Benefits Open Enrollment
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- September 15 thru October 10
- Any change will take effect January 1, 2015
Click here to view the 2014 Open Enrollment page on CalPERS website
2015 HEALTH PLAN RATES [PDF]
Please review the attached 2015 Health Plan rates to determine if your health plan premium will be increasing or decreasing in 2015.
HELPFUL CALPERS BENEFITS TOOLS AND RESOURCES
CALPERS HEALTH BENEFIT CHANGES FOR 2015
Highlights of the 2015 CalPERS health benefit changes are listed below. Please refer to the health plan’s Evidence of Coverage (EOC) booklet for a complete explanation of the benefits covered, as well as limitations and exclusions that apply. For additional information on CalPERS health plans, please refer to the CalPERS open enrollment materials, or visit the CalPERS website at: http://www.calpers.ca.gov.
- Inclusion of Acupuncture and Chiropractic benefits for all HMO plans.
- Plans that don’t currently offer Acupuncture or Chiropractic services will provide twenty (20) annual visits (combined) for these services, regardless of medical necessity, at the standard office visit copay level ($15).
- Removal of Sharp Medical Group from Blue Shield’s NetValue plan.
- If an impacted employee would like to keep his/her current PCP through the Sharp Medical Group, the employee will need to select another CalPERS health plan option or verify if their current PCP is available through another NetValue network provider.
- Employees currently enrolled in the Sharp Medical Group through Blue Shield’s NetValue plan who fail to make a change during open enrollment, will automatically be defaulted to a new NetValue network provider based on his/her zip code.
- Blue Shield will no longer require the use of Centers of Excellence for knee/hip replacements.
- Blue Shield has eliminated the $250 outpatient hospital copay for upper endoscopies, colonoscopies, cataract surgery, and knee injections.
- Adoption of High Performance Generic Step Therapy (HPGST) for HMO, EPO and PPO plans.
- High Performance Generic Step Therapy encourages the use of a preferred drug prior to the utilization of a non-preferred drug. The preferred drug is FDA recommended and represents the most cost-effective drug for a given condition. Per CalPERS, an established evidence-based protocol must be met before a non-preferred specialty drug will be covered. It is important to note that the targeted brands in HPGST have generic alternatives within therapeutic classes and the dispensing of a generic alternative requires a new prescription from the prescriber.
- Implementation of Affordable Care Act (ACA) maximum out-of-pocket (MOOP) requirements.
- For 2015, the ACA limits maximum out-of-pocket (MOOP) amounts for health plans to $6,600/$13,200 for individuals/families, for both medical and pharmacy benefits combined.
- The HMO/EPO plans presently have a $1,500/$3,000 MOOP for medical benefits, and no MOOP for pharmacy benefits. The inclusion of a $5,100/$10,200 MOOP for pharmacy benefits will allow the plans to meet the law’s requirement with no impact on premiums.
- The PPO plans presently have no MOOP for medical or pharmacy benefits. The inclusion of a $4,600/$9,200 MOOP for medical benefits and $2,000/$4,000 for pharmacy benefits will allow the plans to meet the law’s requirement with no impact on premiums.
- Blue Shield’s NetValue plan is withdrawing from Humboldt County.
- Employees currently enrolled in Blue Shield’s NetValue plan residing in Humboldt County will need to choose a different health plan for 2015.
- United Healthcare has expanded its service area to also encompass San Joaquin and Solano Counties.
Voluntary Benefits – The following voluntary benefits are offered through payroll
Additional information regarding these voluntary benefit plans and how to enroll can be found on the CSU Systemwide Benefits Portal at: www.calstate.edu/hr/benefitsportal/. Please note that all of the above voluntary benefit plans, with the exception of the MetLaw Legal plan, allow employees to enroll throughout the year.
- MetLaw Legal Plan - This is your annual opportunity to enroll in the MetLaw Legal Plan for a low monthly premium of $19.70. The MetLaw Legal Plan offered by Hyatt Legal Plans, Inc., provides representation for many personal legal services for employees and their eligible dependents. Employees that do not enroll in the plan during open enrollment, will not have another opportunity to enroll in the plan until next year’s open enrollment period.
- CalPERS On-Line Video for Open Enrollment
CalPERS is offering an on-demand video as an alternative to hosting onsite open enrollment health fairs. The video, “2015 CalPERS Health Plan Rate and Benefit Changes”, will provide employees, retirees, and their dependents with an overview of the many changes beginning January 2015. The video will provide participants with 24/7 access, and the materials are available for download. CalPERS has also posted pre-recorded videos, "Presenting the 2015 CalPERS Health Plans" on its website with information presented by expert representatives from each of the CalPERS health plans. Learn about CalPERS health plan benefits from representatives of our seven providers: Anthem Blue Cross, Blue Shield of California, CVS Caremark, Health Net, Kaiser Permanente, Sharp Health Plan, and UnitedHealthcare. Please refer to CalPERS Health Program [PDF] highlights for additional information.
Benefits Information Worksheet [PDF]
HCRA/DCRA Enrollment Form [PDF]
HCRA/DCRA ASI Claim Form [PDF]
FlexCash Enrollment Form [PDF]
If you have any questions regarding Open Enrollment or Employee Benefits, please contact Human Resources at (310) 243-3771.