7 CalPERS Health FAQs Answered

From starting a new job to getting married, having children, moving, or retiring, life events can impact your health care decisions any time of year. To help you navigate these changes, we’ve compiled answers to frequently asked questions about managing your CalPERS health coverage.

1. Understanding Your Health Plan Options

Where can I find customized information regarding my health benefits?

If you’re looking for details on your current CalPERS health plan, there are several ways to access this information:

• • Log in to myCalPERS: View your coverage details, including:
    • Premiums and out-of-pocket costs
    • Covered dependents
    • Plan eligibility and enrollment status
  • Access key documents: Find essential plan details through the Forms & Publications webpage, including:
    • Evidence of Coverage (EOC)
    • Summary of Benefits and Coverage (SBC)

Who manages my dental and vision benefits?

Your dental and vision benefits are managed differently based on your employment status. Find more details on our Dental & Vision Benefits page.

Are all CalPERS health plans available everywhere?

No, some health plans are only available in certain counties and ZIP codes. If you’re considering changing your coverage or moving, use the Health Plan Search by ZIP Code tool or log in to myCalPERS for a personalized comparison of available options.

With this tool, you can:

• • • Compare available health plans in your area.
    • View monthly premiums and member satisfaction ratings.
    • See side-by-side benefit comparisons, including copay information.
    • Search for your specific doctors or medical groups to determine which plans they accept.

What is health vesting, and how much will my employer contribute in retirement?

Health vesting is the amount of time you need to work for your employer before they help pay for your health coverage in retirement. Just like they contribute to your CalPERS pension, they may also contribute to your monthly health premium when you retire.

• • • State and CSU Employees: The amount your employer pays depends on your job classification, hire date, and union agreement. Most employees need to work a certain number of years before receiving their employer’s contribution toward retiree health coverage.
    • Public Agencies and Schools: Each agency or school district has its own contract provisions for health coverage in retirement. Some follow a 20-year vesting schedule, while others have different requirements. Check with your HR department for details on what applies to you.

For more information, review pages 8-9 of the Health Program Guide (PDF).

2. Making Changes to Your Health Plan

Can I change my health plan outside of Open Enrollment?

You may change your health benefits outside of Open Enrollment if you experience a qualifying life event, such as:

• • • Loss of Coverage: If your health benefits were canceled due to an involuntary loss of coverage, you must provide proof that your previous coverage ended.
    • Relocation: If you move, you may select a health plan available in your new location.
    • Retirement: You have a 60-day window from your retirement date to change your health plan.
    • Medicare Eligibility: When you become eligible for Medicare, you may choose a new CalPERS Medicare health plan.

If you experience a qualifying life event, you have 60 days from the date of the life event to submit your request. You can make changes directly in myCalPERS, but if you are an active employee, be sure to check with your employer before making changes in myCalPERS.

What if my medical group is no longer part of my plan?

If your medical group or provider ends its contract with your health plan, you do not qualify to change your health plan. However, you may qualify for continuity of care. If you receive a notice that your provider, medical group, or hospital is no longer in your health plan, you may be able to keep that provider, medical group, or hospital for a limited time. This is called “continuity of care.” To receive continuity of care, you must call your health plan to see if you qualify.

Visit the Eligibility & Enrollment for Active Members and Eligibility & Enrollment for Retirees webpages and review the When You Can Change Your Health Plan section on page 21 in the Health Program Guide (PDF) for more information on making changes to your health plan outside of Open Enrollment.

3. Dependent Verification

What is dependent verification and how often do I need to complete it?

To ensure only eligible family members are enrolled in health and/or dental benefits under the CalPERS Health Benefits Program, all state and CSU employees and retirees must verify their dependents’ continued eligibility.

Dependent verification is required every three years for the following dependents:

• • • Spouses
    • Registered domestic partners
    • Stepchildren
    • Children of registered domestic partners

Natural-born and adopted children only need to be verified once while you are an active employee and once during your re-verification as a retiree.

