Current through Register 2022 Notice Reg. No. 14, April 8, 2022
For the purposes of this subchapter:
(a) Terms used in this subchapter that are
defined by the Public Employees' Medical and Hospital Care Act (Title 2,
Division 5, Part 5 (commencing with Section 22750 ) of the Government Code)
shall have the meanings therein set forth.
(b) "Employing office" means any office of
the state or contracting agency to which jurisdiction and responsibility for
health benefits action for the employee concerned have been delegated. For
annuitants, whether or not the annuitant is also an employee, the Health
Benefits Division of the Public Employees' Retirement System is the employing
(c) "Payroll office" means
either the office of the State Controller for agencies participating under the
Uniform Payroll System, or the employing office for agencies not participating
under the Uniform Payroll System, irrespective of whether or not salary
warrants are issued by the State Controller.
(d) "Time." Whenever in this subchapter a
time is stated in which an act is to be done, the time is computed by excluding
the first day and including the last day. If the last day is a holiday, it is
(e) "Annuity period"
means the period for which a single installment of a retirement allowance or
annuity is customarily paid for annuitants.
(f) "Enroll" means to file with the employing
office a properly completed Health Benefits Plan Enrollment Form electing to be
enrolled in a health benefits plan.
(g) "Enrolled" means to be enrolled in a
health benefits plan approved by the Board under this subchapter.
(h) "Register not to enroll" means to file
with the employing office a properly completed Health Benefits Plan Enrollment
Form electing not to be enrolled in a health benefits plan.
(i) "Cancellation" is the act, by an enrolled
employee or annuitant who is eligible to continue enrollment, of filing a
Health Benefits Plan Enrollment Form, terminating enrollment in a health
action" is the completion or approval, by the Health Benefits Division, of a
Health Benefits Plan Enrollment Form terminating or changing the enrollment of
an employee, annuitant, or family member in accordance with the provisions of
means eligible under the law and this subchapter to be enrolled.
(l) "Retirement System" means the Public
Employees' Retirement System, the State Teachers' Retirement System, the
Legislators' Retirement System, or the Judges' Retirement System, as the case
may be, under which a retired person has acquired the status of
(m) Tenses and Number.
The present tense includes the past and future, and the future the present; the
singular includes the plural and the plural the singular.
(n) A "child," as described in Government
means an adopted, step, or recognized natural child until attainment of age 26,
unless the child is disabled as described in section 599.500, subdivision
In addition to a "child"
as described in Government Code section
"family member" also includes any child for whom the employee or annuitant has
assumed a parent-child relationship (PCR), in lieu of the relationship
described in subdivision (n), as indicated by intentional assumption of
parental status, or assumption of parental duties by the employee or annuitant,
as certified by the employee or annuitant at the time of enrollment of the
child, and annually thereafter up to the age of 26, unless the child is
disabled as described in section 599.500, subdivision (p). This section should
not be construed to include foster children.
Certification of the parent-child relationship by the
employee or annuitant under this subsection shall be provided to the employing
office and shall include:
CalPERS-issued "Affidavit of Parent-Child Relationship," Rev. June 2015, which
is hereby incorporated by reference, signed by the employee or annuitant, and
For a PCR dependent under
1. A copy of the first page of the
employee or annuitant's income tax return from the previous tax year listing
the child as a tax dependent. In lieu of a tax return, for a time not to exceed
one tax filing year, the employee or annuitant may submit other documents that
substantiate the child's financial dependence upon the employee or
For a PCR
dependent from age 19 up to age 26:
1. A copy
of the first page of the employee or annuitant's income tax return from the
previous tax year listing the child as a tax dependent; or
Documents that substantiate that the child
is financially dependent upon the employee or annuitant provided that the
a. Either lives with the employee or
annuitant for more than 50 percent of the time, or is a full-time student,
Is dependent upon the
employee or annuitant for more than 50 percent of the child's support.
If the employee or annuitant fails to provide the
employing office any of the above required documents, the child shall not be
enrolled, or if enrolled, the employee or annuitant shall be given notice that
all coverage of the child will be terminated effective as of the last day of
the month following said notice.
means a child, as described in Government Code section
section 599.500, subdivision (n) or (o), who at the time of attaining age 26,
is incapable of self-support because of a physical or mental disability which
existed continuously from a date prior to attainment of age 26 and who is
enrolled pursuant to section
(d) and (e), until termination of such incapacity.
Meanings of terms related to Medicare are
"Medicare" means the Health Insurance For The Aged
provided under Title XVIII of the Social Security Act; "Part A" means Hospital
Insurance as defined in Title XVIII of the Social Security Act; and "Part B"
means Medical Insurance as defined in Title XVIII of the Social Security
Plan" means a health benefits plan providing supplemental benefits for persons
enrolled under Medicare Parts A and B.
(s) "Health benefit(s) plan," as defined in
of the Government Code, or "plan" includes any benefit design and premium rate
structure offered by the Board to employees, annuitants, and family members
through contracts with carriers or self-funded plans administered by the Board
pursuant to Sections
of the Government Code. "Health benefit(s) plan" includes basic or supplemental
(t) "Basic Plan" means a
health benefit(s) plan providing benefits for employees, annuitants, and family
members not enrolled in a supplemental plan.
(u) "Conversion plan" means a nongroup
contract offered by the carrier as its standard individual membership
(v) "Control Period" means a
period from January 1 through June 30 or July 1 through December 31.
(w) "Alternative benefit plan" means a health
benefits plan approved, or contracted for, by the Board exclusively for
employees or annuitants of contracting agencies pursuant to Section
of the Government Code.
adjustment" means an actuarial tool used to calibrate premiums paid to health
benefits plans or carriers based on geographical differences in the cost of
health care and the relative differences in the health risk characteristics of
employees, annuitants, and family members enrolled in each plan. Risk
adjustment establishes premiums, in part, by assuming an equal distribution of
health risk among health benefits plans in order to avoid penalizing employees,
annuitants, and family members for enrolling in a health benefits plan with
higher than average health risk characteristics.
(y) "Risk assessment" means an objective
determination of whether an individual employee, annuitant, or family member or
group of employees, annuitants, and family members represents a health risk
that is reasonably close to the population average and, if not, of quantifying
the relative deviation from the average.
(z) "Risk Adjusted Premium," means the
actuarially calculated premium utilizing risk adjustment.