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CalPERS Open Enrollment runs Sept. 14 to Oct. 9

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CalPERS mailed out Health Plan Statements in August to help members review the increases or decreases in their providers 2016 rates and determine whether they want to make changes.

The biggest change for many state retirees in 2016 will be the new Medicare Advantage Plan, which was adopted by the CalPERS Board of Administration in an effort to improve member health and wellness, while lowering the costs of member health care.

Medicare eligible members will be able to choose from:

UnitedHealthcare (UHC) Group Medicare Advantage Preferred Provider Organization (PPO) Plan
Kaiser Permanente Senior Advantage Health Maintenance Organization (HMO) Plan
PERSCare, PERS Choice and PERS Select Supplement to Medicare PPO health plans

     After Dec. 31, 2015, the following plans will no longer be available: Anthem Blue Cross HMO plans; Blue Shield of California HMO plans; Blue Shield of California plans; Blue Shield of California EPO plan; Health Net HMO plan; and Sharp HMO plan.

            If you are in one of the plans that will no longer be available and you don’t choose another available plan, CalPERS will automatically enroll you in the UnitedHealthcare Group Medicare Advantage PPO plan, effective Jan. 1, 2016. In most cases, the change will be seamless and members who switch over will be able to keep their same doctors.

There are about 1,500 CalPERS members who have participants in Medicare and Basic Health plan coverage and reside outside of UHC’s basic health plan zip code area. They will be enrolled in PERS Choice, effective Jan. 1, 2016, unless they select one of the other plans available to them.

 CalPERS says the primary benefit of the UHC Group Medicare Advantage PPO plan is that plan members will continue to receive care – at the same benefit level – from any willing Medicare provider. It covers Medicare Parts A, B, and D, and will cover members in all 58 California counties and in all states and U.S. territories.

Although members living out of state who are enrolled in PPO and Kaiser Medicare plans are not affected by this change, they may find the UHC offering attractive because of its extensive nationwide coverage. Any member who thinks the UHC Group Medicare Advantage PPO plan is a better option can choose to leave those plans and enroll in the UHC plan during the Open Enrollment period.

CalPERS' decision to adopt UHC's PPO could save a minimum of $24 million if at least 40,000 members move into this new Medicare plan option.

"The UnitedHealthcare plan is a very good option for our members," said Priya Mathur, chair of the CalPERS Pension & Health Benefits Committee. "The primary benefit is that the UHC plan is a Medicare Advantage plan - rather than a Medicare Supplemental Plan - so members are relieved of co-insurances and can receive care from any provider who accepts Medicare. This proposal also includes Silver Sneakers, an exercise program specifically targeted at older adults to help keep our members healthy."

Mathur added that retired members have been requesting wellness programs like Silver Sneakers, which can lead to lower health care costs in the long run.


     The dental and vision programs for state retirees, which have the same open enrollment dates of Sept. 14-Oct.9, are administered by the California Department of Human Resources (CalHR). For additional information about these programs, contact CalHR at (916) 322-0300 or online at www.calhr.ca.gov

New for 2016, state retirees will be able to choose between two vision plans. California State Retirees is responsible for establishing both the Basic Vision Plan in 2007 and the Premier Vision Plan, which becomes available Jan. 1, 2016. The premier plan offers several upgrades, including a $200 annual allowance for a wide selection of frames or contact lenses.

CalPERS is projected to spend $8 billion in 2015 to purchase health benefits for 1.4 million active and retired state, local government, and school employees and their families.

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