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Human Resources Benefit Information and Forms
About Our Plans
- HMO - A Health Maintenance Organization (HMO) plan provides health care from specific doctors and hospitals under contract with the plan. You pay co-payments for some services, but you have no deductible, no claim forms, and a geographically restricted service area.
- PPO - A Preferred Provider Organization (PPO) is similar to a traditional "fee-for-service" plan, but you must use doctors in the PPO provider network or pay higher co-insurance (percentage of charges). You must usually meet an annual deductible before some benefits apply. You’re responsible for a certain co-insurance amount and the plan pays the balance up to the allowable amount.
- Combination Plans - A combination plan means at least one family member is enrolled in a Medicare health plan and at least one family member is enrolled in a Basic health plan through the same health carrier. CalPERS requires all family members to have the same health carrier.
Open Enrollment is here!
September 19 - October 14, 2022.
Changes made during 2022 Open Enrollment will take effect January 1, 2023.
2023 Open Enrollment
2023 Benefits
2023 Open Enrollment Forms
- 2023 CalPERS Health Benefits Enrollment Form (HBD12)
- 2023 Cafeteria Plan Option Packet
- 2023 Vision Service Plan (VSP) Enrollment Form
- 2023 Delta Dental Enrollment Form
Flexible Spending Account (FSA)
- 2023 Flexible Spending Account (FSA) Online Enrollment Instructions
- P&A GROUP FSA HEALTH
- P&A GROUP FSA Dependent Care Assistance Account
- P&A GROUP FSA Transit Reimbursement
- P&A GROUP FSA Parking Reimbursement
FSA Tools
2022 Benefits
Access your health information year-round, including Open Enrollment updates, by logging into my|CalPERS, or learn more by visiting Using my|CalPERS page.
2023 SUMMARY OF BENEFITS AND COVERAGE
What the Plan covers and what you will pay for covered services
HMO Medical Plans
Anthem California Public Employees' Retirement System Medical Plans
SUMMARY OF BENEFITS AND COVERAGE:
- 2023 Select HMO Plan CalPERS
- 2023 Traditional HMO Plan for CalPERS
- 2022 Select HMO Plan CalPERS
- 2022 Traditional HMO Plan for CalPERS
CalPERS HMO Members Anthem Blue Cross Customer Service
1-855-839-4524
TDD: 1-818-234-3547
www.anthem.com
Blue Shield Access HMO
SUMMARY OF BENEFITS AND COVERAGE:
Health Net of CA
SUMMARY OF BENEFITS AND COVERAGE:
Member Services:
General benefit questions or issues.
1-888-926-4921
711 (TTY)
www.healthnet.com
Kaiser Permanente
SUMMARY OF BENEFITS AND COVERAGE:
Member Services:
(800) 464-4000
www.kp.org
Western Health Advantage
SUMMARY OF BENEFITS AND COVERAGE:
Member Services:
(888) 942-7377
For TDD/TYY: 888.877.5378
www.westernhealth.com/calpers
PPO Medical Plans
Anthem California Public Employees' Retirement System Medical Plans
PERS GOLD
SUMMARY OF BENEFITS AND COVERAGE:
PERS PLATINUM
SUMMARY OF BENEFITS AND COVERAGE:
PORAC (PEACE OFFICERS RESEARCH ASSOCIATION OF CALIFORNIA)
SUMMARY OF BENEFITS AND COVERAGE:
- 2023 PORAC Prudent Buyer PPO Plan - Peace Officers Only
2022 PORAC Prudent Buyer PPO Plan - Peace Officers Only
CalPERS PPO Members Anthem Blue Cross Customer Service
1-877-737-7776
Outside the continental US: 1-818-234-5141
TDD: 1-818-234-5141
Member Services:
(800) 288-6928
www.anthem.com
Dental and Vision
Employee Assistance Program (EAP)
We are excited to introduce Anthem EAP as our new Employee Assistance Program (EAP) partner
EAP Benefit Highlights
Starting November 1, 2021, these services through Anthem will be available to eligible employees, dependents, and members of your household:
- Non-Sworn: Five (5) short-term counseling sessions per problem per year.
- Sworn Employees will be entitled to twelve (12) short-term counseling sessions per problem per year
- Counseling is available in-person, by telephone, or online via Anthem’s tele-health solution LiveHealth Online and are available to you and your eligible dependents
- Legal: Free 30 minute consultation with a lawyer for a variety of legal concerns such as real estate issues or wills. If the lawyer is retained, you can get 25% discount off rates
- Financial: Receive unlimited telephone consultation for financial concerns such as budgeting, bankruptcy, or retirement planning
- Child/Elder care resources and referrals: Resource information on day care, preparing for college or retirement
- Anthem EAP Informational Flier
- General (Full-Time Permanent Employees) EAP
- Fire Department (Local 188 & RFMA) and Sworn Police Officers EAP
Family and Medical Leave Act (FMLA)
- FMLA Handbook
- Request for FMLA Form
- FMLA: Certification of Health Care Provider for California Family Rights Act (CFRA)
Long-Term Care
Long-Term Disability Insurance
Flexible Spending Account (FSA)
www.padmin.com
FSA BROCHURE
2020 Eligible Dependent Defined
Health Care Expense account cannot exceed $2,850 per plan year
2020 Health Extended Eligibility List
Letter of Medical Necessity Form
The following are just some expenses you can pay with your health care FSA:
- Chiropractic treatment
- Contact lenses and saline solution
- Dental work and orthodontia
- Eye exams and eyeglasses
- Hearing aids
- Health plan copays
- Laboratory fees
- Mental health counseling
- Over-the-counter items
- Prescriptions
- and more
Dependent Care Account Limit Single $5,000 per plan year
Save money on child and Elder Daycare expenses. Eligible dependent expenses of a qualifying child, under 13 years of age or relative, as define in Internal Revenue Code Section 152.
- Before/After School Programs
- Child Daycare
- Elder Daycare
- Preschool
- Summer Day Camp
Parking Benefit Account cannot exceed $280 per month
Commuter Parking Account is a pre-tax benefit account used to pay for parking as part of your daily commute to work. It's a great way to put extra money in your pocket each month and make your commute more convenient and affordable.
- Account Claim Form Account Mobile Features
- Account Online Access Instructions
- Dependent Care Documentation Form
- Extensive Health FSA Eligibility Expense List
- Letter of Medical Necessity Form
- Online Claims Process
- Request Additional Debit Card
- Transportation Parking Claim Form
LegalShield
- Legal Aid Summary Sheet
- LegalShield Overview (Legal Services) - Video
- IDShield Overview (Identity Theft Services) - Video
The Standard Insurance
CalPERS Health Plans
The City of Richmond is committed to providing a rich benefit package for their employees. For information on our plans, please refer to the links below. Additional questions can be directed to our main line at 510-620-6602.
Additional Resources and Information:
- CalPERS Health Program Guide
- CalPERS Health Benefit Summary
- Delta Dental Benefit Summary
- Delta Dental SmileWay Wellness Benefits
- VSP Vision Benefit Summary
- The Standard - Group Additional Life Insurance
CalPERS 2023 Evidence of Coverage and Disclosure Forms:
Anthem Blue Cross Select HMO
Anthem Blue Cross Traditional HMO
Blue Shield of California Access +HMO Basic Plan
Health Net of California SmartCare HMO
Kaiser Permanente HMO
PORAC PPO
PERS Gold PPO
PERS Platinum PPO
Western Health Advantage HMO