CalPERS 2011 Open Enrollment News by hishamcamille


									                                     Open Enrollment News

Open Enrollment begins               Welcome to Open Enrollment News
September 13, 2010,                  This newsletter provides you with information about Health Open Enrollment,
                                     including highlights for 2011 and resources to help you choose the plan that’s
and ends October 8, 2010
                                     right for you.
                                          If you have Internet access, be sure to visit the Open Enrollment Center on
                                     the home page of CalPERS On-Line at The Open Enrollment
                                     Center includes “Quick Links” to Health Program publications, health plan rates
Open Enrollment Checklist            and information, and other online resources.

  Learn about changes
  for 2011

  Review your current health
  plan and benefits                   2011 Health Program Highlights
                                     Health premiums next year will increase by an average of 9.1 percent. This
  Assess your medical and
                                     increase mainly reflects higher costs charged by hospitals, medical providers,
  pharmacy needs
                                     and suppliers of prescription drugs – not from members using more services
  Confirm your eligibility            or the new federal health care law.
  ZIP Code
                                          The 2011 rates provide several benefit modifications designed to
  Consider your health plan          promote more appropriate use of medical products and services, such as
  choices for 2011                   encouraging the use of over-the-counter (OTC) alternatives to prescription
  Select a health plan that          drugs and establishing a 50 percent co-insurance for discretionary drugs used
  best meets your needs              to treat sexual dysfunction. Tip: If you are on a non-formulary drug, ask your
  Update your address and            doctor about changing to a generic or formulary medication, or OTC option.
  phone number with CalPERS          For a list of formulary medications, please contact your health plan.
  and your employer                       Following are general health plan and benefit highlights for 2011. For
                                     additional changes specific to your plan, refer to the Evidence of Coverage
                                     (EOC) booklet available on the plan’s website or CalPERS On-Line at

                                     Blue Shield Access+/NetValue (Basic)       Blue Shield NetValue (Basic & Medicare)
                                     •   Adding a $250 co-pay for use of        •   Offering coverage to Santa Cruz and
Important! Look inside this packet       an outpatient hospital instead of          Santa Clara counties, and expanding
for an insert about the extension        an ambulatory surgery center for           access in San Mateo County
of dependent coverage for children       gastrointestinal endoscopy, spinal
up to age 26.                            injections, and cataract surgery
                                                                                                 Continued on next page
2011 Health Program Highlights            Choosing the Right Health Plan
Continued from front page                 Selecting a health plan for yourself and your family is one of the most
                                          important decisions you make. We understand that comparing health
    Blue Shield Access+/NetValue          plan benefits, features, and costs can be complicated. That’s why we
    (Basic & Medicare)                    offer several resources on CalPERS On-Line at to
•     Excluding non-formulary brand       help you decide which health plan is right for you.
      prescription co-pays from the
      out-of-pocket maximum
•     Increasing non-formulary brand
      waiver co-pay                       •   2010 Member Rating Information:
                                              Tells you how other CalPERS members
    Blue Shield 65 Plus (Medicare)            rate the health plans and gives you
•     Expanding coverage in San               tips to guide you in making other
      Bernardino and Riverside counties       important decisions, such as choosing
                                              a doctor.
    Kaiser Permanente (Medicare)
•     Increasing co-pays for more
      than a 30-day supply of
      prescription drugs                  •   2011 Health Benefit Summary:
                                              Provides valuable information to help               2011 Health Benefit Summary
                                                                                                  Helping you make an informed choice
    PERS Select (Basic)                       you make an informed choice about                   about your health plan

•     Increasing co-insurance for             your health plan; compares benefits,
      hospitals not in the PERS Select        covered services, and co-payment
      Hospital Network                        information for all CalPERS health
                                              plans. If you do not have Internet
    PERS Select/Choice/Care (Basic)           access, you may request a printed
•     Encouraging use of high-quality,        copy by completing and returning the
      cost-effective hospitals for hip        enclosed postage-paid postcard.
      and knee replacements
•     Adding a $250 per-admission
      co-pay for bariatric surgeries
      not performed at Centers of         •   Health Plan Chooser: Lets you           •   Health Plan Search by ZIP Code:
      Medical Excellence                      weigh the benefits and costs for             Identifies which plans are available
                                              each plan, search for specific               in your area. Just enter the ZIP Code
    PERS Select/Choice/Care                   doctors, and view overall plan              for your residential or work address,
    (Basic & Medicare)                        satisfaction ratings.                       select your Member Category, and
•     Excluding non-preferred brand                                                       then “Search” to view your results.
      prescription co-pays from the
      out-of-pocket maximum
•     Increasing non-preferred brand
      waiver co-pay
Enrolling in a Plan                                                                                      Changing Your Plan
                                                              Health Program Guide
The Health Program Guide describes                            An informational guide to your
                                                                                                         Here’s how you can change your
                                                              CalPERS health benefits
Basic and Medicare health plan                                Information as of August 2010
                                                                                                         health plan during Open Enrollment.
                                                              for plan years effective January 1, 2011