Review the Dependent Eligibility Verification (State and CSU only) section on pages 22-23 in the Health Program Guide (PDF) and Dependent Eligibility Verification webpage for more information.

4. Coverage When Traveling

What if I need medical care while traveling?

Emergency services and urgent care are covered nationwide under all CalPERS health plans.

PPO Platinum members typically have access to nationwide provider networks and may seek care outside of California.

Members should confirm coverage details with their health plan before traveling.

For plan-specific information, check your Evidence of Coverage (EOC) or Summary of Benefits and Coverage (SBC). These can be accessed through the Forms & Publications webpage.

5. Medicare and Retirement Health Benefits

How can I ensure that my medical benefits roll into retirement?

If you are already enrolled in CalPERS health benefits and you retire within 30 days of your separation date, your benefits will automatically transition into retirement. If you wish to decline coverage, you must indicate this on your retirement application. Review the When You Are Retiring Section on page 24 of the Health Program Guide (PDF) for more information.

Why did I receive an invoice for the Medicare Part B premium?

Medicare Part B requires a monthly premium, which can be deducted from your Social Security benefits or billed directly by Medicare. You must pay for and maintain enrollment in Medicare Part B to remain enrolled in the CalPERS health program.

Do I need to enroll in Medicare to keep my CalPERS health benefits?

Yes. If you and/or your dependent are over 65, retired, and eligible for premium-free Medicare Part A, you must also enroll in Medicare Part B, to continue your CalPERS health benefits. Learn more on page 5 of the Medicare Enrollment Guide (PDF).

Additional resources:

• • • How Medicare Works With Your CalPERS Health Plan
    • CalPERS Medicare webpage
    • CalPERS Quick Tip Video on Medicare: Eligibility and Ineligibility

6. COBRA

What happens if I lose my CalPERS health coverage?

If you lose health coverage due to job loss, divorce, or aging out of a parent’s plan, Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to extend your health coverage for up to 36 months:

• Active employees can continue COBRA coverage for 18 months.
• Dependents may enroll in COBRA for up to 36 months.
• You can continue coverage for up to 29 months if you’re recognized as disabled through the Social Security Administration or the Supplemental Security Income program.

Your cost under COBRA may include an additional administrative fee, but it generally will not exceed 102% of the monthly group premium rate.

To avoid a lapse in coverage, report your loss of coverage within 60 days to your employer (if you’re an active member) or to CalPERS (if you’re a retiree). Coverage will begin the first of the month following CalPERS’ receipt of your request.

For more details on COBRA continuation coverage including how to enroll, cancel, or extend your coverage, refer to page 20 of the Health Program Guide (PDF) and visit the COBRA webpage.

Who provides COBRA forms?

Active employees will receive COBRA notifications from their employers. In addition, CalPERS generates notifications and forms for all members experiencing COBRA-qualifying events, including initial health enrollment. This applies to active and retired subscribers and dependents.

When a dependent becomes eligible for COBRA, both the subscriber and the dependent will receive a COBRA notice and election form, regardless of whether they share the same mailing address.

To access COBRA election forms, visit the COBRA webpage.

7. Health Benefits for Survivors

Do survivor benefits include health coverage?

Health benefits are automatically canceled upon the death of a CalPERS member. However, a surviving beneficiary may enroll in or re-enroll in health coverage if:

• The survivor was enrolled in, or eligible to enroll in a CalPERS health plan before the member’s passing, and
• The survivor receives a continuing monthly survivor benefit payment.

If eligible, the survivor’s health coverage will be reinstated retroactively from the date of cancellation once CalPERS confirms eligibility.

For more information on survivor health benefits, visit Life Events that Can Impact Your Enrollment on page 18 within the Health Program Guide (PDF). If the survivor is ineligible for continued CalPERS coverage, they may be able to enroll in COBRA health coverage.