Medical

     

General Information

Must be Retired for disability or service directly from active service with either 15 years of San José service or receive allowance that is at least 37.5% of final comp. Also eligible if member separates from service after 7/5/92, but prior to retirement with 20 years of San José service and leaves contributions in the retirement plan and former member receives an allowance (i.e., applies & qualifies for retirement).

Eligible retirees have two (2) medical providers available to choose from: Kaiser Permanente and Anthem Blue Cross. Visit your health plan's website to learn how benefits, claims, and payment of claims are covered, as well as the service limitations and exclusions that may apply. Some health plans are available only in certain counties and/or ZIP Codes. Contact the health plan before enrolling to make sure they cover your ZIP Codes and that their provider network is accepting new patients in your area.

Open Enrollment is an annual process that occurs every November 1 through November 30. During this time, you can enroll or change health plans, add eligible dependents, delete dependents, or cancel coverage. Changes made during Open Enrollment become effective January 1st.

QUALIFYING LIVE EVENTS

A Qualifying Life Event (QLE) is a specific life event that allows City of San José Retirees to request their benefit elections be changed outside of the annual Open Enrollment period. Qualifying events include, but are not limited to, the events below. An INS100 form and proof of the QLE are required within 30 days from the date of the event. Benefit changes will start the first of the month following the date of the event.

See: Qualifying Life Events Reference Guide


HEALTH IN-LIEU

Retirees now have an In-Lieu credit program. If you are eligible to enroll in medical insurance, but you choose to not take the insurance through City of San José, you can enroll in the Health In-Lieu credit program. These credits accumulate in an account for you. If in the future you decide to enroll in a City of San José Retiree medical plan coverage, you can use your in-lieu credits to pay premiums.  Enrollment in the In-Lieu credit program does not carry over from year-to-year automatically.  You must re-enroll for In-Lieu every year during Open Enrollment.

RATES AND EMPLOYER CONTRIBUTIONS

Retirement System pays 100% of lowest-cost plan that is available to active City employees.  If retiree does not choose the lowest cost plan, retiree pays the difference between that premium and the premium for the lowest-cost plan. Medical Rates can be found under the Non-Medicare, Medicare, and VEBA tabs.

ABOUT OUR PLANS

HMO - A Health Maintenance Organization (HMO) plan provides health care from specific doctors and hospitals under contract with the plan. You pay co-payments for some services, but you have no deductible, no claim forms, and a geographically restricted service area.

PPO - A Preferred Provider Organization (PPO) is similar to a traditional "fee-for-service" plan, but you must use doctors in the PPO provider network or pay higher co-insurance (percentage of charges). You must usually meet an annual deductible before some benefits apply. You're responsible for a certain co-insurance amount and the medical plan pays the balance up to the allowable amount.

SPLIT PLANS - A split plan means at least one family member is enrolled in a Medicare health plan and at least one family member is enrolled in a Non-Medicare health plan through the same health carrier. All family members must have the same health carrier.

Plan Providers

Click here to visit Kaiser Permanente's website

1-800-464-4000
Group #887 (Northern CA)
Group# 230179 (Southern CA)

Kaiser NORCAL and SOCAL have service area zip code requirements:

Medicare Non-Medicare

Click here to visit Anthem's website

Anthem MEDICARE Customer Service
(833) 848-8730
Anthem MEDICARE Rx Pharmacy Customer Service
(833) 285-4630

NOTE: You can also email your question to our new Anthem Concierge Service Representative:

Tanya Astar
Email: Tanya.Astar@anthem.com
Phone: (408) 794-1044

Anthem has service area zip code requirements:

Medicare

Anthem HMO Plans are for members who reside in California.
Anthem PPO Plans are nationwide and do not require a California residence.

Click here to visit Anthem's website

Anthem NON-MEDICARE Commercial Customer Service
(844) 963-0448
Anthem Commercial NON-MEDICARE Rx Pharmacy Customer Service
(833) 261-2460

NOTE: You can also email your question to our new Anthem Concierge Service Representative:

Tanya Astar
Email: Tanya.Astar@anthem.com
Phone: (408) 794-1044

Anthem HMO Plans are for members who reside in California.
Anthem PPO Plans are nationwide and do not require a California residence.

Non-Medicare



Medical > Non Medicare > Kaiser Hawaii and Northwest




Medical > Non Medicare > Health In-Lieu


Medicare



Medical > Medicare > Kaiser Hawaii and Northwest




Medical > Medicare > Health In-Lieu


Zip Code Requirements

HMO plans are California-only plans and have zip code service area requirements. Please verify your zip code on the applicable list prior to submitting insurance enrollment forms. If your zip code is not listed, you will need to select a different plan. If you are enrolled in a split plan and have moved, please verify your new zip code on a Commercial and Medicare list. Your zip code must be on both lists to continue enrollment in your current plan.