Medical

     

General Information

You must be Retired for disability or service with 15 years of service or receive an allowance that is at least 37.5% of final compensation. (“Deferred vested” members are eligible.)

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 > Rates




Medical > Non Medicare > Anthem




Medical > Non Medicare > Kaiser California




Medical > Non Medicare > Kaiser Hawaii and Northwest




Medical > Non Medicare > Health In-Lieu


Medicare



Medical > Medicare > Rates




Medical > Medicare > Medicare Transition




Medical > Medicare > Anthem




Medical > Medicare > Kaiser California




Medical > Medicare > Kaiser Hawaii and Northwest




Medical > Medicare > Health In-Lieu


VEBA

A VEBA is a defined contribution health reimbursement arrangement plan for retiree healthcare expenses. Employees at the City of San José will be placed into the VEBA if they are in Federated Tier 2B or Police and Fire Tier 2.

INFORMATION FOR RETIRED VEBA MEMBERS

If you have retired from the City of San José or separated from City Service and reached retirement age (Age 50 for Police & Fire, 55 for Federated), you can find more information about using your VEBA: Click Here

WHAT EXPENSES ARE REIMBURSABLE UNDER THE VEBA?

This flyer contains the eligible expenses: Click Here

For additional information about VEBA benefits: Click Here.


CONTACT INFORMATION

Human Resources
Phone: (408) 535-8322
Email: veba@sanjoseca.gov



Medical > VEBA


Medical > VEBA > Rates