Eligibility & Enrollment (Active Member)

Permanent-intermittent state employees are eligible for health benefits after working 480 hours during one of two control periods:

• January 1 through June 30 (effective enrollment date of August 1)
• July 1 through December 31 (effective enrollment date of February 1)

You cannot attain eligibility in the middle of a control period, even if you met the minimum hours at the beginning of the period. To become eligible, you must receive credit for a minimum of 480 paid hours at the end of a control period.

To continue your eligibility, you must either:

• Be credited with at least 480 paid hours at the end of each control period
• Have at least 960 hours in two consecutive control periods (current and prior)

June 30 and December 31 are the checkpoints we use to determine whether you've satisfied the hour requirements.

To be eligible to enroll, you must:

• Have an appointment that is six months or greater
• Work at least half time

Check with your personnel office for more information.

• Temporary Leave
• Military Duty
• Leaving Your Job

If your employer contracts for the CalPERS Health Program, you may be eligible to enroll in or continue health coverage into retirement if you:

• Retire within 120 days of your separation date with your employer
• Receive a monthly retirement allowance
• Are eligible for health enrollment on the date of your separation

If you don't want your health insurance to continue into retirement, check the appropriate box on your retirement application indicating you do not want health benefits in retirement. You may also visit your personnel office prior to retirement and request to cancel your health insurance.

A special enrollment period (SEP) is a 60-day period for members to notify CalPERS of a specific qualifying event.

• New enrollment due to loss of other coverage
• Adding a dependent due to marriage, birth, adoption, or placement for adoption
• Loss of coverage

With your employer’s approval, you can submit many health enrollment changes online through your myCalPERS account. Visit Online Health Enrollment for Active Members for more information.

We’re committed to ensuring that health care is equitable and individualized for all members, regardless of race, ethnicity, language, sexual orientation or gender identity. By completing your Health Demographic Profile in myCalPERS, you’re helping us to better understand our members and work towards better health outcomes for all.

2024 Open Enrollment ended October 11. Changes made during 2024 Open Enrollment will take effect January 1, 2025.

Access your health information year-round, including Open Enrollment updates, by logging in to myCalPERS, or learn more by visiting our Using myCalPERS page.

You can enroll yourself and eligible family members in a CalPERS health plan before the next Open Enrollment when you experience certain life events.

Special enrollment opportunities are available for:

• An eligible spouse, domestic partner, or minor child requiring health coverage because of a court order
• New children by birth or adoption, or placement of adoption
• New family members due to marriage or domestic partnership registration
• Those whose health plan was canceled due to an involuntary loss of coverage (you must provide proof your coverage ended)

You must submit your request within 60 days following the life event.

For more information about special enrollment opportunities, read the Health Program Guide (HBD 120) (PDF).

If you decline or cancel enrollment for yourself or your dependents and do not qualify for special enrollment, you or your dependents will have limited opportunities to enroll in the future. You may enroll during the next CalPERS Open Enrollment or at any time with within a 90-day waiting period. The earliest effective date of enrollment will be the first of the month following the 90-day waiting period or the January 1 after Open Enrollment.

• Where can I find more information regarding the 2025 PPO changes and continuity of care?
  • You can find more information by visiting the 2025 PPO Administrators webpage.
• Do I need to take any action during Open Enrollment if I want to remain in my current plan?
  • If you wish to remain enrolled in your current plan, there’s no need to take action during Open Enrollment. If you are currently enrolled in a plan that will no longer be available in 2025, you should select a new plan during Open Enrollment otherwise you will automatically be enrolled in a comparable plan.
• I’m currently in a Basic plan and turning 65, do I need to change plans or enroll in a Medicare plan?

  • If you are 65 or older, retired, and eligible for premium-free Medicare Part A in your own right or through the work history of a current, former, or deceased spouse, you must enroll in a CalPERS Medicare health plan. You must also enroll and pay for Medicare Part B. At this time, you’ll have the option to choose a new health plan. If you do not choose one, CalPERS will enroll you in your current health carrier’s Medicare plan or one that is available to you if your current health carrier does not offer a CalPERS-sponsored Medicare health plan. A few months prior to your 65th birthday, you'll receive notifications about the transition. You can also choose to switch plans during Open Enrollment.

    If you are still working and have employer group health coverage, you may defer your enrollment in Medicare Part B. You must provide proof of your active employer group health plan to CalPERS to maintain your Basic health plan coverage.

• What happens when my dependent turns 26 and is no longer eligible for coverage under my health plan?
  • When your dependent turns 26, they will age out of your health plan. A few months prior to your dependent’s 26th birthday, you will receive mailed notifications regarding this transition, and your dependent will be offered COBRA coverage, allowing them to temporarily continue their health insurance. Be sure to regularly check your mailbox and your myCalPERS account for important notifications and instructions on how to proceed with COBRA coverage. For more information, visit the Eligibility & Enrollment for Active Members and Eligibility & Enrollment for Retirees webpages.
• If I give birth outside of the Open Enrollment period, does that qualify me to change my health plan or just add the baby to my existing plan?
  • Giving birth outside of the Open Enrollment period qualifies as a special enrollment event, allowing you to add your baby (or other dependents) to your existing plan. This also applies to other qualifying life events such as marriage, adoption, or placement for adoption. However, it does not allow you to change your health plan outside of Open Enrollment. For more details on special enrollment opportunities and qualifying events, visit the Eligibility & Enrollment for Active Members and Eligibility & Enrollment for Retirees webpages.
• Do PERS Gold and PERS Platinum have different provider networks, even though they are both administered by Blue Shield?
  • Yes, PERS Gold and PERS Platinum have different provider networks, even though they are both administered by Blue Shield. PERS Platinum offers a larger and broader network, while PERS Gold has a more narrow network. To find out if your doctors are in-network, you can log in to your myCalPERS account and use the Search Health Plans tool to shop and compare health plans, review monthly premiums, and search for your doctors, specialists, and medical groups. For more information, visit the 2025 PPO Administrators for Basic Plan Members webpage.
• If my child is away at college, what healthcare options do they have?
  • Certain plans such as Blue Shield Access +, Blue Shield Trio, Anthem HMO (Traditional and Select), Kaiser, and PERS Platinum offer options for members that are traveling or temporarily away from their service area. Some of these programs may allow your child to see a primary care doctor in their area. Emergency and urgent care services are covered regardless of the health plan. For specific details on coverage and available providers while your child is away from home, check with your health plan directly.
• What are the differences between Medicare Advantage plans and Medicare supplemental plans, and how can I determine which one is better for me?
  • These plan types have differences in service areas and out-of-pocket cost sharing. Our CalPERS Medicare Enrollment Guide (PDF) provides details on the differences between these plan types starting on page 11. Our CalPERS 2025 Health Benefit Summary (PDF) can help you compare plans to determine which one best suits your needs.
• Where can I find more information regarding Online Health Enrollments?
  • Active members, visit the Online Health Enrollment for Active Members webpage to learn more about how to make changes through your myCalPERS account. If you’re retired, visit the Online Health Enrollment for Retirees webpage.