claims are covered, as well as the service limitations and exclusions that may apply. Here are some tips to help you choose a health plan:
- Log in to my|CalPERS to use the Find a Medical Plan tool to research the health plan coverage and benefits most important to you and your family.
- Review each plan's Evidence of Coverage, and Summary of Benefits and Coverage with Glossary, in the sections below.
- Use our Health Plan Search by ZIP Code tool to see which plans are available in your area.
- View the 2019 Health Benefit Summary (PDF) to compare features of the different health plans.
- Refer to our Medicare Enrollment Guide (PDF) for eligibility information and when to enroll in a Medicare health plan.
- View the Non-Discrimination Notice (PDF) in accordance with Section 1557 of the Affordable Care Act.
- View the CalPERS Policy on Provider Disruption (PDF).
Rates & Employer Contributions
2019
View the 2019 health premium rates approved by the CalPERS Board of Administration:
Employer Contribution Amounts
Below are the contribution rates. Your cost is any amount above the employer contribution.
CalPERS Health Program
| State Annuitant Contribution Rates for 2019 | |||
|---|---|---|---|
| Basic 80-80 Formula | Single (1) | 2-Party (2) | Family (3+) |
| $583 | $1,170 | $1,518 | |
| Medicare 80-80 Formula | Single (1) | 2-Party (2) | Family (3+) |
| $278 | $554 | $833 | |
| 100-90 Formula | Single (1) | 2-Party (2) | Family (3+) |
| $734 | $1,398 | $1,788 | |
Contribution Formula Availability – State Annuitants
State retiree contribution formulas outlined in the table below, vary by first hire date to the State of California and State Bargaining Unit. State Annuitants enrolled in Basic plans use the Basic 80/80 formula and State Annuitants enrolled in Medicare plans use the Medicare 80/80 formula. All bargaining units not listed as 80/80, have the 100/90 state retiree contribution formula.
| First hired by the State of California | Hired into State Bargaining Unit (SBU) | 100/90 or 80/80 Formula |
|---|---|---|
| Prior to 01/01/2016 | All SBU | 100/90 |
| On or after 01/01/2016 |
SBU
|
80/80 |
| On or after 01/01/2017 |
All SBU
|
80/80 |
| On or after 04/01/2017 |
All SBU
|
80/80 |
Retired CSU Members
- One-Party: $734; Two-Party: $1,398; Family: $1,788
COBRA Rates
If you have continued health coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA), contact your employer for your monthly premium rate. Refer to COBRA for information on continuing health coverage for yourself and your dependents if you involuntarily lose your health benefits.
Since health care costs vary throughout California, regional pricing adjusts premiums to reflect the actual cost of health care in your specific region. This ensures that your CalPERS premiums are appropriate and competitive for where you live.
To find your specific health plan premium rates, choose your region from the options below:
- Bay Area Rates (PDF) - View rates for Alameda, Amador, Contra Costa, Marin, Napa, Nevada, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma, Sutter, and Yuba.
- Los Angeles Area Rates (PDF) - View rates for Los Angeles, San Bernardino, and Ventura.
- Other Northern California Rates (PDF) - View rates for Alpine, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Plumas, San Benito, Shasta, Sierra, Siskiyou, Stanislaus, Tehama, Trinity, and Tuolumne.
- Other Southern California Rates (PDF) - View rates for Fresno, Imperial, Inyo, Kern, Kings, Madera, Orange, Riverside, San Diego, San Luis Obispo, Santa Barbara, and Tulare.
- Out-of-State Rates (PDF) - View rates for health plans available outside of California.
- Sacramento Area Rates (PDF) - View rates for El Dorado, Placer, Sacramento, and Yolo.
Employer Contribution Amounts
Contributions vary by employer. Contact your employer to find out how much they contribute toward your monthly premium rate.
COBRA Rates
If you have continued health coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA), contact your employer for your monthly premium rate. Refer to COBRA for information on continuing health coverage for yourself and your dependents if you involuntarily lose your health benefits.
For state retirees, the amount the state contributes towards your health coverage depends on whether or not you're "vested." If you meet the requirements to continue health benefits into retirement and were first hired by the state:
- Before January 1, 1985 - You're eligible to receive 100 percent of the state's contribution.
- Between January 1, 1985 and January 1, 1989 - You're subject to "vesting" requirements. You must have 10 years of service to be fully vested and qualify for 100 percent of the state's contribution towards health coverage. With less than 10 years, you are still eligible for health coverage. However, there will be an additional cost to you since the state's contribution is reduced by about 10 percent for each year of service under 10 years.
