Health Plan Options
ACERA offers a range of healthcare plan options to ACERA retirees, dependents, and survivors who are receiving a monthly pension benefit from ACERA. Members can enroll family members in coverage. Members who qualify can receive subsidies to offset health plan costs (though not for family members). The plans available, their coverage levels and costs, are subject to change from year-to-year. A summary list of plans and costs is below. Find the full plan details in the Retiree Enrollment Guide.
Medical Plans
2024 Non-Medicare Plans and Costs
Available to members who are not yet eligible for Medicare (generally, those under age 65)
| Plan | Self Premium | Self + 1 | Family | Co-pays |
|---|---|---|---|---|
| Kaiser Permanente HMO | $1,037.76 | $2,075.52 | $2,936.90 | $15 |
| UnitedHealthcare SignatureValue HMO | $1,464.90 | $2,929.64 | $4,145.40 | $15 |
| UnitedHealthcare SignatureValue Advantage HMO | $957.68 | $1,915.18 | $2,709.92 | $15 |
| Via Benefits individual plan if you live outside group plan service areas | Varies | Varies | Varies | Varies |
2024 Medicare Plans and Costs
Available to members who are eligible for Medicare (generally those over age 65 or with certain qualifying medical conditions)
| Plan | Self Premium |
Self + 1 2 w/ Medicare |
Self + 1 1 w/ Medicare |
Family 2 w/ Medicare |
Family 1 w/ Medicare |
|---|---|---|---|---|---|
| Kaiser Permanente HMO | $354.31 | $708.62 | $1392.07 | $1570.00 | $2253.45 |
| Via Benefits individual plan if you live outside group plan service areas | Varies | Varies | Varies | Varies | Varies |
To enroll in an ACERA-sponsored Medicare plan, you must first sign up for and maintain enrollment in Medicare Parts A and B. Members who qualify can receive a Medicare Part B Reimbursement to offset the cost of being enrolled in Medicare Part B. See the Medicare and ACERA page for more information on how ACERA plans work with Medicare.
Dental and Vision Plans
ACERA’s dental and vision plans provide participants with access to coverage through a nationwide network of providers. Monthly premiums are subsidized and enrollment is mandatory for retirees who have:
- 10+ years of ACERA service credit
- Service-connected disability
- Non-service-connected disability retirement prior to 2/1/2014
Retired members with less than 10 years of ACERA service credit and other payees may enroll in a voluntary plan which offers the same coverage, but no subsidy is available.
Reciprocal Service Doesn’t Count Toward the Service Credit Requirement for the Dental and Vision Subsidy
When planning your retirement, it’s important to understand that reciprocal service credit does not count toward the service credit required to be eligible for the dental and vision subsidies or any of the healthcare benefits. Reciprocal service credit is service credit you earned working for another public agency in California before or after your active membership with ACERA, and where you’ve linked the retirement systems together by establishing reciprocity. Service credit you earned in another retirement system could possibly be used to establish healthcare benefits with that system; contact that other retirement system to learn about what healthcare benefits they offer.
2024 Dental Plans and Costs
- DeltaCare USA HMO Plan Summary
- Delta Dental PPO Plan Summary
- Delta Dental Dual Coverage Flyer
- How to Get a Pre-Estimate for the Cost of a Dental Procedure
10+ Years ACERA Service Credit or 2 & 3 Above
Mandatory Enrollment
| Plan | Self Premium / Subsidy | Self + 1 | Family |
|---|---|---|---|
| Delta Dental PPO (Nationwide) |
$51.05 Subsidy |
$99.02 |
$174.43 |
| DeltaCare USA (CA Only) |
$22.18 Subsidy |
$36.64 | $54.13 |
Less Than 10 Years ACERA Service Credit
Voluntary Enrollment
| Plan | Self Premium | Self + 1 | Family |
|---|---|---|---|
| Delta Dental PPO (Nationwide) |
$74.60 |
$121.82 |
$195.94 |
| DeltaCare USA (CA Only) | $31.05 | $45.51 | $63.00 |
2024 Vision Plans and Costs
10+ Years ACERA Service Credit or 2 & 3 Above
Enrollment is mandatory for the VSP Standard plan at minimum. Members can buy up into the VSP Premium plan, but the subsidy will remain at $4.63, so premium plan enrollees pay the difference between their premium and the subsidy.
