2017 Contra Costa County Open Enrollment

October 10, 2016 through October 28, 2016

Plan Changes are effective on January 1, 2017

**NEW FOR 2017**
Voluntary Vision Plan and Kaiser HDHP Health Savings Account
Voluntary Vision Plan and Health Savings Account Enrollment Form

Open enrollment is the time to:
NOTE: If no changes are being made for the health 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 2017 plan year.  Please refer to 2017 rate table for changes in the health and dental plan premiums.

Quick Links:
2017 Open Enrollment Guide
2017 Health and Dental Rates
2017 Active Health & Dental Comparison Guide
Contra Costa County Health Plans Summary of Benefits

For complete information about negotiated benefits, please see your applicable Memorandum of Understanding or Management Resolution.

2016 Benefit Statements, 2017 rates and enrollment forms were mailed to all County employees to the address on record as of September 1, 2016.  Benefit Statements include information on record as of September 1, 2016.

If you would like to make a plan change for 2017, please be sure Employee Benefits Service Unit receives your completed original enrollment forms no later than 5:00 PM on October 28, 2016 to the address below:

                        Employee Benefits Services Unit 
                        651 Pine Street, 5th Floor 
                        Martinez, CA 94553 
                        TEL: (925) 335-1746
                        FAX: (925) 335-1798
                        Email:  Benefits@hrd.cccounty.us

Flex Spending Accounts

Per IRS regulation, you must re-enroll in the Health Care Spending Account (HCSA) and/or Dependent Care Assistance Program (DCAP) each Plan Year.
In order to enroll in either HCSA or DCAP, you are required to submit the election form no later than 5:00 p.m. on October 28, 2016 to the Employee Benefits Services Unit.
Only original forms will be accepted do not fax or email.

Health Care Spending Account (HCSA): 
*Max 2017 annual contribution $2,550
HCSA Handbook
2017 Enrollment Form 

Dependent Care Assistance Program (DCAP)
*Max 2017 annual contribution $5,000
DCAP Handbook
2017 Enrollment Form 
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In accordance with IRS Code, Section 125, the Contra Costa County Premium Conversion Plan (PCP) allows eligible employees to authorize a salary reduction for payment of monthly medical and dental plan premiums. The PCP does not defer taxes to a later date; it exempts your medical and dental plan contributions from Federal, State, and Social Security (FICA) taxes. You may participate in the PCP if you are enrolled in a County sponsored medical and/or dental plan and pay for coverage through payroll. 

2017 PCP Election Form
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Age Limit: 26
Requirements: Include original certified birth certificate and dependent verification form with open enrollment form.

Reminder: Be sure to provide Social Security Number on the open enrollment form.

Dependent Verification form

Age Limit: 26
Requirements: Include original certified birth certificate and dependent verification form with open enrollment form.


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.

Reminder: Be sure to provide Social Security Number on the open enrollment form.

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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 Partners application
Imputed Income IRC Section 152 Form 
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Life Insurance

Life and Accidental Death & Dismemberment (AD&D) Insurance Enrollment Open Enrollment Form - Special Enrollment for 2017

Evidence of Insurability Instructions

Evidence of Insurability Form
  • must be completed if employee is requesting coverage amount greater than Guranteed Issue (GI) Limit of $100,000
  • must be completed if requesting coverage for dependents

Supplemental Life Insurance Plan Booklet

Monthly Premium Rate sheet