Open Enrollment for 2020 Health Plan Changes
September 9th – October 4th
(for changes effective January 1, 2020)
CalPERS Open Enrollment is September 9th through October 4th. This is your one-time opportunity to make benefit elections/changes for the upcoming plan year without a qualifying event. We encourage you to walk through this enrollment process to review your benefits carefully and make changes as needed. Please see below for more information.
All Open Enrollment change requests must be submitted to HR no later than 5:00 pm on Friday, October 4, 2019.
Beginning August 26, log in to your my|CalPERS participant account to view:
- Specific health benefit changes that may impact you in the coming year
- Your current 2019 monthly premium rate and 2020 monthly premium rate if you do not change your health plan.
- 2020 health plans and monthly premium rates available based on your health eligibility ZIP code
- Which health plans your doctor participates in
- Your enrolled dependents
Thinking of changing your health plan for 2020? Please note that not all CalPERS plans are available in all areas/zip codes. To compare available health plans for 2020 based on your eligibility ZIP code (home or work), log in to your my|CalPERS account and use the Search Health Plans tool to research the health plan coverage and benefits most important to you and your family.
NEW FOR 2020:
- Effective January 1, 2020, CalPERS public agency and school health pricing regions will change from five to three regions. In the new three-region model, Region 1 will consist of 43 Northern California counties, including El Dorado, Sacramento, Yolo and Bay Area counties. There will no longer be different rates for Sacramento area plans.
- Blue Shield is introducing a new HMO health plan called Blue Shield Trio. This plan will be available in El Dorado, Placer, Sacramento and Yolo Counties, in addition to Los Angeles and Nevada.
If you are NOT MAKING ANY CHANGES to your current health enrollment (same plan, same dependents) NO ACTION is required!
If you are WAIVING coverage for 2020 you must sign the Annual Opt-Out Waiver form. You must turn in a new waiver to receive the cash-in-lieu (“cash back”)
If you are MAKING CHANGES to your health benefit election for 2020, please use the chart below to identify what forms you need to submit:
Any changes submitted during Open Enrollment will take effect January 1, 2020, however because the City prepays for premiums, deductions for the January premium will reflect on the December paychecks.
All completed forms must be submitted to HR no later than 5:00 pm on Friday, October 4, 2019.
Open Enrollment Forms
- HBD-12 CalPERS Open Enrollment Form
- 2020 Cafeteria Plan Forms
- Opt-Out (“Waiver”) Attestation – Required ANNUALLY if you are waiving City medical coverage
CalPERS Health Plan Information
- 2020 CalPERS Health Plan Rates
- 2020 CalPERS Open Enrollment Newsletter
- 2020 Health Plan Benefit Summary & Comparison Chart
Dropping Dependents at Age 26 Limit: REMEMBER that if your dependent is dropped by CalPERS for reaching age 26 and that reduces your plan tier, you MUST notify HR to change to the lower tier/deduction on your paycheck. CalPERS does not automatically notify HR.
Dental – United Concordia (UCCI)
This benefit is fully paid by the City of San Rafael (pro-rated for part-time employees) and includes any eligible dependents. Employees can log-in to the United Concordia website to view their covered dependents and search providers. If you don’t have your member #, which is needed to log-in, please call UCCI at 1-800-332-0366. You can print an ID card once you’re logged on to the website.
Please review the Summary of Benefits provided below to learn more about your deductibles and services covered.
Complete the UCCI Enrollment Form to sign up or add eligible dependents (up to age 19, or age 23 if a full-time student).
United Concordia Dental
- United Concordia Enrollment Form
- United Concordia Dental Benefits Summary (Advantage Plus PPO Network)
Vision – Medical Eye Services (MES)
Members in certain bargaining groups are eligible for vision coverage through MES. This benefit is fully paid by the City for Employee Only coverage (pro-rated for part-time employees). Employees may enroll all eligible dependents for an out-of-pocket cost of $11.13 per month. The City picks up the cost to enroll eligible dependents for Executive and Mid-Management employees. Employees can log-in to the MES website to view their coverage details, covered dependents, search providers and print an ID card.
Please review the Summary of Benefits provided below to learn more about your coverage and copays.
Complete the MES Enrollment Form to sign up or add eligible dependents (up to age 19, or age 25 if a full-time student).
Medical Eye Services
CIGNA Life Insurance – Make sure your Beneficiaries are up to date
All employees are automatically enrolled in the city-paid Basic Life insurance benefit, as designated in the appropriate MOU, upon hire. Employees should maintain an updated Basic Life Beneficiary Designation form on file.
There is no formal open enrollment period to purchase Voluntary Life insurance for yourself and/or your eligible dependents. Please note that in order to purchase life insurance for your spouse and/or child(ren), you are required to purchase voluntary life insurance for yourself. Evidence of Insurability is required for all new elections (outside of the 30-day window from date of hire); see form below. This optional benefit is fully paid for by the employee.
CIGNA Life Insurance
- Voluntary Life Insurance Application
- Voluntary Life Insurance brochure
- Voluntary Life Insurance Sample Rate Sheet
- Beneficiary Designation Change Form (for Basic and Voluntary life insurance)
Flexible Spending Account (FSA) – Enroll by November 15th
Enrollment in FSA Health Care Reimbursement and the Dependent Care program requires an annual election. This means you must submit a new enrollment form even if you are setting aside the same amount as previous years.
The enrollment deadline for this benefit is November 15th each year. In the meantime, learn more about Flex Spending Accounts and eligible expenses.
- FSA (125 Plan) Enrollment form (required annually)
Employee Commute Program
All regular full-time and part-time employees are eligible to participate in the program, which includes incentives for carpooling or walking/biking to work. Visit the Commuter Program page to sign up.
Employees interested in setting aside pre-tax funds for public transit expenses are encouraged to purchase clipper card value online with My Commuter Check. Orders must be placed by the 10th of each month for passes/value to be added for the following month (e.g. ECO pass/clipper value for January must be purchased by December 10th).
Take the time to understand your benefit choices so you can make sound decisions in choosing the right options for you and your family. If you still have questions after visiting the links above, please contact the Human Resources Department via email at firstname.lastname@example.org or via telephone at (415) 485-3063.