| Plan | Self Premium | Self + 1 | Family |
|---|---|---|---|
| VSP Standard |
$4.63 Subsidy |
$6.73 |
$12.08 |
| VSP Premium |
$16.63 |
$24.15 |
$43.36 |
Less Than 10 Years ACERA Service Credit
Voluntary Enrollment
| Plan | Self Premium | Self + 1 | Family |
|---|---|---|---|
| VSP Standard |
$6.69 |
$9.70 |
$17.42 |
| VSP Premium |
$18.43 |
$26.77 |
$48.07 |
Medical Subsidies: Monthly Medical Allowance (MMA)
The Monthly Medical Allowance (MMA) helps eligible retirees offset their monthly medical costs for enrollment in ACERA-sponsored medical plans (costs for outside plans are not covered). The MMA is a non-vested (non-guaranteed) benefit subject to available funds. Benefit levels are determined annually by the Board of Retirement.
Reciprocal Service Doesn’t Count Toward the Service Credit Requirement for the Monthly Medical Allowance
When planning your retirement, it’s important to understand that reciprocal service credit does not count toward the service credit required to be eligible for the Monthly Medical Allowance or any of the healthcare benefits. Reciprocal service credit is service credit you earned working for another public agency in California before or after your active membership with ACERA, and where you’ve linked the retirement systems together by establishing reciprocity. Service credit you earned in another retirement system could possibly be used to establish healthcare benefits with that system; contact that other retirement system to learn about what healthcare benefits they offer.
Who is Eligible?
- ACERA retirees with 10+ years ACERA service credit (receive MMA based on years of service credit)
- Service-connected disability retirees (receive full MMA)
Who is Not Eligible?
- Retirees with less than 10 years of ACERA service (except service-connected disability retirees)
- Spouses and dependents
- Non-member payees (i.e., survivors, former spouses)
ACERA retirees are responsible for 100% of the costs to cover these individuals.
Group Plans MMA
For Plans
- Kaiser Permanente HMO in California
- Kaiser Permanente Senior Advantage in California (Medicare)
- UnitedHealthcare SignatureValue HMO
- UnitedHealthcare SignatureValue Advantage HMO
MMA Will Cover
- Monthly premiums
| Years of ACERA Service | Portion of MMA | 2024 MMA Amount |
|---|---|---|
| < 10 years | No MMA | $0 |
| 10+ years | 1/2 | $317.69 |
| 15+ years | 3/4 | $476.53 |
|
20+ years or service-connected disability retirement |
Full | $635.37 |
More Info
The maximum MMA amount is limited to your self-only medical premium or the highest allowable benefit under the MMA, whichever is lower. Plan premium costs exceeding the MMA contribution are deducted from your monthly retirement allowance. Premiums for your dependents are also deducted from your monthly retirement allowance.
Individual Plans Non-Medicare MMA
For Plans
- Via Benefits Individual Non-Medicare Plans
- Kaiser Permanente Non-Medicare Plans Outside California
MMA Will Cover
- Monthly premiums
- Copays
- Deductibles
| Years of ACERA Service | Portion of MMA | 2024 MMA Amount |
|---|---|---|
| < 10 years | No MMA | $0 |
| 10+ years | 1/2 | $317.69 |
| 15+ years | 3/4 | $476.53 |
|
20+ years or service-connected disability retirement |
Full | $635.37 |
More Info
Your MMA can be used to pay your self-only monthly medical plan premiums as well as medical or prescription copays and deductibles (our plan excludes other IRS Code Section 213(d) reimbursement expenses). You will need to submit those claims to Via Benefits for reimbursement (including Kaiser members). ACERA will fund a tax-free Health Reimbursement Account (HRA) up to the amount you are eligible for, and Via Benefits will reimburse you for expenses out of your HRA. You set up an automatic reimbursement to your bank account.