- After January 1, 1989 - You're still eligible for health coverage. However, the percentage of the state's contribution is based on your completed years of state service. The table below shows the percentage of the state's contribution you will receive.
| Years of Credited State Agency Service (Hired After January 1, 1989) |
State Contribution |
|---|---|
| Less than 10 | 0% |
| 10 | 50% |
| 11 to 19 | 50%, plus 5% added per year |
| 20 or more | 100% |
Some bargaining units have a 25-year vesting schedule for state employees hired on or after certain dates. These bargaining units and hire dates are as follows:
- Bargaining Unit 12 - January 1, 2011
- Bargaining Units 9 and 10 - January 1, 2016
- Bargaining Units 1, 2, 3, 4, 6, 7, 8, 11, 13, 14, 15, 17, 18, 19, 20, 20, 21, and the Judicial Branch - January 1, 2017
- Bargaining Unit 16 - April 1, 2017
If you're a member of one of these bargaining units and were hired on or after the date indicated above, then once you reach 25 years of state service, you're fully vested and qualify for 100 percent of the state's contribution toward your health premium.
| Years of Credited State Agency Service | State Contribution |
|---|---|
| Less than 15 | 0% |
| 15 | 50% |
| 15 to 24 | 50%, plus 5% for each year after the 15th year |
| 25 or more | 100% |
CSU Health Vesting Requirements
Some CSU bargaining units hired on or after certain dates are subject to a 10-year health vesting period for retiree health benefits. Once you reach 10 years of state service, you are fully vested and qualify for 100 percent of state's contribution towards your health premium. The bargaining units and hire dates are as follows:
Bargaining Unit 3 - July 1, 2017
Non-represented employees - July 1, 2018
Bargaining Unit 1, 2, 4, 5, 6, 7, 9 and 10 - July 1, 2018
2020
The CalPERS Board reviews health plan contracts annually to determine health plans, covered benefits, monthly rates, and co-payments.
Check back in late June for next year's rates.
About Our Plans
- HMO - A Health Maintenance Organization (HMO) plan provides health care from specific doctors and hospitals under contract with the plan. You pay co-payments for some services, but you have no deductible, no claim forms, and a geographically restricted service area.
- PPO - A Preferred Provider Organization (PPO) is similar to a traditional "fee-for-service" plan, but you must use doctors in the PPO provider network or pay higher co-insurance (percentage of charges). You must usually meet an annual deductible before some benefits apply. You're responsible for a certain co-insurance amount and the plan pays the balance up to the allowable amount.
- EPO - The Exclusive Provider Organization (EPO) plan offers the same covered services as an HMO plan, but you must seek services from the plans' PPO network of preferred providers. You're not required to select a primary care physician.
- Combination Plans - A combination plan means at least one family member is enrolled in a Medicare health plan and at least one family member is enrolled in a Basic health plan through the same health carrier. CalPERS requires all family members to have the same health carrier.
Health Plans
Health Plan Events & Resources: Take advantage of wellness events and resources offered by our health plans. Many of these events are free and open to the public.
2019
Administrator: Anthem Blue Cross
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
- 2019 Anthem Blue Cross Select HMO Basic Evidence of Coverage (PDF)
- 2019 Anthem Blue Cross Select HMO Basic Summary of Benefits and Coverage with Uniform Glossary (PDF)
- 2019 Anthem Blue Cross Traditional HMO Basic Evidence of Coverage (PDF)
- 2019 Anthem Blue Cross Traditional HMO Basic Summary of Benefits and Coverage with Uniform Glossary (PDF)
- 2019 OptumRx Outpatient Prescription Drug Benefit Plan for Selected HMO Basic Plans Evidence of Coverage (PDF)
Anthem Blue Cross EPO is available only in Del Norte county.
Administrator: Anthem Blue Cross
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Basic Publications
Administrator: Blue Shield of California
Offers Medicare? No
Directory: Find a Doctor
Basic Publications
Blue Shield EPO is available only in Colusa, Mendocino, and Sierra counties.
Administrator: Blue Shield of California
Offers Medicare? No
Directory: Find a Doctor
Basic Publications
You must belong to the specific employee association and pay applicable dues to enroll in the California Association of Highway Patrolmen (CAHP). Note: The Prudent Buyer Network for CAHP’s Basic and Combination Plan is available only in California and in limited areas of selected states outside of California. Contact us at 888 CalPERS (or 888-225-7377) for further assistance.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Directory: Find a Doctor
Basic Publications
- 2019 CAHP Basic Health Plan Evidence of Coverage (PDF, 3.16 MB)
- 2019 CAHP Summary of Benefits and Coverage with Uniform Glossary (PDF, 1.04 MB)
Medicare Publications
You must belong to the specific employee association and pay applicable dues to enroll in the California Correctional Peace Officers Association (CCPOA). The CCPOA plan is available only to dues-paying members of that organization and their families.
