2023 NonPERS Retiree/Survivor Open Enrollment

October 17, 2022 through November 4, 2022

 
 Plan changes are effective
          January 1, 2023
 
 
Open Enrollment is the time to:
 

  • make benefit plan changes for County health and County dental;
  • add or delete dependents.

 
 *Note: If no changes are being made for the medical and dental plans, you do not need to return the enrollment form. You will continue to keep your current health and dental plan for the 2023 plan year. Please refer to 2023 rate table for changes in the health and dental plan premiums.
 
 Questions can be directed to
 (925) 655-2100 or
 email:  benefits@hrd.cccounty.us


   


 Quick links:
 

Optional Plans:
 CalPERS Long Term Care


 

Retiree/Survivor Open Enrollment Guide and Rates

 

The Retiree/Survivor Open Enrollment guide is provided to assist you in your decision process regarding your benefits. The guide includes description of benefits, eligibility requirements, comparison guide for the health and dental plans, CHIP notice and a certificate of creditable coverage to keep for your records. Please click on the link below to review the guide: 

2023 Medical and Dental Rates
 
Please use the 
2023 RATE TABLE link to access information on medical and dental plan rates.
 
 2022 Benefit Statements, 2023 rates and enrollment forms were mailed to all Retiree/Survivor for review of present benefits. Information was mailed to the address on record on September 1, 2022.  Please contact our office if you have an address change.

 


Adding Adult Children

 

MEDICAL
 Age Limit: 26
 Requirements:
 Include original certified birth certificate with open enrollment form.
 
 Reminder: Be sure to provide Social Security Number on the enrollment form.
 
Medicare Supplemental/Coordinated Health Plans
Age Limit: 19 - 24
 Requirements:
Must be a) full-time student, b) receive more than one-half of support from employee and c) unmarried. Include original
certified birth certificate with enrollment form and Dependent Verification Form (PDF).
   
 Reminder: Be sure to provide Social Security Number on the enrollment form. 
 

DENTAL (DeltaCare PMI)
 Age Limit: 26

Requirements:  Include original certified birth certificate with open enrollment form.
 
 Reminder: Be sure to provide Social Security Number on the enrollment form.
 
DENTAL (Delta Premier)
 Age Limit: 19 - 24

Requirements: Must be a) full-time student, b) receive more than one-half of support from employee and c) unmarried. Include original certified birth certificate with open enrollment form and Dependent Verification Form (PDF)
  
 Reminder: Be sure to provide Social Security Number on the enrollment form.

 


Adding Domestic Partners

Please read the following Domestic Partner Information to see what the requirements and documentations are to add a domestic partner to your health and/or dental benefits.
 
 Be sure to include the following forms with your Open Enrollment application.

 
Declaration of Domestic Partner Form (PDF)

 

IRC Section 152 Form (PDF)
  
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