For more information on receiving reimbursements, read the Making Your Via Benefits Reimbursements Easier Flyer.
Unused MMA amounts at the year’s end do not carry over into the new plan year, and do go back into ACERA’s reserve funds.
An Alternative to the MMA for Via Benefits Plans: A Federal Subsidy
When you call Via Benefits to explore enrolling in a non-Medicare eligible plan, your Benefit Advisor can help you choose between utilizing ACERA’s MMA to offset your medical plan costs (if you’re eligible), or selecting a public healthIndividual Plans Non-Medicare MMAcare plan and utilizing the federal government’s healthcare subsidy (tax credit) to offset the costs of your plan. The level of subsidy you could be eligible for is based on your level of income. You can’t receive both an MMA from ACERA and a federal subsidy
Individual Plans Medicare MMA
For Plans
- Via Benefits Medicare Plans
- Kaiser Permanente Senior Advantage Medicare plans outside California
MMA Will Cover
- Monthly premiums
- Copays
- Deductibles
| Years of ACERA Service | Portion of MMA | 2024 MMA Amount |
|---|---|---|
| < 10 years | No MMA | $0 |
| 10-14 years | 1/2 | $243.37 |
| 15-19 years | 3/4 | $365.06 |
|
20+ years or service-connected disability retirement |
Full | $486.74 |
More Info
MMA Will Also Cover
- IRMAA – Additional Medicare Part B costs paid to Medicare above the Lowest Standard Premium
Other Info
Monthly premiums for individual Medicare plans are lower than group plan premiums, so the MMA amounts are accordingly lower.
Your MMA can be used to pay your self-only monthly medical plan premiums as well as medical or prescription copays and deductibles (our plan excludes other IRS Code Section 213(d) reimbursement expenses). You will need to submit those claims to Via Benefits for reimbursement (including Kaiser members). ACERA will fund a tax-free Health Reimbursement Account (HRA) up to the amount you are eligible for, and Via Benefits will reimburse you for expenses out of your HRA. You set up an automatic reimbursement to your bank account.
For more information on receiving reimbursements, read the Making Your Via Benefits Medicare Reimbursements Easier flyer.
Unused MMA amounts at the year’s end do not carry over into the new plan year, and do go back into ACERA’s reserve funds.
Who Can Enroll in Healthcare Plans?
You
ACERA retirees and anyone who receives an ACERA monthly allowance can enroll in a plan, as long as the live in the plan’s service area. See below.
Your Dependents
If you are enrolled in an ACERA-sponsored health plan, you can choose to cover your eligible dependents. Your eligible dependents include:
- Your legal spouse or domestic partner (more info below)
- Your or your domestic partner’s children under age 26 (more info below)
- Your or your domestic partner’s child(ren) over age 26 who are incapable of supporting themselves due to a mental or physical handicap incurred prior to age 26 (must provide proof of child’s incapacity prior to age 26)
Children Under Age 26
Your or your domestic partner’s children under age 26 (married or unmarried), include your:
- Biological children
- Adopted children, from the date of placement
- Stepchildren
- Dependents under a legal guardianship/conservatorship
- Dependents for whom plan coverage has been court-ordered through a Qualified Medical Child Support Order (QMCSO) or through a National Medical Child Support Notice (NMCSN)
Domestic Partners
Domestic partners of ACERA retirees are eligible to be enrolled in ACERA healthcare plans including medical, dental, and vision. Prior to enrollment, the retiree must complete and have on file with us an Affidavit of Domestic Partnership.
