Health Open Enrollment

Presenter 1: Good morning and welcome to theCalPERS webcast, Health Open Enrollment. Before we get to the main presentation, let’stake care of some housekeeping items. To provide you with a future reference and makeyour note taking easier, we’ve provided a learning guide for this webcast. You’ll see the link to thelearning guide below the YouTube viewing window. The video for this webcast will stay postedhere on YouTube, so you can come back and watch again if you need to. All of our other previouswebcasts are also posted to our YouTube channel. In this webcast, we’ll bediscussing what open enrollment is, the health open enrollment resources available toyou and finally, we’ll touch on open enrollment for dental and vision benefits. Let’s getstarted. So, what is open enrollment? Open.

Enrollment is a yearly event, held in the fall,for those eligible for CalPERS health coverage. Open enrollment is when you’re able tomake changes to your health coverage. The specific dates of Open Enrollment change everyyear, so you can check our website to confirm when it’s happening. Any changes made during openenrollment take effect January 1st of the new year. During Open Enrollment you can enroll ina plan or change your plan. You can also add eligible family members and delete dependents.You can even cancel your coverage altogether. Keep in mind, you don’t need to wait until openenrollment to delete dependents or cancel your coverage. You can do those things any time duringthe year. There are, however, some situations where a deletion of a dependent is mandatory.For example, when your dependent child turns 26,.

They are no longer able to be covered under yourCalPERS-sponsored health or state dental plans. This deletion is mandatory and automatic unlessthey can be certified as a disabled dependent. Now we’ll go over the open enrollment process. One week prior to open enrollment, wepost the open enrollment packet online. For those who have chosen to receive it bymail, it’s mailed out at this time as well. This packet includes the Health Plan Statement,which is available in your myCalPERS account, and the Open Enrollment Newsletter. TheOpen Enrollment Newsletter contains health program highlights, changes to healthbenefits and other important information. Even if you don’t plan on makingany changes for open enrollment,.

You’ll still want to review the healthplan premium rates for the next year. Rates change every year and you don’t want tobe surprised by an unexpected price change. The Health Plan Statement is available todownload online in your myCalPERS account. For those who have not chosen to access itelectronically, it will be mailed to you. The Health Plan Statement is a snapshot of yourhealth enrollment as of August 1st so if you make any changes effective after this date,they will not be reflected in the statement. You’ll see the health plan you’reenrolled in, your eligibility zip code, which we use to determine what plans are availableto you, and finally, who’s enrolled in your plan. Your health plan statement also provides you anall-inclusive list of the health plans we offer.

And some resources and tools available to you, afew of which we’ll be discussing shortly. Before we move into the additional resources we have foryou, we need to highlight some significant changes to our health plans for 2022. A significantchange to the Health Maintenance Organization, HMO, and the Exclusive Provider Organization,EPO plans, include the addition of a new plan and the expansion of current plans into additionalcounties. Blue Shield Access Plus is reentering several counties in the Bay Area includingAlameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara, Sonoma and Solanocounties. Blue Shield’s EPO is expanding to Lassen and Shasta counties, and Blue ShieldTrio is expanding to Santa Cruz, Stanislaus and Orange counties. UnitedHealthcare has the newSignatureValue Harmony plan that will be available.

In five southern California counties includingLos Angeles, Orange, Riverside, San Bernardino and San Diego. And finally, Western HealthAdvantage is expanding into Humboldt county. We would like to share a significant change toour Preferred Provider Organizations or PPO’s. PERSCare and PERSChoice will now be combined intoPERS Platinum. The PERS Platinum plan retains a 10 percent coinsurance and the same network ofproviders that you had with PERSCare and PERS Choice. PERS Select will now become PERS Goldwhich retains a 20 percent coinsurance and the same network of providers as PERS Select. Thereare also plans that have been expanded or added for those on Medicare. Anthem Blue Cross MedicarePreferred is now available in all 58 counties in California. Blue Shield Medicare Advantage isa new plan that will be available nationwide.

Like the basic plans, PERSCare, and PERS ChoiceSupplement to Medicare plans will change to PERS Platinum Supplement to Medicare Plan andPERS Select Supplemental will become PERS Gold Supplement to Medicare Plan. There are nochanges to the benefits. The new UnitedHealthCare Medicare Advantage Plan is nationwide andincludes OptumRX and its pharmacy and finally, Western Health Advantage MyCare Select MedicareAdvantage is a new plan for Sacramento, Yolo, Solano, El Dorado, Placer, Colusa,Marin, Napa and Sonoma counties. For information on all the available healthplans, you can refer to the plans and rates pages which we’ll cover shortly or the HealthBenefit Summary which we’ll cover next. To help you better understand the types of plansand what’s available, let’s move on to one of our.

