Getting & Managing Health Coverage

You

ACERA retirees and anyone who receives an ACERA monthly allowance can enroll in a plan, as long as the live in the plan’s service area. See below.

For the medical plans, members who are under age 65 and not yet eligible for Medicare can enroll in a non-Medicare medical plan. Members who are age 65 an older must enroll in Medicare Part B through the federal government and select an ACERA Medicare Plan to enroll in medical coverage through ACERA.

Your Dependents

If you are enrolled in an ACERA-sponsored health plan, you can choose to cover your eligible dependents. Your eligible dependents include:

• Your legal spouse or domestic partner (more info below)
• Your or your domestic partner’s children under age 26 (more info below)
• 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)

Children Under Age 26

Your or your domestic partner’s children under age 26 (married or unmarried), include your:

• Biological children
• Adopted children, from the date of placement
• Stepchildren
• 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)

Domestic Partners

Domestic partners of ACERA retirees are eligible to be enrolled in ACERA healthcare plans including medical, dental, and vision. Prior to enrollment, the retiree must complete and have on file with us an Affidavit of Domestic Partnership.

Definition of a Domestic Partnership for ACERA Healthcare Enrollment

A “domestic partnership” can exist between two persons, one of whom is a retired member of ACERA, regardless of their gender. Each of the two persons is considered the “domestic partner” of the other if they both complete, sign, date, and file with ACERA an Affidavit of Domestic Partnership where they attest to the following:

1. The two parties reside together and share the common necessities of life;
2. The two parties are not married to anyone; eighteen years or older; not related by blood closer than would bar marriage in the State of California; mentally competent to consent to contract;
3. The two parties declare that they are each other’s sole domestic partner and they are responsible for their common welfare;
4. The two parties agree to notify ACERA if there is a change of circumstances attested to in the Affidavit;
5. The two parties affirm, under penalty of perjury, that the assertions in the Affidavit are true to the best of their knowledge.

Terminating a Domestic Partnership With ACERA

A member of a Domestic Partnership may end the relationship as it concerns eligibility for enrollment in ACERA healthcare plans by filing a with ACERA, affirming under penalty of perjury that:

1. The partnership is terminated, and
2. A copy of the termination statement has been mailed to the other partner.

Filing a New Statement of Domestic Partnership After Terminating One

No person who has filed an Affidavit of Domestic Partnership may file another such Affidavit until six (6) months after a Termination of Domestic Partnership Form of the previous partnership has been on file with ACERA.

 

Plan Service Areas: Your Eligibility Is Based on Where You Live

Enrollment in an ACERA healthcare plan requires you to live in the plan service area. The general plan services areas are listed in the table below. However, before selecting a plan, be sure to contact the plan provider to confirm whether your zip code is within the plan service area.

ACERA Group Plan Service Areas 

Healthcare Plan	Service Area
Kaiser Permanente HMO Kaiser Permanente Senior Advantage (Medicare) UnitedHealthcare SignatureValue HMO UnitedHealthcare SignatureValue Advantage HMO Delta Dental DeltaCare USA	Metro areas of California including: San Francisco Bay Area Los Angeles / San Diego Area Sacramento Fresno Santa Cruz (Kaiser only)
Delta Dental PPO Vision Service Plan (VSP)	US nationwide

Individual Plan Service Areas

Service areas for individual plans differ for every plan. Enrollment in these plans is directly with the individual carrier. Refer to the Retiree Enrollment Guide for enrollment instructions.

Healthcare Plan	Service Areas Depend on Each Individual Plan
Via Benefits Non-Medicare Plans	US states other than California Non-metro areas of California See further eligibility information below.
Via Benefits Medicare Plans	US nationwide
Kaiser Permanente Plans Outside California	Kaiser Permanente sites outside California

Are You Eligible to Enroll in a Via Benefits Non-Medicare Plan?

You can participate if you meet all three criteria:

1. You’re an ACERA retiree, spouse, or surviving beneficiary receiving a monthly retirement allowance
2. You’re not eligible for Medicare (generally this means you’re under age 65)
3. 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:

• ACERA-non-medicare-group-plan-zip-codes.pdf

 

Your Retirement Allowance Must Be Greater Than the Plan Premium to Enroll in Group Plans

The monthly retirement allowance you receive from ACERA must be large enough to cover the premium costs for the group plan benefits you wish to elect or you cannot newly enroll in our group plans. This includes your dependents; if your allowance is only sufficient for you to enroll yourself and not your dependents, you cannot enroll your dependents.

Can I Enroll in a Via Benefits Individual Medical Plan if My Pension Allowance is Less Than the Plan Premium?

Yes. The amount of your pension allowance will not impact the ability to obtain coverage. You will pay premiums directly to the carrier and if you are eligible for a Monthly Medical Allowance subsidy, you will be reimbursed through a Health Reimbursement Account.

What Happens if I’m Already Enrolled in a Group Plan, and the Premium Increases to Be More Than My Pension Allowance?

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.

The monthly cost of being enrolled in a healthcare plan is called a “premium.” Premiums for medical, dental, and vision coverage are based on the plan and coverage level you select. 

Paying Group Plan Costs 

Your monthly premiums (yours and any dependents you enroll) will be deducted from your monthly retirement allowance. If you’re eligible for the Monthly Medical Allowance and dental and vision subsidies, you’ll see your subsidies added in same pension check. When you seek services or purchase prescription drugs, you will be responsible for paying copays out of pocket.

Paying Individual Plan Costs

You will make payments directly to your insurance carrier. To set up an automatic monthly payment for the plan directly to the insurance carrier from your bank account, simply call Via Benefits at 1-888-427-8730 even if you’re in a non-California Kaiser Permanente medical plan. If you are eligible for ACERA’s Monthly Medical Allowance, ACERA will fund a tax-free Health Reimbursement Account up to the amount you are eligible for. You can also set up an automatic reimbursement to your bank account.

For more information on receiving reimbursements, read the Making Your Via Benefits Reimbursements Easier Flyer.