Presenter 1: Hello and welcome to the CalPERS
health benefits for public agency and school members webinar. Our agenda covers several
topics including the types of health plans CalPERS offers, eligibility and enrollment,
making changes to your health plan, COBRA and the CalPERS Long-Term Care program. We’ll
also cover some of the various resources available to you. Presenter 2: Let’s start with who’s eligible
for CalPERS health benefits and identify the different types of health plans available.
CalPERS Health Benefits are available to you as a public agency or school member only if
your employer contracts with us to offer this benefit. These benefits are also available
to all State and California State University employees. In this webinar, we’ll cover
information about CalPERS health benefits Public Agency and School members. Health Benefits
for State Agencies and CSU members will be covered in a different webinar. CalPERS offers three different types of health
plans. First are the Preferred Provider Organizations, or PPOs. As a PPO health plan member you get
maximum benefit coverage when you use their network of physicians and hospitals. The plans
allow you to select a primary care provider and specialists without referral. But you
must use doctors in the PPO provider network or pay higher co-insurance, which is a percentage
of charges. You must usually meet an annual deductible before some benefits apply. You
are responsible for certain co-insurance amounts, and the plan pays the balance up to an allowable
amount. Next are the Health Maintenance Organizations,
or HMOs. An HMO is a plan that provides care from specific doctors and hospitals under
contract with that plan. While you pay co-payments for some services, you have no deductibles
or claim forms to deal with. HMOs have a geographically restricted service area. The HMO provides
a list of primary care physicians to choose from who will coordinate all of your care,
including referrals to a specialist. And third are the Exclusive Provider Organizations plans
which offers the same covered services as an HMO plan, but you must seek services from
the plans’ network of preferred providers. When you retire you have the same basic health
plan choices available as when you were active. Currently, CalPERS offers the following plans.
For Preferred Provider Organizations, we have PERS Care, PERS Choice and PERS Select which
are all administered by Anthem Blue Cross. Our HMOs currently include Kaiser Permanente,
Blue Shield of California, Sharp Health Plan, UnitedHealthcare, Health Net of California,
Anthem Blue Cross, and Western Health Advantage. Kaiser is available in California and select
areas outside of our state. The other HMO’s are only available in limited areas. Our Exclusive Provider Organizations are administered
by Anthem Blue Cross but are limited to Del Norte county. There are also Association Plans
which are only available to members who pay dues to these specific associations. You must
continue paying dues after retirement to keep these plans. The plan public agency members
may be eligible for is the Peace Officers Research Association of California. Presenter 1: Next we’ll cover eligibility
and enrollment. There are basic requirements that employees must meet to be eligible to
enroll in a CalPERS health plan. One is that you must have a permanent or limited-term
appointment that will last more than six months and the other is that you must work at least
half time or more. If you’re a school employee who works an average of 10 months, you are
still entitled to 12 months of health coverage. You have 60 calendar days from the date of
your initial appointment to enroll in a health plan with coverage becoming effective the
first day of the month following the date that your health benefits officer receives
your completed enrollment form. Only one election is allowed during the 60-day period. You may also have dependents on your health
coverage. Dependent Coverage may include your spouse or registered domestic partner, children
up to the age of 26 who are natural, adopted or a stepchild, a certified disabled dependent
child over the age of 26 can stay on your plan if the disability occurred prior to the
age 26, or if a parent-child relationship exists such as a grandparent with custody
of a grandchild. A common question we hear is, “Will I have
health benefits after I retire?” and the answer is, “It depends”. There are requirements
for continuation of health benefits into retirement. To be eligible, you must retire within 120
days of separating from your CalPERS employer. For example, if you separate from your employer
at 45 years old, which is too young to retire, and come back later to apply for retirement
allowance when you’re first eligible at age 50 or 52, you’d be outside that 120
days and no longer eligible for health benefits. You must be eligible for health benefits on
the date that you separate, and you must receive a monthly retirement allowance. Health coverage
eligibility and the cost of your health plan may vary depending on where you live and the
health plan you choose. Your employer may or may not contribute towards your premium
in retirement. Please check with your employer for this information. If you have dependents currently on your health
plan, they’ll continue to be covered after you retire as long as they continue to be
eligible. Any dependents that are eligible but not enrolled at retirement may enroll
within the 60 day retirement window, or during any future open enrollment period. Dependents
may also be covered after your death in retirement as long as they receive a continuing monthly
benefit from CalPERS and are eligible for health benefits at the time of your death.