Definition of a Domestic Partnership for ACERA Healthcare Enrollment
A “domestic partnership” can exist between two persons, one of whom is a retired member of ACERA, regardless of their gender. Each of the two persons is considered the “domestic partner” of the other if they both complete, sign, date, and file with ACERA an Affidavit of Domestic Partnership where they attest to the following:
- The two parties reside together and share the common necessities of life;
- The two parties are not married to anyone; eighteen years or older; not related by blood closer than would bar marriage in the State of California; mentally competent to consent to contract;
- The two parties declare that they are each other’s sole domestic partner and they are responsible for their common welfare;
- The two parties agree to notify ACERA if there is a change of circumstances attested to in the Affidavit;
- The two parties affirm, under penalty of perjury, that the assertions in the Affidavit are true to the best of their knowledge.
Terminating a Domestic Partnership With ACERA
A member of a Domestic Partnership may end the relationship as it concerns eligibility for enrollment in ACERA healthcare plans by filing a with ACERA, affirming under penalty of perjury that:
- The partnership is terminated, and
- A copy of the termination statement has been mailed to the other partner.
Filing a New Statement of Domestic Partnership After Terminating One
No person who has filed an Affidavit of Domestic Partnership may file another such Affidavit until six (6) months after a Termination of Domestic Partnership Form of the previous partnership has been on file with ACERA.
Plan Service Areas: Your Eligibility Is Based on Where You Live
Enrollment in an ACERA healthcare plan requires you to live in the plan service area. The general plan services areas are listed in the table below. However, before selecting a plan, be sure to contact the plan provider to confirm whether your zip code is within the plan service area.
ACERA Group Plan Service Areas
|
Healthcare Plan |
Service Area |
|---|---|
|
Metro areas of California including:
|
|
US nationwide |
Individual Plan Service Areas
Service areas for individual plans differ for every plan. Enrollment in these plans is directly with the individual carrier. Refer to the Retiree Enrollment Guide for enrollment instructions.
| Healthcare Plan | Service Areas Depend on Each Individual Plan |
|---|---|
|
See further eligibility information below. |
|
US nationwide |
|
Kaiser Permanente sites outside California |
Are You Eligible to Enroll in a Via Benefits Non-Medicare Plan?
You can participate if you meet all three criteria:
- You’re an ACERA retiree, spouse, or surviving beneficiary receiving a monthly retirement allowance
- You’re not eligible for Medicare (generally this means you’re under age 65)
- You live outside of California or in parts of non-metro California outside the service areas for our group medical plans. More specifically, you do not live in one of the zip codes in this PDF list:
Your Retirement Allowance Must Be Greater Than the Plan Premium to Enroll in Group Plans
The monthly retirement allowance you receive from ACERA must be large enough to cover the premium costs for the group plan benefits you wish to elect or you cannot newly enroll in our group plans. This includes your dependents; if your allowance is only sufficient for you to enroll yourself and not your dependents, you cannot enroll your dependents.
Can I Enroll in a Via Benefits Individual Medical Plan if My Pension Allowance is Less Than the Plan Premium?
Yes. The amount of your pension allowance will not impact the ability to obtain coverage. You will pay premiums directly to the carrier and if you are eligible for a Monthly Medical Allowance subsidy, you will be reimbursed through a Health Reimbursement Account.
What Happens if I’m Already Enrolled in a Group Plan, and the Premium Increases to Be More Than My Pension Allowance?
You may continue coverage. However, at the time your premium exceeds your income, you are required to submit payment for the entire premium cost each month to ACERA. Contact us for more information.
When Can You Enroll in or Change Health Plans?
Times when you can enroll in or make changes to your medical, dental, and vision coverage elections fall into 3 categories:
1. Enrolling at Retirement
At retirement, you may choose to continue your medical plan coverage through an ACERA-sponsored plan. You can cover yourself and your eligible dependents, if they were covered under a medical plan prior to your retirement date. You must make this election within 30 days of your retirement date. If you decline coverage, you cannot enroll in an ACERA-Sponsored plan until open enrollment. Enrollment forms for medical, dental, and vision coverage are included in your retirement application package.
A retirement specialist will review your options with you prior to retirement during your ready-to-retire counseling session. If you’re not going to attend a counseling session, you can call ACERA and ask for the healthcare unit for help with enrollment.
