Who is Eligible to Enroll in a Health Plan?
Retired members or non-member payees (e.g., eligible spouses or domestic partners) who receive an ACERA monthly retirement allowance and who live within a plan’s designated service area are eligible to enroll in an ACERA-sponsored medical, dental, and/or vision plan.
Your Eligibility is Based Where You Live
Your and your dependents’ eligibility for enrollment in a medical and dental plan is affected by where you live, because ACERA’s plans may require you to live in their specific service areas. Before selecting a plan, be sure to check with the plan’s member services to confirm whether your zip code is within the appropriate service area. Contact the plan provider to ask about which zip codes fall within service areas.
ACERA Healthcare Plan Service Areas
|Healthcare Plan||Service Area|
In metro areas of California including:
See the next section below for further eligibility information for these plans.
US States other than California where Kaiser Permanente provides service
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:
Enrolling Your Dependents
If you are enrolled in an ACERA-sponsored health plan, you may also choose to cover your eligible dependents. Your eligible dependents include:
- Your legal spouse or domestic partner (see the page on Domestic Partners and Healthcare Eligibility)
- Your or your domestic partner’s children under age 26 (married or unmarried), including your:
- Biological children
- Adopted children, from the date of placement
- 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)
- 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).
Your Eligibility Under a Disability Retirement
Members who are approved for an ACERA disability retirement may be eligible for ACERA-sponsored medical, dental, and vision coverage. As explained under “Monthly Medical Allowance (MMA)”, ACERA may pay a portion of your medical insurance premium. Individuals approved for a service-connected disability retirement will receive a MMA amount equal to that paid to a retiree with 20 years of service; individuals approved for a non-service-connected disability retirement with at least 10 years of service will receive a pro-rated MMA amount, if they have less than 20 years of service.
If Your Retirement Allowance Is Less Than the Premium Costs for Your Elections
The monthly retirement allowance you receive from ACERA must adequately cover the premium costs for the group plan benefits you elect. In the event your retirement allowance is not sufficient to cover your premium costs, you may not be eligible to enroll in ACERA-sponsored coverage. (Via Benefits plans are excluded from this requirement.)
Here’s how this works:
- For currently enrolled retired members and non-member payees, making annual elections during annual Open Enrollment or due to a status change event: 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.
- For new retirees: You may not enroll in an ACERA-sponsored group health plan if your retirement allowance is less than the monthly premium for the plan you’re seeking.
- For retirees who enroll in an individual medical plan through Via Benefits: you pay premiums directly to the carrier and are reimbursed through a Health Reimbursement Account. The amount of your retirement allowance will not impact the ability to obtain coverage.