Most useful publications for Open Enrollment, theHealth Benefits Summary. This publication contains a wealth of information regarding specific planbenefits, but it contains more than just benefit information. The Health Benefits Summary describesthe differences between the different types of health plans. The Health Maintenance Organizationsor HMOs, Preferred Provider Organizations or PPOs, and Exclusive Provider Organizations or EPOs. Forexample, if you need to see a specialist under an HMO, you must first seek a referral fromyour primary doctor first. For a PPO or EPO, no prior approval is necessary. On the HealthPlan Availability by County chart, you’ll find a list of the health plans and which countiesthey serve. These charts are broken out by basic plans and Medicare plans. Also in the HealthBenefit Summary is the Health Plan Directory..

This provides you with all of the plan’s phonenumbers and website addresses so you can find out more about ID cards, deductibles, limitations,or if you have specific coverage questions not answered in the Health Plan Summary and links toresources you can use to evaluate and select a doctor and hospital. And finally, there are theCalPERS Health Plan Benefit Comparison charts. These are side-by-side descriptions of whatthe plans cover. The comparison charts are separated by basic, or non-Medicare plans and theMedicare plans. Please keep in mind these are just summaries of the plan benefits. While theydo include the most popular benefit features of each plan, they are still only summaries. Ifyou have additional questions not covered by the Health Benefit Summary, please contact the plansthemselves. We cannot answer coverage questions.

The Evidence of Coverage publications are amore detailed description of the plan benefits and limitations. These publicationsare generated by the plans themselves, they are not CalPERS publications. We link to theEvidence of Coverage publications on our website under the forms and publications section butbecause they have to be sent to us by the plans, these links may not be availableduring open enrollment. If you’d like a paper copy sent to you, you’llneed to make this request directly to the plan. You should review the Open Enrollment pageson our website. There are two versions of the of the open enrollment page, one foractive members, and one tailored to retirees. If you’re a retiree and find yourself onthe active members page, there’s a link.

That will take you directly to the retiree page.There’s a similar link on the retiree's page. Both pages provide important health enrollmentreminders such as being aware that you can’t change health plans outside of openenrollment if the medical group you're with ends its contract with that plan. Your IDcards are issued by your health plan, not us. And you should review your check to make sureyour health plan premium deduction is correct if you change health plans, enroll for the firsttime, or add or delete anyone from your plan. Below that, you’ll find the health planchanges for the new year and to the right, you’ll find links to many otheruseful resources and publications. Another great source of information on theavailable CalPERS health plans is our plans.

And rate pages. Like open enrollment, there aretwo versions of the plans and rates pages, one for active members, and one tailored to retirees.The one we’re showing here is for retirees. A great tool we want to call your attentionto is the Health Plan Search by Zip Code tool. You can use this throughout the year to findout what plans are available in your area, and it’s available on both the active andretiree pages. Enter your current home zip code, or the zip code you’re planning to move to, choosethe correct member category, and search year. You’ll be provided with the HMO,PPO, and association plans available, separated by basic, Medicare, or a combination ofthe two. This tool is really helpful when you’re planning a move, becoming eligible for Medicare,or during Open enrollment. Keep in mind this tool.

Doesn’t use any of your personal informationsuch as your employer or bargaining unit. If you want a more personalized search, usethe Search Health Plans tool in your myCalPERS account. When you keep scrolling through either ofthe Plans and Rates pages, you’ll find the health plan rates for all of our health plans. They areseparated by year and by employment category. State and California State Universityretirees will find their plan rates and the State contribution amounts. Public agency andschool retirees will find their rates separated by region. Employer contributions are notposted here because they vary by employer. Check with your employer for whatthey pay towards your health benefits. Another useful aspect of the Health Plan Search byZip Code tool is it’ll tell you what region you’re.

In when you enter the required information. Evenif you don’t plan on making any changes during open enrollment, make sure to always check thehealth plan rates and employer contributions. There are some really useful tools andresources in your myCalPERS account as well. Let’s take a look at the Health Plan Summary page.This shows you a lot of information about your current health enrollments and dental enrollments,if applicable. This page shows what plan you’re currently enrolled in. And your monthly premium.If you’re a State or CSU member, you can see the share amount you pay and what your employer pays.If you are a public agency or school member, you’ll need to check with your employer for thoseamounts. And when you scroll further down, you’ll see who’s currently covered on your plan. This isa great way to get a real-time view of your health.