2. Enrolling During Open Enrollment
Open Enrollment is your annual opportunity to consider your benefit needs and options and to make changes, if needed. You can change plans and add or drop coverage for you and/or your eligible dependents.
Open Enrollment Periods and Plan Years
| Healthcare Plans | Open Enrollment Period | Plan Year |
|---|---|---|
|
Nov 1 – Nov 30 | The following Feb 1 – Jan 31 |
|
Nov 1 – Dec 15 | The following Jan 1 – Dec 31 |
|
Oct 15 – Dec 7 | The following Jan 1 – Dec 31 |
3. Enrolling or Making Plan Changes Outside of Open Enrollment
In general, you cannot change your benefit elections or add dependent coverage outside of ACERA’s annual open enrollment period, unless you experience a status change event or special enrollment event.
Status Change Events (Qualifying Events)
- Marriage or divorce, or commencement or termination of a domestic partnership (Affidavit of Domestic Partnership required)
- Birth or adoption of a child
- Death of a dependent
- Loss of a child’s eligibility for dependent coverage (e.g., child marries or reaches the maximum age for coverage)
- Need to cover a child due to a Qualified Medical Child Support Order (QMCSO)
- Change in retiree/spouse/dependent’s employment status, work schedule, or residence that affects their eligibility for benefits (e.g., moving your residence outside of your medical plan’s service area)
- Entitlement or loss of entitlement to Medicare or Medi‑Cal/Medicaid or SCHIP coverage (you have 60 days to make a change with this one)
- Certain changes in the cost of coverage, composition of coverage or curtailment of coverage of the retiree or spouse’s plan
- Changes consistent with special enrollment rights and FMLA leaves
You need to notify ACERA in writing within 30 days of a status change event. ACERA will determine if your change request is permitted. If so, changes become effective on the first day of the month following the event date.
Cancelling Coverage
You may cancel medical plan coverage at any time during the year, for any reason. Plan coverage is cancelled automatically if you or your enrolled dependents no longer meet the plan’s enrollment eligibility criteria. If coverage is cancelled, you will be allowed to continue coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). If you cancel your medical plan coverage, you cannot re-enroll yourself or your eligible dependents in an ACERA-sponsored plan until the next open enrollment period.
Requesting Cancellation of Coverage
You need to request your coverage cancellation in writing to ACERA. Your written request should specify which plan you want to cancel and for whom you are cancelling coverage (i.e., yourself and/or your dependents). Typically, the effective date of cancellation is on the first of the month following ACERA’s receipt of your written cancellation request. However, if ACERA receives the request after its monthly payroll close date, cancellation will be effective the second month following your written notification. There is no retroactive cancellation of coverage.
How Do You Pay for Your Health Plan?
The monthly cost of being enrolled in a healthcare plan is called a “premium.” Premiums for medical, dental, and vision coverage are based on the plan and coverage level you select.
Paying Group Plan Costs
Your monthly premiums (yours and any dependents you enroll) will be deducted from your monthly retirement allowance. If you’re eligible for the Monthly Medical Allowance and dental and vision subsidies, you’ll see your subsidies added in same pension check. When you seek services or purchase prescription drugs, you will be responsible for paying copays out of pocket.
Paying Individual Plan Costs
You will make payments directly to your insurance carrier. To set up an automatic monthly payment for the plan directly to the insurance carrier from your bank account, simply call Via Benefits at 1-888-427-8730 even if you’re in a non-California Kaiser Permanente medical plan. If you are eligible for ACERA’s Monthly Medical Allowance, ACERA will fund a tax-free Health Reimbursement Account up to the amount you are eligible for. You can also set up an automatic reimbursement to your bank account.
For more information on receiving reimbursements, read the Making Your Via Benefits Reimbursements Easier Flyer.
How to Enroll in Healthcare Plans
Enrollment instructions start on page 4 of our Retiree Enrollment Guide.
Enrollment Forms
Avoid paper, ink, scanning, and hassle with DocuSign E-Forms.
