More information on benefits, refer to
2023 Active Employees’ Medical & Dental Plan Rates
2023 CalPERS Employees Medical/Dental
2023 Retirees/Survivors medical/dental
View the Kaiser 2019 Sample Fee List (PDF) for the High Deductible Health Plan
If adding dependents, provide copy of marriage certificate (spouse), birth certificate (children/stepchildren/domestic partner children), certificate of domestic partnership (domestic partner). Please note domestic partner has to be covered in the plan in order to include domestic partner’s children. You must also enter the social security number for each dependent you are adding to the plan.
Review qualifying events (PDF) and supporting documentation requirements for adding and deleting dependents from medical and/or dental plan during the plan year.
Additional Information from Health Plan Carriers
- Summaries of Benefits
- Instructions to Upload Evidence of Coverage (PDF) from Health Net website.
- Health Net Medical Loss Ratio (PDF)
- Delta Dental PPO
- DeltaCare USA HMO
- Annual Notice from Delta Dental (PDF)
Optional Change Form
Life Insurance Beneficiary Form (PDF)
More info on Deferred Compensation. Includes information on enrolling in Deferred Compensation and Special Benefit. Please note that you must submit three forms to enroll in the plan which are included on the webpage.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce and, other life events.
Portability of Health Coverage (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) provides rights and protections for participants and beneficiaries in group health plans. HIPAA includes protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. HIPAA may also give you a right to purchase individual coverage if you have no group health plan coverage available, and have exhausted COBRA or other continuation coverage
The annual open enrollment period allows you to make changes to your health and dental coverage, and to add or to delete dependents without a qualifying event.