More in Eligibility & Enrollment

Enroll Family Members

If you choose to enroll your family members in the CalPERS Health Program, you may select one of the following:

  • Self and one eligible family member
  • Self and two or more eligible family members*

*Once you've added two or more family members, additional dependents will not change your premium amount.

You can add the following family members at the time of your enrollment, during the annual Open Enrollment, or with a qualifying event:

  • Children age 18 or older
  • Dependents in military, when they return to civilian life
  • Eligible children who are not in your custody
  • Spouse or registered domestic partner not living in your home

You also have the option to enroll only yourself, regardless of the status of your marriage or registered domestic partnership.

Spouses

To add your spouse or registered domestic partner to your health plan, you must:

  • Add them within 60 days after the date of your marriage or registration of your domestic partnership.
  • Provide a copy of your marriage certificate or Declaration of Domestic Partnership.
  • Provide your spouse's or domestic partner's Social Security number.

Former spouses and domestic partners are not eligible.

Children

Your children, adopted children, stepchildren, or domestic partner's children who are under age 26 may be added to your health plan regardless of whether they live with you.

Another person's child under age 26 may be eligible for coverage if a parent-child relationship exists. An Affidavit of Parent-Child Relationship (PDF) must be filed prior to enrollment and be updated upon request.

Disabled Dependents

For a child to be eligible as a disabled dependent, the child must be 26 years old or older, and the following must be true:

  • The child is incapable of self-support because of a mental or physical condition.
  • The disability existed prior to reaching age 26 and continuously since age 26, as certified by a licensed physician.

Step 1 – Know When to Enroll

The initial certification of the disabled dependent must occur during one of the two eligibility periods:

  • For an enrolled dependent, within 90 days before and ending 60 days after the child’s 26th birthday.
  • For an unenrolled dependent age 26 or over, within 60 days of your initial enrollment in the CalPERS Health Program.

Step 2 – Complete the Forms

If you have a disabled child who is nearing age 26 or is 26 and over and is incapable of self-support, then you are responsible for:

  1. Confirming your dependent’s eligibility
  2. Requesting the initial or continued enrollment of your dependent as a disabled dependent

Follow the instructions on the Disabled Dependent Member Questionnaire and Medical Report Form (HBD-34) (PDF) and the Authorization to Disclose Protected Health Information Form (PDF).

Step 3 – Get Certified

Initial Certification

  • The dependent’s physician specializing in their disability must complete and submit the HBD-34 to us for review within the dependent’s initial certification timeframes.
  • Once we certify eligibility and enrollment, we’ll mail you and your employer a notification with the certification period.

Recertification

  • Upon the certification period expiration date, you’re required to submit an updated HBD-34 to recertify your disabled dependent if they remain incapable of self-support.
  • We must receive the HBD-34 by the expiration date, but no earlier than 90 days before.
  • If we don’t receive the HBD-34 on time, the dependent will be deleted, and they won’t be eligible for future reinstatement.

Lapse in Coverage

  • California Code of Regulations 599.501(e) states that a disabled dependent’s enrollment in a CalPERS health and/or dental benefits must be continuous once they attain age 26 if they remain incapable of self-support because of a physical or mental disability.
  • If a disabled dependent over the age of 26 is removed from CalPERS health and/or dental benefits for any reason, the removal is permanent, and they are not eligible for future reinstatement.

Split Enrollments

You and your spouse or registered domestic partner can enroll in the CalPERS Health Program separately if you both work, or worked, for agencies in the CalPERS Health Program.

If you choose to enroll separately, one parent must carry all dependents on one health plan. Dependents cannot be split between parents. For example, if a CalPERS member with children marries another CalPERS member with children and each member has their own enrollment in the CalPERS Health Program, then all children must be enrolled under one parent.

If split enrollments are discovered, they will be retroactively corrected. You will be responsible for any costs incurred from the date the split enrollment began.

Dual Coverage

You cannot be enrolled in a CalPERS health plan as both a member and a dependent or as a dependent on two enrollments. This is called dual coverage and it is against the law. When dual coverage is discovered, the coverage will be retroactively canceled. You may have to pay for costs incurred from the date the dual coverage began.

Family Changes

Divorce

When you divorce or terminate a registered domestic partnership:

  • A copy of the final divorce decree or Notice of Termination of Domestic Partnership is required when you delete a former spouse or registered domestic partner from your health plan.
  • Coverage ends at midnight on the last day of the month that the marriage dissolution is final.
  • Your former spouse or registered domestic partner is no longer eligible to receive CalPERS health benefits under your coverage.

Former spouses may be eligible for coverage under COBRA or an individual conversion policy. Active members must submit a copy of their final divorce decree or Notice of Termination of Domestic Partnership to their personnel office. Retired members must submit the copy to CalPERS by contacting us.

Learn how divorce can impact your CalPERS benefits.

Newborn or Newly Adopted Child

Newborn children should be added within 60 days of birth. Coverage is effective from the date of birth.

Newly adopted children should be added within 60 days of physical custody. Coverage is effective from the date physical custody is obtained.

Know what details to take care of with a Birth or Adoption.

Death

Death of CalPERS Member

In the event of a member's death, report this information to the member's employer. If the member was retired, contact us at 888 CalPERS (or 888-225-7377).

Surviving family members may be eligible for health coverage as long as they:

  • Continue to qualify as eligible family members
  • Qualify for a monthly survivor check from CalPERS
  • Were enrolled or were eligible to enroll as dependents at the time of the member's death
Active State Employees

Upon the death of an active state employee, the law requires their employer to continue to pay contributions for the enrolled survivor's health coverage for up to 120 days after their death.

This law applies to participating bargaining units. Contact the California Department of Human Resources (CalHR) for participating bargaining units and instructions. If you find you are no longer eligible for the CalPERS Health Program, you may be eligible for COBRA.

Death of a Dependent

If you lost a family member who is a dependent under your health plan, notify your employer as soon as possible. If you are retired, call us at 888 CalPERS (or 888-225-7377).

Learn what additional steps to take in the event of a death.