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.

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 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
  • 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 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:

2024 Retiree Enrollment Guide

2024 Open Enrollment Letter

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

VSP Plan Summary Flyer

Medicare Part D Creditable Coverage Notice (mailed separately to some enrollees)

Healthcare Plan Summary Flyers

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 PDF Optional. If you’d like to enroll in an ACERA group medical plan
Kaiser Permanente Senior Advantage Enrollment Form DocuSign PDF

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 PDF

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 PDF

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 PDF

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 PDF 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   PDF 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.