Open Enrollment for 2021 Health Plan Changes
September 21st – October 16th
(for changes effective January 1, 2021)
CalPERS Open Enrollment is September 21st through October 16th. 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 for health coverage must be submitted to HR no later than 5:00 pm on Friday, October 16, 2020. Completed forms (see below) should be e-mailed to firstname.lastname@example.org.
If you are currently enrolled in health coverage, please log in to your my|CalPERS participant account to view:
- Specific health benefit changes that may impact you in the coming year
- Your current 2020 monthly premium rate and 2021 monthly premium rate if you do not change your health plan.
- Compare plans (and premiums) available to you for 2021 based on your health eligibility ZIP code (home or work)
- Plans in which your doctor participates
- Your enrolled dependents
Thinking of changing your health plan (or enrolling) for 2021? Not all CalPERS plans are available in all areas/zip codes. Be sure to use the Search Health Plans tool to research the health plan coverage and benefits most important to you and your family.
CalPERS Health Plan Information:
- 2021 CalPERS Health Plan Rates
- 2021 CalPERS Open Enrollment Newsletter
- 2021 Health Plan Benefit Summary & Comparison Chart
- 2021 Summary of Benefits and Coverage Notice for all CalPERS plans
Changes for 2021 plans:
- Basic (non-Medicare) HMO plans will see a 4.44% average premium increase. Basic PPO plans will see an overall average increase of 8.54%. Be sure to check your my|CalPERS participant account for premium changes.
- UC Davis will no longer be available to UnitedHealthcare HMO Basic members.
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 2021 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 2021, please use the chart below to identify what forms you need to submit:
Any changes submitted during Open Enrollment will take effect January 1, 2021, 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 16, 2020.
Open Enrollment Forms
- HBD-12 CalPERS Open Enrollment Form
- 2021 Cafeteria Plan Forms
- Opt-Out (“Waiver”) Attestation – Required ANNUALLY if you are waiving City medical coverage
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) – Additional information will be provided as it becomes available
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.
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 email@example.com.