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Enrollment Guidelines

Eligible employees must enroll in a plan(s) within 60 calendar days of employment (or re-employment, if there has been a break of service of more than 30 calendar days). The effective date of benefits depends on many factors; including your first day of employment, the date you submit enrollment documents, your pay plan and the pay period.

The premium for your first month of benefits will likely not be deducted from your first paycheck. You will be asked to sign an accounts receivable agreement for re-payment of the initial premium(s). Subsequent premium payments will automatically be deducted from your pay.

Supplemental documentation is required to enroll all dependents. Social Security numbers are required for all dependents.

You may enroll your spouse or domestic partner to your health plan within 60 days of your marriage or registration of your domestic partnership.

You may enroll your newborn, adopted or stepchild to your health plan within 60 days of the child’s birth, placement, your marriage or registration of your domestic partnership.

Your children, adopted children, or stepchildren must be under age 26 regardless of whether or not they are living with you.

A child over age 26, who is incapable of self-support due to a mental or physical condition that existed prior to age 26, may be included when you first enroll. You will need to provide the child’s birth certificate and social security number. You must also submit a Member Questionnaire for Disabled Dependent Benefit Form (HBD-98) and your doctor must submit a Medical Report for the CalPERS Disabled Dependent Benefit Form (HBD-34) for CalPERS approval. You will need to update these forms periodically upon request. If the disabled child has a Social Security–approved disability you must also provide CalPERS with a copy of his/her Medicare card.

Members who are married, or in a registered domestic partnership who both work, or worked, for agencies in the CalPERS Health Program can enroll separately.

You cannot be enrolled in a CalPERS health plan as a member and a dependent, or as a dependent on two enrollments.

If you divorce or terminate a domestic partnership, your former spouse/domestic partner is no longer eligible to be enrolled in your health coverage, even if the court orders you to provide health coverage for them. The coverage terminates on the first day of the month in which the final decree of divorce or termination is granted.

Plan changes or adding/deleting eligible dependents may only occur during the annual open enrollment period OR after submitting supporting documentation of a qualified life event.

All plan changes require supporting documents and a completed Benefit Enrollment/Change Worksheet.

Open enrollment occurs annually (date is determined by CalPERS) and usually in the fall with all changes taking effect on January 1st of the following year.

CALPERS – LIMIT OF RETROACTIVE REIMBURSEMENT LIABILITY FOR HEALTH PREMIUMS

California Code of Regulations (CCR), sections 599.502(f) (2) and 599.506(c) (1), limit the liability of health plans for reimbursement of health premiums to members and employers to the amount of excess health premiums paid for a period of up to six months prior to the date on which the action is processed and recorded, pursuant to the member’s request for retroactive cancellation or deletion of the ineligible family member.

Members who fail to report an enrollment change in a timely manner could be liable for retroactive reimbursement to their employer of premiums in excess of six months prior to the date on which the action is processed and recorded. In addition, members may be liable for costs incurred as a result of services delivered to an ineligible dependent.