Open Enrollment for Employers

If an employee's January 1, 2025 pay warrant does not reflect the proper premium payment of a health plan change, the premium payment will be adjusted during a subsequent pay period.

Advise the employee they should've discontinued using their prior plan after December 31, 2024. Verify that myCalPERS reflects the appropriate enrollment and advise the employee that the payroll discrepancy will be resolved.

Health plan ID cards for members enrolled in a PPO plan will be mailed mid-December 2024. If members enrolled in PERS Gold or Platinum don't receive their ID card by January 1, 2025, they should contact Included Health.

Below are answers to frequently asked questions we received during the webinar:

• Where can I find more information regarding the 2025 PPO changes?
  • You can find more information by visiting the 2025 PPO Administrators for Basic Plan Members page and watching a recording of the Introducing CalPERS New PPO Administrators Blue Shield and Included Health webinar that took place on August 22.
• Is Included Health going to attend Health fairs?
  • Yes, Included Health is partnering with Blue Shield of California to attend health fairs. If you submitted an Open Enrollment Health Fair request by the September 1 deadline, each health plan, including Blue Shield of California, received the notification. They will contact you directly if you haven’t already been reached. The dates for onsite and virtual Open Enrollment support are from September 3 through October 11. If you have not heard back, connect with Blue Shield of California.
• Is Included Health replacing Carelon?
  • Yes, Carelon will no longer be part of the Blue Shield or Included Health contracts in 2025. Carelon was a subcontractor for Anthem, and with the transition, Included Health will take over member services and care coordination. They will work closely with Blue Shield to manage approvals for prior authorizations and clinical needs, while members will go through Included Health for support. Services previously provided by Carelon will now be handled by Included Health and Blue Shield.
• Does the PERS Gold plan offer an away-from-home care program for a dependent going to college out-of-state?
  • If an employee is traveling or otherwise temporarily traveling outside of California and require medical care or treatment, they may access the Preferred Providers through the BlueCard program. To find BlueCard providers, they can call 1-800-810-BLUE (2583).
• For the PPO plans, will prior authorizations transfer over from Anthem to Blue Shield of California?
  • Yes, CalPERS is working with Optum and Anthem to ensure the transfer of prior authorizations, whether for medical procedures or prescription drugs. All prior authorizations from this year will be transferred over to Included Health and Blue Shield of California.
• Will the plan codes remain the same for PERS Gold and PERS Platinum under Blue Shield of California?
  • No, the plan codes are different with Blue Shield as the administrator. Reach out to health_business_partner_support@calpers.ca.gov to receive them.
• How will employers be notified of the file erroring out if demographics do not match what’s in myCalPERS?
  • Employers will be notified of demographic errors in a response file placed in the secure file transfer protocol (SFTP) folder where they submitted their enrollment file. This response file will specify which transactions encountered errors and provide details on the demographic issues that caused the errors.
• What will I be required to put in an employee’s OPF if the employee completes an online health enrollment?
  • The supporting documentation will be stored electronically in myCalPERS for you to access any time. You do not need to print and store a duplicate hard copy in a physical OPF unless your agency policies dictate you do so.
• Where can I find more information regarding Online Health Enrollments?

  • Find employer information on the Online Health Enrollments for Active Employees page.

    Refer your employees to the Online Health Enrollment for Active Members page for information on how to make changes to their health plan using myCalPERS.

• How and where can I purchase/order the 2025 Health Benefit Summary?
  • The 2025 Health Benefit Summary (PDF) is available online in the forms and publications section of the CalPERS website. Employers can also order Health Benefit Summary publications through their myCalPERS account. Additionally, you can call our call center to request for them to be mailed.

As the designated health benefits officer or assistant health benefits officer, you're the authorized point of contact to process CalPERS health transactions and provide health eligibility and enrollment information to your employees. Encourage your employees to reach out to you directly for any questions or assistance related to Open Enrollment transactions.

To ensure successful ongoing CalPERS health benefits and communication, all employees should:

• Have a myCalPERS account.
• Maintain a current email address, health eligibility ZIP code, and communication preference.
• Submit supporting documentation needed to verify their dependents.
• Confirm their new health plan and monthly premium adjustments in their January 2025 paycheck.

You have a fiduciary responsibility to manage the CalPERS Health Program by ensuring that only eligible employees and their dependents are covered. Employers are responsible for obtaining and maintaining records of all supporting documentation that determines the eligibility of enrolled dependents. At the time of enrollment – or anytime thereafter – you have the right to request additional supporting documentation needed to verify a dependent's eligibility.

To find a list of eligible dependent types and for additional information, refer to the Health Program Guide (PDF).

All health enrollment transactions should be submitted through myCalPERS. If your employees are using online health enrollments self-service, you will need to review and approve those transactions in myCalPERS. Early submission and approval will ensure timely processing of health plan ID cards and proper payroll deductions. For more information on adding and updating health transactions review our myCalPERS Student Guides.

• The deadline for processing all Open Enrollment transactions is 11:59 p.m. (Pacific Time) on Friday, November 8, 2024.
• Your employees may choose to use their employer ZIP code as their health eligibility ZIP code when they first enroll in CalPERS health, upon a move, or during any Open Enrollment period.
• If you're unable to complete all Open Enrollment transactions before the processing deadline, contact us at 888 CalPERS (or 888-225-7377). Don't forward unprocessed Open Enrollment request forms to us.

During Open Enrollment, you're responsible for submitting transactions for former employees or their dependents enrolled in COBRA continuation coverage who want to change or cancel health plans or add/delete eligible dependents.

You're also responsible for submitting transactions during Open Enrollment for employees on a leave of absence who want to change plans or add/delete dependents. Employees who do not change plans or add/delete dependents during Open Enrollment may do so within 60 days from the date they return to regular pay status.

You can rescind health transactions when the effective date of the transaction occurs in the future. For example, before the January 1, 2025 effective date, if an employee decides they no longer want to change health plans, you can rescind the transaction in myCalPERS.

Rescinded transactions must be updated before the December 2024 cutoff date. Open Enrollment transactions rescinded after the December 2024 cutoff date will be adjusted during a subsequent pay period.

State and CSU Agencies

Visit Civil Service Benefits Cutoff Calendar to access the State Controller's Office (SCO) benefit cutoff dates.

Contracting Agencies and Schools

Refer to the 2024 Health Billing Cutoff Dates, Contracting School Districts and Public Agencies (PDF) attachment linked in Circular Letter 600-004-24 for 2024 health billing cutoff dates and payment information.

To comply with CalPERS guidelines, the following items are prohibited from being distributed at any health fair, Open Enrollment function, or any health fair held for the sole purpose of initial enrollment, regardless of date:

• gifts (such as pens, cups, clothing, food, etc.)
• prizes for raffles or drawings
• game prizes
• giveaways

Any literature provided to members at these three types of events must be limited to educational information about the Health Plans. This policy applies only to the Health Plans, not agencies hosting Open Enrollment fairs.

To register for a class, log in to your myCalPERS business partner account, then select Education. Participate in the Health Business Rules class to increase your understanding of the following:

• Eligibility & enrollment requirements
• Health Plan options
• Health benefits into retirement
• Best ways to manage resources