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.

How to Enroll During Open Enrollment

Enrollment instructions start on page 4 of our Retiree Enrollment Guide.

Retiree Enrollment Guide

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. Emailed and faxed enrollment forms must be time stamped by 11:59 pm PST on November 30, 2019. Mailed enrollment forms must be postmarked by November 30, 2019. Enrollment forms are below.

If you’re enrolling in a 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
Kaiser Permanente HMO California Kaiser Permanente Senior Advantage California (Medicare) UnitedHealthcare SignatureValue HMO UnitedHealthcare SignatureValue Advantage HMO Delta Dental Vision Service Plan (VSP)	Nov 1 – Nov 30	The following Feb 1 – Jan 31
Via Benefits Non-Medicare Plans	Nov 1 – Dec 15	The following Jan 1 – Dec 31
Via Benefits Medicare Plans	Oct 15 – Dec 7	The following Jan 1 – Dec 31

 

Open Enrollment 2020 Packet

All retirees and payees receive a packet in the mail in mid-October.

Packet Materials

2020 Retiree Enrollment Guide

Open Enrollment Letter

Making Your Via Benefits Reimbursements Easier

2019 Health Fair Pamphlet

Kaiser Permanente Flyer - Get More From Your Health Plan

VSP Flyer - What Do Your Eyes Say About You?

Delta Dental Flyer - Preventing Gum Disease May Reduce Alzheimer’s Risk

Group Plan Enrollment Forms

Medical Plan Enrollment Form

Dental Plan Enrollment Form

Vision Plan Enrollment Form

KPSA Form

Other Relevant Forms

Affidavit of Dependent Eligibility

Affidavit of Domestic Partnership

Medicare Part B Reimbursement Plan (MBRP) Application Form

Medicare Part D Creditable Coverage Notice

Medicare Part D Creditable Coverage Notice