So, if you want an eligible dependent to continue their health benefits after you pass away
in retirement, you need to be sure they are eligible for a monthly benefit as a survivor
or a beneficiary. Medicare and your CalPERS health benefits
will need to be coordinated. Automatic coordination can occur if you enroll in Medicare at least
60 days prior to your 65th birth month. We’ll send you a notification four months prior
to you or your dependent’s 65th birth month. Included in this letter will be an Ineligibility
of Medicare Certification form which must be completed if you’re not eligible for
Premium-free Part A either in your own right or through the work history of a current,
former, or deceased spouse. You can also note whether you are deferring Part B because you
or your spouse who carries you on their health are still actively employed. If you’re not
eligible or deferring, you’ll stay in the basic plan. If you enroll in Parts A & B 60 days or less
from your birth month, then you must provide proof of your Medicare enrollment to us. Provide
us with a copy of your Medicare card and a completed Certification of Medicare Status
form. And it’s important not to ignore these notices. If you fail to enroll in Medicare
by your birth month, then your health plan will be cancelled the first of the month following
your birthday. Also, Medicare will assess penalties if you delay enrollment. Review
the CalPERS Medicare Enrollment Guide which you can find on our website under forms and
publications. This publication outlines everything you need to know about coordinating your benefits.
You can also find more information about Medicare eligibility and enrollment at Presenter 2: Now let’s go over the ways
you can make changes to your health plan. If you need to make a change to your health
plan, there are two ways in which it can be done. The first is during open enrollment.
The open enrollment period is held in the fall of each year with changes becoming effective
January 1st of the new year. Changes include switching health plans as well as adding or
deleting family members. You can also change your health plan outside of open enrollment
upon a qualifying event. Some examples of qualifying events are getting
married or entering into a domestic partnership, the birth of a dependent, or a divorce or
dissolution. Also, loss of coverage due to being cancelled as a dependent from someone
else’s plan and moving are qualifying events. While you are actively employed, the health
plan you choose can be based on either your physical home address or work location. Our
next topic is the Consolidated Omnibus Budget Reconciliation Act or COBRA. COBRA allows
you to continue health coverage if you lose your health benefits due to separation from
your employer without retiring. It’s also available to a dependent child who loses coverage
when they turn 26 or to a former spouse. You may submit the Cobra Election Form within
60 days following notification of eligibility. If you were active, this form must be submitted
through your employer. Once retired, it must be submitted to us. Coverage must be continuous
and you will be required to pay premiums from the date your employer-sponsored coverage
ends. Your premium will not exceed 102 percent of the group monthly premium rate. You also
have the option of purchasing your own private health coverage through Covered California. Presenter 1: Now we’ll introduce the CalPERS
Long-Term Care Program. The CalPERS Long-Term Care Program is the nation’s only voluntary,
self-funded, not-for-profit program helping to protect assets and lifestyles against the
catastrophic cost of needing long-term care services. It’s entirely funded by member
premiums. The CalPERS Long-Term Care Program is available to all California public employees
and retirees. Most family members are also eligible, even if the employee who makes them
eligible doesn’t apply. For the full list of those eligible, you can visit the Long-Term
Care website. You can find more information on the various plans, the enrollment packet
and answers to frequently asked questions by visiting Or
you can contact us by phone Monday through Friday from 8:00 a.m. to 5:00 p.m. at (800)
908-9119. We also have a Long-Term Care video which can be found on our YouTube channel. We have several resources available if you
need more information regarding Health Benefits. Our website is a great resource that provides
you with more in-depth information on eligibility and enrollment, available health plans and
rates along with CalPERS Long-term care program. You can use the Health Plan Search by Zip
Code tool on our website to check whether your health plan is offered in the area that
you’re moving to. If not, you’ll need to change your plan. Log into your my|CalPERS
to use the Find a Medical Plan search tool to research the health plan coverage benefits
that are most important to you and your family. As a reminder, while an active employee, all
updates must go through your employer. Once you’re retired, you can contact us to make
any changes to your health plan. Under forms and publications section on our
website, you can download or view the Health Program Guide which covers basic and Medicare
health plan eligibility, enrollment, and choices. The Health Benefits Summary which explains
the differences between HMO and PPO plans. The Evidence of Coverage publications review
the terms and conditions of coverage for each health plan, including benefits, covered services,
and co-payment information. And the CalPERS Medicare Enrollment Guide covers how Medicare
works with your health benefits, and when you need to enroll in a CalPERS Medicare plan. In your own my|CalPERS account, you’ll find
the Health Plan Summary page which provides information about your Medical Plan, the Coverage
Type, when you were enrolled and your premium. At the bottom of the page, you’ll find your
subscriber information as well as a list of any dependents enrolled on your health plan.
The Open Enrollment page is where you’ll find your current health plan statements including
rates for the new year and premium information for other plans. As an active member, you’ll
still need to contact your employer to make your health benefit changes. If you’re retired,
you can make any open enrollment changes right from the open enrollment page. We went through a lot of information today.
Our presentation today was intended to provide you with information about CalPERS health
benefits. Remember, this was a brief overview. You can find more detailed information on
our website and through the publications we recommended. Thank you for taking time out
to attend our webinar, and have a great rest of your day!