eligibility, enrollment, and choices.                                                                       Active Employees – Contact
You can obtain this publication online.                                                                  your Health Benefits Officer or
If you do not have Internet access,                                                                      Personnel Office for required forms
you may request a printed copy via                                                                       and documentation.
the enclosed postcard.                                                                                      Retirees – If you have Internet
   If you are an active employee or                                                                      access, you can change your
a working CalPERS retiree, you may                                                                       health plan online during Open
enroll in a health plan using either                                                                     Enrollment through my|CalPERS
your residential or work ZIP Code.                  You cannot use the address of the                    at If
The exception to this rule is if you are            employer from which you retired to                   you prefer, you may write to us at
enrolling in a Medicare Advantage                   establish ZIP Code eligibility.                      P.O. Box 942714, Sacramento, CA
plan, you must use your residential                                                                      95229-2714, or call us toll-free at
address and ZIP Code. (You cannot                   Tip: Contact the plan before enrolling to            888 CalPERS (or 888-225-7377) to
use a P.O. Box to establish eligibility.)           make sure it covers your ZIP Code and                make a change to your health plan.
Whether you use your residential or                 that the provider network is accepting
work ZIP Code to establish eligibility,             new patients in your area.
all enrolled dependents must receive
all covered services (except emergency
and urgent care) within the health
plan’s service area, even if they do                my|CalPERS: Easy, Fast & Secure
not live or work in that service area.              View your current plan and family members enrolled in your plan, search for
   If you are a retired CalPERS                     health plans, access CalPERS Health Program forms, order Health Program
member, you may select any plan                     publications, and more through my|CalPERS at
in your residential ZIP Code area.

                                                    Medicare Enrollment Guide                            Medicare Part D
         Medicare Enrollment Guide                  The CalPERS Medicare Enrollment                      If you enroll in a Medicare Part D
         A practical guide to understanding how
         CalPERS and Medicare work together
                                                    Guide provides information about how                 plan outside of CalPERS, you will
         Information as of August 2010
         for plan years effective January 1, 2011

                                                    Medicare works with your CalPERS                     lose your CalPERS health coverage.
                                                    health benefits, including when you need              For most members, your CalPERS
                                                    to enroll in a CalPERS Medicare health               health plan provides prescription
                                                    plan. You can find this publication on                coverage that is as good as – or
                                                    CalPERS On-Line at,               better than – Medicare Part D.
                                                    or request a printed copy using the
                                                    enclosed postcard.
Health Care Reform: Near-term Impacts

The Patient Protection and Affordable Care Act, as amended by the Health
Care and Education Affordability Reconciliation Act of 2010, expands health
coverage for various groups and provides mechanisms to lower costs and
increase benefits for Americans with health insurance. Some measures of
the law go into effect earlier than others, as outlined below.

Extension of Coverage                         Early Retiree Reinsurance Program       Social Security Numbers
for Children Until Age 26                     The Early Retiree Reinsurance Program   Existing federal regulations require
Under federal law, provisions relating        temporarily reimburses participating    CalPERS and our health plans to
to extension of coverage for children         employment-based plans for a portion    report the Social Security numbers
are effective for plan years on or after      of the cost of health care for early    for our members and their dependents.
September 23, 2010. For CalPERS,              retirees age 55 and older who are       The federal government uses the
the new plan year is January 1, 2011.         not eligible for Medicare, and their    Social Security number for various
Children of CalPERS health benefit             spouses, surviving spouses, and         purposes, such as verifying eligibility
subscribers, whether previously on their      dependents. The purpose of the          for subsidies and reimbursements.
parent’s plan or not, are eligible for        reimbursement is to make health         By providing your employer or CalPERS
health coverage up to age 26. They            benefits more affordable by lowering     Social Security numbers for your
are eligible even if they are married,        premiums or reducing costs for plan     dependents, you can help CalPERS
do not live with their parent, or are         participants.                           maximize the federal funding available
not students. For additional details,             The Early Retiree Reinsurance       to help offset program costs.
please refer to the insert included           program has specific requirements
with this newsletter.                         on how the sponsor, CalPERS, must
                                              use the proceeds under this program.
Lifetime and Annual Limits                    As the plan sponsor, CalPERS submit-
Beginning, January 1, 2011, plans             ted an application to HHS on behalf         Questions
will be prohibited from imposing life-        of the State and contracting public         For up-to-date information
time limits on the value of benefits           agencies under the Public Employees’        about CalPERS and Health
for participants or beneficiaries.             Medical and Hospital Care Act.              Care Reform, please refer to
CalPERS will remove lifetime limits           CalPERS will collect the reimburse-         the Health Care Reform page
beginning in 2011.                            ment monies and use funds received          on CalPERS On-Line at
   Historically, CalPERS plans have           through the program to reduce health
had annual limits on certain services.        care premiums beginning in 2011.
As federal regulations establish
standards relating to annual limits,
CalPERS may need to modify benefits

CalPERS Health Benefits Program P.O. Box 942714, Sacramento, CA 94229-2714
888 CalPERS (or 888-225-7377)

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