2017 Retiree/Survivor County Open Enrollment

November 7, 2016 through November 23, 2016
 
Plan changes are effective
         January 1, 2017

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 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.

Questions can be directed to
(925) 335-1746 or
email:  benefits@hrd.cccounty.us

      
    Quick links:

All completed original enrollment forms must be received by Employee Benefits Services Unit no later than 5:00 PM on November 23, 2016. Enrollment forms can be mailed or delivered to the following address:

Employee Benefits Services Unit
651 Pine Street, 5th Floor
Martinez, CA 94553

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: 
 
Revised Retiree/Survivor Open Enrollment Guide **Revised page 24 11/14/16**
 

2017 Health and Dental Rates
Please use the 2017 RATE TABLE link to access information on health and dental plan rates.

2016 Benefit Statements, 2017 rates and enrollment forms were mailed to all Retiree/Survivor for review of present benefits. Information was mailed to the address on record on November 1, 2016.  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.
 
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.

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.

Information regarding Domestic Partners
Declaration of Domestic Partners application


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