The annual open enrollment period runs from Monday, October 10 through Friday, November 4, 2011 by 5:00 p.m. with a January 1, 2012 effective date. The open enrollment period covers Medical, Dental, Dependent Care Reimbursement Account (DCRA), Health Care Reimbursement Account (HCRA) and FlexCash plans. If you do not wish to make changes, additions or deletions, to your health or dental plan no action is required.
During the open enrollment period, eligible employees may:
- enroll as a new enrollment, change health plans, or add or delete eligible family members to health plans;
- enroll in FlexCash -- if employee has an alternate non-CSU medical and/or dental plans; or
- enroll or re-enroll in the DCRA or HCRA plans for the new tax year
These changes will require you to submit a hard copy of the Open Enrollment Benefits Worksheet to be submitted to Human Resources. Social Security Numbers and Birth Certificate are required to add a dependent.
- Download and complete the O pen Enrollment Benefits Worksheet form.
- Submit form (hand delivered is preferred) with required documentation (i.e., copy of dependent birth certificate, marriage certificate, Domestic Partnership, proof of alternate non-CSU plan) to the Human Resources Office, Joyal Administration Building, Room 211 (second floor) during the business hours of 8 a.m. to 5 p.m.
- The deadline date for submitting all Open Enrollment requests will be no later than 5:00 p.m. on Friday, November 4, 2011. No exceptions.
- Your will receive a receipt from Human Resources when you drop off the Open Enrollment Benefits Worksheet.
Please note: Some enrollment requests will require you to sign the original enrollment documents that will be submitted to the State Controller’s Office. Human Resources will contact you after you submit your Open Enrollment Benefits Worksheet to obtain an original signature on the documents in order to complete your Open Enrollment request.
Retirees will need to contact CalPERS 1-888-225-7377 for Open Enrollment Changes.
2012 Health Plan Changes
- Medical Plans
- Dental Plans
- Health Care and Dependent Care Reimbursement Plans
- CalPERS Enrollment Guidelines and Eligible Dependents
HEALTH CARE REIMBURSEMENT ACCOUNT(HCRA)/ DEPENDENT CARE
If you are currently participating in one of these accounts and wish to continue your deduction for the next tax year or are new to the program(s), you will need to re-enroll/enroll during the Open Enrollment period by completing a new HCRA/DCRA Enrollment form.
- Submit form (hand delivered is preferred to the Human Resources Office, Joyal Administration Building, Room 211 (second floor) during the business hours of 8 a.m. to 5 p.m. The deadline date for submitting all Open Enrollment requests will be no later than 5:00 p.m. on Friday, November 4, 2011. No exceptions.
- You will receive a receipt from Human Resources when you drop off the HCRA/DCRA Enrollment form.
The following is a summary of some of the most important changes to your health benefits coverage effective January 1, 2012. There are no changes to the current dental and vision plans.
View the health plan's Evidence of Coverage (EOC) bookletfor a complete explanation of the benefits covered, as well as limitations and exclusions that may apply. Be sure to review this information carefully to determine whether you need to make a health plan change. Additional information is available on the CalPERS website: http://www.calpers.ca.gov/index.jsp?bc=/member/health/home.xml
Service Area Changes
Blue Shield NetValue Basic & Medicare plan- HMO :
- Expanding service area to include Contra Costa County, and withdrawing from Santa Barbara County.
- Adding providers in Los Angeles, Riverside, Orange and San Bernardino Counties.
Blue Shield 65 Plus (Medicare )- HMO:
- Expanding service area to include Imperial, San Joaquin, San Francisco, and Nevada Counties.
PERS Select (Basic & Medicare) - PPO :
- Expanding service area to include Marin County.
ALL HEALTH PLANS: General Pharmacy Benefit Highlights :
- Retail co-payments for brand name drugs will increase by $5.
- Members may receive a 90-day supply of maintenance medication through mail order for the price of a 60-day retail supply.
- Members maintain access to brand name drugs when a Food and Drug Administrationapproved generic equivalent is available by paying the difference between the cost of the generic and brand name drug. A brand co-payment applies when a prior authorization for the brand name drug is obtained due to medical necessity.
- Exclude discretionary lifestyle drugs from the $1,000 out-of-pocket maximum for mail order prescriptions.
PERS Select/Choice/Care (Basic) – PPO :
- Expanding the Value Based Site of Care program; and establishing a payment threshold for
- three additional elective procedures. When members receive service at an outpatient hospital
- rather than an ambulatory surgery center the following thresholds apply:
- Arthroscopy - $6,000 limit
- Cataract Surgery - $2,000 limit
- Colonoscopy - $1,500 limit
- New Pharmacy Benefit Manager for CalPERS PPO Members
- CalPERS has selected CVS Caremark to administer prescription drug benefits for more than 346,000 members of CalPERS self-funded PERS Select, PERS Choice and PERSCare PPOs effective January 1, 2012. CVS Caremark will offer several new benefits:
- A Maintenance Choice Program will allow members to pick up a 90-day supply of medication directly from a CVS pharmacy at a time convenient to them. Members will pay their typical mail order co-pay for a prescription on the same day and be able to talk face-to-face with a pharmacist.
- The “Gaps in Care Plus” Medical Program will use an integrated medical and pharmaceutical approach to identify potential gaps and omissions in drug and medical therapy for participating CalPERS members.
- Members will be able to save money by choosing “best choice” medications (generics and preferred brands) and 90-day supplies, where appropriate, in the “iBenefit” personalized mailing program.
Peace Officers Research Association of California (PORAC):
- Increasing the deductible from $50 to $100 for the Medicare
All health plans (CSU Medical, CSU Dental, and CSU Vision) will require a Social Security number for each enrolled dependent and documents noted below.
Eligible Dependents & Documents
- Spouse (Requires a copy of Marriage Certificate)
- Domestic Partners: same-sex domestic partners over age 18and opposite-sex domestic partners with one partner age 62 or older whose domestic partnership is registered with the Secretary of State are eligible. (Requires a copy of Declaration of Domestic Partnership.)
- Under the age of 26 – Natural children, stepchildren or adopted children. (Requires copy of Birth Certificate/Adoption documents)
- Under the age of 26 - Economically dependent children (Requires Certificate and Affidavit of Eligibility of Economically-Dependent Children Form (HBD-35) for each dependent.) Please contact Human Resources for additional information (559) 278-2032.
Members who are married and who both work or worked
(retirees), for agencies in the CalPERS Health Program can enroll
separately. If you and your spouse enroll separately, you must
enroll all eligible family members, regardless of the relationship,
under only one of you. Dependents cannot be split between parents.
For example, if a CalPERS member with children marries another
CalPERS member with children and each member has their own
enrollment in the CalPERS Health Program, all children must be
enrolled under one parent. The effective date of coverage will be
the first of the month following the date of marriage. If split
enrollments are discovered, they will be retroactively corrected.
You will be responsible for all costs incurred from the date the
split enrollment began.
Dual Coverage: You cannot be enrolled in a CalPERS health plan as a member and a dependent or as a dependent on two enrollments. This is called dual coverage and it is against the law. When dual coverage is discovered the coverage will be retroactively canceled. You may have to pay for all costs incurred from the date the dual coverage began.
PERS (PPO) Select/Choice/Care
Medical Expense Worksheet