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Cafeteria Plan Forms for 2023 Health Plan Changes

Region 1- to see a full list of counties visit CalPERS. Please submit Cafeteria Plan forms ONLY if you are making changes to your enrollment or if you are enrolling for the first time. Flex dollar allowances and premium rates are for 2023, however since CalPERS requires prepayment of premiums, the scheduled rate increases go into effect in December of 2022 (for January 2023 coverage).

Executives, Mid-Mgmt & Electeds

San Rafael Fire Chief Officers’ Association

San Rafael Firefighters’ Association

San Rafael Police Mid-Mgmt Association

San Rafael Police Association

AFSCME/ Public Employees Local-1 Confidential Unit

SEIU-  Local 1021

SEIU- Child Care

Western Council of Engineers

Fixed-Term employees


Additional resources: CalPERS website.

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