Enrollment. In addition to the Health Plan Summaryscreen we just reviewed, myCalPERS health section offers useful tools. The Search Health Planstool enables you to search for and then compare the features of available health plans. It alsoallows you to search for a doctor or a specialist. The Health Costs into Retirement Calculatorenables you to find out how much health benefits will cost you in retirement. This calculatoris intended to provide an estimate only. Your actual health benefit costs will bedetermined when you formally apply for retirement. This tool is only available to active employeeswho are eligible to retire. Finally, the open enrollment link provides important informationabout the changes possible during open enrollment as well as some publications and other resourcesavailable. We’ve reviewed many of these items.

In this webcast. Active employees need tomake any changes through their employers. Retirees have the option of making health planchanges through this page during open enrollment. As a retiree, you can makechanges at If you don’t want to or can’t makeyour changes online there are other ways for retirees to make changes during openenrollment. You can call us at 888-225-7377. Most requests can be completed over the phone.You can also submit your open enrollment requests by mail or fax. Or you can make an appointmentwith one of our regional office team members. Although our regional offices arecurrently closed for in-person visits, you can still schedule a phone or videoappointment through your myCalPERS account..

Again, if you’re an active employee, you need tomake health plan changes through your employer. Just a note, if you are a retiree and make achange online during open enrollment but then change your mind, you can call us to cancelthat change. For example, if I decided after open enrollment that I didn’t want to change myplan to Kaiser and wanted to keep Blue Shield, I can call or write in any timebefore the plan change takes effect and request to change theplan back to Blue Shield. This is only allowed if I’m still eligible forthe Blue Shield plan I was enrolled in previously. But what if it’s still open enrollmentand I want to cancel my change to Kaiser, but don’t want to go back to Blue Shield?I can do that and choose a different plan.

I’m eligible for but only if it’s stillduring the open enrollment period. If you’re an active employee, you’llneed to contact your employer. If you want to cancel your changeoutside of the open enrollment window, you can only request to go back to theplan you were previously enrolled in, if you’re still eligible for that plan. For ourlast topic, we’ll briefly go over some information about dental and vision enrollment. If you are anactive employee and work for the State and need to change your dental or vision coverage, contactyour department’s personnel office. If you’re a California State University, CSU, employee, youshould contact your campus benefits office. And, if you’re a school or public agency employee,you should contact your personnel office.

Once retired, State andCalifornia State University retirees should contact CalPERS at888-CalPERS, which is 888-225-7377. If you’re a member of the CaliforniaAssociation of Highway Patrolmen, you may have chosen CAHP for your dental plan.If that’s the case, you’ll need to contact CAHP. For State, CSU, or CAHP retiree, Open Enrollmentfor dental is at the same time as for health. Although we don’t administer the dental programs, we process all of the dental transactionsfor retirees, so if you want to make changes to your dental plan during open enrollment,or anytime during the year, give us a call. If you’re a school or a public agency retiree,you’ll need to contact your personnel office..

If you are a public agency or schoolretiree and have a dental or vision rider plan through one of our health planssuch as Kaiser, you’ll need to contact us. For State retirees, dental information,including a summary of dental plan choices, coverage, cost information and premiums can befound on the CalHR website at and then by selecting State Retirees, thenRetirement Benefits, and Retiree Dental Benefits. If you’ve been enrolled in dental as a retireebefore, most open enrollment requests can be processed over the phone but if you’reenrolling for the first time as a retiree, you’ll need to submit your request in writing. CSUretirees can get more information on their dental benefits by visiting the Chancellor’s benefitwebsite at

Here you’ll find benefit information,evidence of coverage publications, Retiree Dental Enrollment Change Requestform if you are enrolling for the first time. If you’re eligible and would like more informationon the California Highway Patrol, CAHP, dental plan you can review the information ontheir website at Please note, once you enroll in the CAHP dental plan youcannot change to one of the state-sponsored plans. If you’re a State retiree, your visionbenefits are administered by CalHR. As a CSU retiree, your vision benefits areadministered by the Chancellor’s Office. All coverage, benefit and enrollment informationis handled by Vision Services Plan or VSP. To make any changes, you’ll need to contact VSP directly.School and public agency retirees should contact.

Your personnel office. Open Enrollment forvision coincides with our health and dental open enrollment. VSP will send open enrollmentmaterials and they complete any transactions. Retirees commit to a minimum of a 12-monthenrollment during open enrollment and can only cancel if a permitting event occurs.If you sign up at the time of retirement, the commitment will be for 12 months plusthe time until the next open enrollment. Premium payments can be withdrawn from yourretirement check as a direct authorization. We went through a lot of informationtoday regarding Open Enrollment. Our presentation today was intended to provideyou with some information about Open Enrollment and the resources available to you. Remember,this was a brief overview. You can find more.

Detailed information on our website andthrough the publications we recommended. Like we mentioned before, all of our webcastsbecome available as videos on the CalPERS YouTube channel, which can be accessed fromour website at Thank you for taking time out of your day to attendour webcast and have a great rest of your day!

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