PDF forms require Adobe Acrobat Reader (free).
| Form | DocuSign E-Form | Manual PDF Form | Notes | |
|---|---|---|---|---|
|
Medical Plan Enrollment Form |
DocuSign | Optional. If you’d like to enroll in an ACERA group medical plan | ||
| Kaiser Permanente Senior Advantage Enrollment Form | DocuSign | Optional. If you’re Medicare-eligible and are enrolling in the Kaiser Permanente Senior Advantage Plan, you must fill this out in addition to the Medical Enrollment Form. | ||
|
Dental Plan Enrollment Form |
DocuSign |
Optional: Less than 10 years ACERA service credit Mandatory: 10+ years ACERA service credit, but there is no cost for member’s monthly premium |
||
|
Vision Plan Enrollment Form |
DocuSign |
Optional: Less than 10 years ACERA service credit Mandatory: 10+ years ACERA service credit, but there is no cost for member’s monthly premium |
||
| Medicare Part B Reimbursement Plan (MBRP) Application Form | DocuSign |
Optional. With 10+ years of ACERA service credit or a service-connected disability retirement, get reimbursed for the federal cost of Medicare Part B. More info on the MBRP page. Before you start, have a scan or photo of your Medicare card available showing your Medicare Part B effective date to upload with the form. |
||
| Affidavit of Dependent Eligibility | DocuSign | Optional. Mandatory if you are electing coverage for your children (or other non-spouse dependents) age 19 through 25 or children age 26 and older if incapable of supporting themselves due to a mental or physical disability incurred prior to age 26 | ||
| Affidavit of Domestic Partnership | Optional. Mandatory if you are electing healthcare coverage for a domestic partner. Since this requires notarization, you can’t submit it through DocuSign. Follow the instructions below to submit your form. | |||
Cancelling Coverage
You may cancel medical plan coverage at any time during the year, for any reason. If you cancel your medical plan coverage, you cannot re-enroll yourself or your eligible dependents in an ACERA-sponsored plan until the next open enrollment period.
Requesting Cancellation of Coverage
You need to request your coverage cancellation in writing to ACERA. Your written request should specify which plan you want to cancel and for whom you are cancelling coverage (i.e., yourself and/or your dependents). Typically, the effective date of cancellation is on the first of the month following ACERA’s receipt of your written cancellation request. However, if ACERA receives the request after its monthly payroll close date, cancellation will be effective the second month following your written notification. There is no retroactive cancellation of coverage.
Plan coverage is cancelled automatically if you or your enrolled dependents no longer meet the plan’s enrollment eligibility criteria. If coverage is cancelled, you will be allowed to continue coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
Open Enrollment for 2024 Plan Year
Open Enrollment is retirees’ annual opportunity to consider their benefit needs and options and to make changes, if needed. You can change plans and add or drop coverage for you and/or your eligible dependents.
How to Enroll During Open Enrollment
Enrollment instructions start on page 4 of our Retiree Enrollment Guide.
For our group plan enrollment forms, ACERA accepts faxes of completed enrollment forms faxed to 510-268-9574. We also accept scanned copies of completed enrollment forms emailed to info@acera.org. Enrollment forms submitted by DocuSign, email, or fax must be time stamped by 11:59 pm PST on November 30, 2023. Mailed enrollment forms must be postmarked by November 30, 2023. Enrollment forms are below.
If you’re enrolling in an individual plan through Via Benefits, you must conclude your enrollment with Via Benefits by the dates specified in the chart below. You must contact Via Benefits by phone or through the Via Benefits website. Instructions for enrollment through Via Benefits can be found in the Retiree Enrollment Guide linked below.
