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 www.calpers.ca.gov. 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
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,
and suppliers of prescription drugs – not from members using more services
Conﬁrm your eligibility or the new federal health care law.
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 www.calpers.ca.gov to
• Excluding non-formulary brand help you decide which health plan is right for you.
prescription co-pays from the
• 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
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
• Increasing non-preferred brand
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 http://my.calpers.ca.gov. 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 http://my.calpers.ca.gov.
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 www.calpers.ca.gov, better than – Medicare Part D.
or request a printed copy using the
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 www.calpers.ca.gov.
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) www.calpers.ca.gov