Administrator: Blue Shield of California
Offers Medicare? Yes
Directory: Find a Doctor
Basic Publications
- 2019 CCPOA Access+ HMO Basic Evidence of Coverage (PDF)
- 2019 CCPOA Access+ Summary of Benefits and Coverage with Uniform Glossary (PDF)
Medicare Publications
Administrator: Health Net of California
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: ProviderSearch
Basic Publications
- 2019 Health Net of California: Salud y Más HMO Evidence of Coverage (PDF)
- 2019 Health Net of California: Salud y Más HMO Summary of Benefits and Coverage with Uniform Glossary (PDF)
- 2019 Health Net of California: SmartCare HMO Evidence of Coverage (PDF)
- 2019 OptumRx Outpatient Prescription Drug Benefit Plan for Selected HMO Basic Plans Evidence of Coverage (PDF)
This plan is available in some states. Refer to the Evidence of Coverage for service area information.
Administrator: Kaiser Permanente
Offers Medicare? Yes
Directory: Doctors & Locations
Basic Publications
- 2019 Kaiser Health Plan Evidence of Coverage (PDF)
- 2019 Kaiser Summary of Benefits and Coverage with Uniform Glossary (PDF)
Medicare Publications
You must belong to the specific employee association and pay applicable dues to enroll in the Peace Officers Research Association of California (PORAC). This plan is available outside of California. Refer to the plan's Evidence of Coverage for service area information.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Directory: Find a Doctor
Basic Publications
- 2019 PORAC Prudent Buyer Plan Evidence of Coverage (PDF)
- 2019 PORAC Prudent Buyer Plan Summary of Benefits and Coverage with Uniform Glossary
- 2019 PORAC Out-of-State Resident Basic Health Plan Evidence of Coverage
- 2019 PORAC Out-of-State Resident Summary of Benefits and Coverage with Uniform Glossary
Medicare Publications
This plan has no geographical restrictions. It provides coverage anywhere in the world.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
- 2019 PERSCare Basic Plan Evidence of Coverage (PDF)
- 2019 PERSCare Basic Plan Summary of Benefits and Coverage with Uniform Glossary (PDF)
Medicare Publications
This plan has no geographical restrictions. It provides coverage anywhere in the world.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
- 2019 PERS Choice Basic Plan Evidence of Coverage (PDF)
- 2019 PERS Choice Basic Plan Summary of Benefits and Coverage with Uniform Glossary (PDF)
Medicare Publications
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
New: Value-Based Insurance Design
Basic Publications
- 2019 PERS Select Basic Plan Evidence of Coverage (PDF)
- 2019 PERS Select Basic Plan Summary of Benefits and Coverage with Uniform Glossary (PDF)
Medicare Publications
Administrator: Sharp Health Plan
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find a Doctor
Basic Publications
Administrator: UnitedHealthcare
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find a Doctor
Basic Publications
- 2019 UnitedHealthcare SignatureValue Alliance Evidence of Coverage (PDF, 1.84 MB)
- 2019 UnitedHealthcare SignatureValue Alliance Summary of Benefits and Coverage with Uniform Glossary (PDF, 1.21 MB)
- 2019 OptumRx Outpatient Prescription Drug Benefit Plan for Selected HMO Basic Plans Evidence of Coverage (PDF)
Administrator: UnitedHealthcare
Offers Medicare? Yes
Directory: Find a Doctor
Publications
Administrator: Western Health Advantage
Offers Medicare? No
Basic Publications
2020
The CalPERS Board reviews health plan contracts annually to determine health plans, covered benefits, monthly rates, and co-payments.
Check back in late June for next year's rates.
Making Changes
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 my|CalPERS.
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).
Dental
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 your 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 |
Vision
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 your 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 |
Health & Medicare
- Dependent Eligibility Verification
- Medicare
- Retiree Plans & Rates
Resources
- California Health Care Quality Report Cards
- Health Plan Search by ZIP Code
- Long-Term Care
- OptumRx Pharmacy Benefits
- Uniform Glossary of Health Coverage and Medical Terms (PDF)
- CA Wildfire Health Information & FAQ
Forms & Publications
- 2019 Health Benefit Summary (PDF)
- 2018-19 Open Enrollment Newsletter (PDF)
- Health Benefits Plan Enrollment for Retirees (PDF)
- Health Program Guide (HBD 120) (PDF)
- Medicare Enrollment Guide (PDF)
Frequently Asked Questions
- Can I change to an HMO Medicare Managed Care (Medicare Advantage) plan if I was enrolled in a Basic HMO plan before retirement?
You may change health plans when you turn age 65 and transition from a Basic plan to a Medicare plan. Enrolling in a Managed Care plan involves two steps. First, notify CalPERS of your intention to enroll in a Medicare Managed Care plan. Second, complete and return the carrier's election form to finalize your transition. The carrier may send you an enrollment kit that includes the election form; if you didn't receive one, contact the carrier directly.