Open Enrollment Periods and Plan Years
| Healthcare Plans | Open Enrollment Period | Plan Year |
|---|---|---|
|
Nov 1 – Nov 30 | The following Feb 1 – Jan 31 |
|
Nov 1 – Dec 15 | The following Jan 1 – Dec 31 |
|
Oct 15 – Dec 7 | The following Jan 1 – Dec 31 |
Open Enrollment 2024 Packet
(Mailed in October 2023)
All retirees and payees receive a paper packet in the mail in mid-October. Here’s the electronic packet:
Making Your Via Benefits Reimbursements Easier flyer
Getting Your Affairs In Order Flyer
2023 Virtual Health Fair Flyer
Virtual Retiree Health Fair Website
Kaiser Permanente Silver&Fit Flyer
Delta Dental PPO Plan Description Flyer
Medicare Part D Creditable Coverage Notice (mailed separately to some enrollees)
Healthcare Plan Summary Flyers
- DeltaCare USA HMO Plan Summary
- Delta Dental PPO Plan Summary
- Delta Dental Dual Coverage Flyer
- VSP Vision Plans Summary
Group Plan Enrollment Forms
Avoid paper, ink, scanning, and hassle with DocuSign E-Forms.
PDF forms require Adobe Acrobat Reader (free).
| Form | DocuSign E-Form | Manual PDF Form | Notes | |
|---|---|---|---|---|
|
Medical Plan Enrollment Form |
DocuSign | Optional. If you’d like to enroll in an ACERA group medical plan | ||
| Kaiser Permanente Senior Advantage Enrollment Form | DocuSign |
Optional. If you’re Medicare-eligible and are enrolling in the Kaiser Permanente Senior Advantage Plan, you must fill this out in addition to the Medical Enrollment Form. IMPORTANT IF USING DOCUSIGN: Upon receipt, ACERA will submit this form to Kaiser on your behalf. Kaiser will call you to confirm your electronic signature on this form. YOU MUST ANSWER THIS CALL. If you do not answer Kaiser’s call, you will have 7 days to return Kaiser’s Medicare Team’s call to confirm your requested enrollment. Kaiser’s Medicare Team can be reached at 877-251-1532. TAKE NOTE: If you delay in responding to Kaiser’s Medicare Team, your effective date of insurance on ACERA’s Kaiser Senior Advantage Group Plan may be impacted. |
||
|
Dental Plan Enrollment Form |
DocuSign |
Optional: Less than 10 years ACERA service credit Mandatory: 10+ years ACERA service credit, but there is no cost for member’s monthly premium |
||
|
Vision Plan Enrollment Form |
DocuSign |
Optional: Less than 10 years ACERA service credit Mandatory: 10+ years ACERA service credit, but there is no cost for member’s monthly premium |
||
| Medicare Part B Reimbursement Plan (MBRP) Application Form | DocuSign |
Optional. With 10+ years of ACERA service credit or a service-connected disability retirement, get reimbursed for the federal cost of Medicare Part B. More info on the MBRP page. Before you start, have a scan or photo of your Medicare card available showing your Medicare Part B effective date to upload with the form. |
||
| Affidavit of Dependent Eligibility | DocuSign | Optional. Mandatory if you are electing coverage for your children (or other non-spouse dependents) age 19 through 25 or children age 26 and older if incapable of supporting themselves due to a mental or physical disability incurred prior to age 26 | ||
| Affidavit of Domestic Partnership | Optional. Mandatory if you are electing healthcare coverage for a domestic partner. Since this requires notarization, you can’t submit it through DocuSign. Follow the instructions below to submit your form. | |||
Health Plan Contact Information
|
1-800-464-4000 |
|
|
1-800-464-4000 |
|
|
for Kaiser Permanente Senior Advantage members
|
1-877-427-4788 (TTY/TDD 711) |
|
Call your local Kaiser |
|
|
1-800-624-8822 |
|
|
1-866-633-2474 |
|
|
1-844-353-0770 |
|
|
1-888-427-8730 |
|
|
1-800-422-4234 |
|
|
1-888-335-8227 |
|
|
1-800-877-7195 |
|
| Other Contact Info | |
| Medicare | 1-800-633-4227 |
| Social Security Administration | 1-800-772-1213 |
| ACRE | 510-350-0649 |
| REAC | Email contact form |
| PERS – Long Term Care | 1-800-982-1775 |
| Deferred Compensation | 1-855-969-4572 |
