Category: 01 – Health Benefits

IMPORTANT: If you are planning to opt out of coverage with SISC using the Declination of Coverage for Retiree Form

Dear Colleagues,
There is a form included in the mailed enrollment packets from the District called the “Declination of Coverage for Retirees”. It is intended to be used by retirees who wish to opt out of coverage through SISC. We have reviewed the wording on the form with our attorney and there is a concern about the impact this waiver of coverage form may have on the ability of retirees to regain coverage through VCCCD in the future should the District move away from SISC.

Due to these concerns about the wording of this form and on the advice of our attorney, we strongly suggest that you consider NOT filling out and submitting the Declination of Coverage for Retirees form until our attorney is able to get clarification about the intent of the form. She is consulting the District’s attorney today, Monday October 16.

Please understand that it is your decision as to whether or not to continue receiving health insurance benefits through the VCCCD and we are not suggesting that you continue coverage if it is your intent to opt out. The deadline to enroll in or opt out of coverage remains the same, November 1, 2023. If it is your intent to opt out of coverage, you must still do so by that date. However, the Declination of Coverage for Retirees form may have far-reaching consequences that you need to consider.

We will inform you of our attorney’s response as soon as we receive it. You may also contact the District Benefits staff yourselves to ask about the intent of this form and whether or not signing it would prevent you from seeking coverage from the District if they move away from SISC in the future.

If you do not intend to waive or ofopt out  coverage through SISC this email does not affect you. Please continue to submit your enrollment forms and documents as directed by the District Benefits staff.

Please contact me with any questions you have.

Susan Bricker
VCCCDRA President

Email from VCCCD HR Benefits Regarding Zoom Meeting

SISC Health Plans – Open Enrollment Presentation – Tuesday, 10/10/2023 – Zoom Meeting

Dear VCCCD Retirees:

Open Enrollment for the SISC health plans starts Wednesday, October 11th and ends on Wednesday, November 1st.

 We’ll share more details soon regarding the health plans and how to enroll.

You will need to take action to enroll in a SISC health plan during Open Enrollment.

Please be sure to attend the virtual SISC Open Enrollment Retiree Presentation via Zoom using the log-in information below.

Representatives from SISC, Navitus (the Anthem pharmacy manager), Burnham Benefits, and the District will be available during the presentation.

Tuesday, October 10, 2023
10:30am – 12:00pm
https://burnhambenefits.zoom.us/j/93801047888?from=addon
Meeting ID: 938 0104 7888
or Phone 1 669 444 9171 US

The meeting will be recorded and posted to the Benefits website next week.

The Benefits Department will also be offering weekly Q&A sessions via Zoom regarding Open Enrollment during October.  The schedule and log-in information will be provided via email soon.

Please contact the Benefits Department with any questions.  We look forward to seeing you on the call next week.

Katy Lyon
Benefits Analyst
Ventura County Community College District
761 East Daily Drive, Suite 200
Camarillo, CA  93010
(805) 652-5535 phone
(805) 652-7711  fax
klyon@vcccd.edu

Move from CalPERS to SISC

Dear Friends and Colleagues,

Many of you have already learned that the District is considering a decision to move from CalPERS to SISC as our health benefits provider. The District’s decision is motivated by the substantial increase in CalPERS premiums for the coming year. While everyone can pretty much agree that the cost of health care and benefits is expensive, the cost increases with CalPERS are exactly what the Retiree’s Association had warned District officials about when the move to CalPERS was being considered. It is what we learned from other colleges that already opted for CalPERS. Since saving money is the motivation, it is highly likely that benefit coverage will be reduced or more difficult to access with the new provider. We have and continue to express our concerns to the District and request clarification. As with most things, the Devil will be in the details.

Here are a few thoughts we have based upon the single information session that was conducted for retirees; please keep in mind that we have very little factual information at this time but we do have some common-sense suggestions that you may want to consider:

  1.  We know that three types of plans were presented to retirees and will likely be offered to us during open enrollment for SISC (Self-Insured Schools of California). They are:
    A) Companion Care – a straight-up Medicare supplemental plan that will only pay for Medicare approved services,B) Anthem PPO – a coordinated benefits plan that may offer coverages beyond Medicare approved services but we are lacking details,
    C) Kaiser Permanente Senior Advantage – as far as we understand, this is the basic Kaiser plan and does have copays. It is not as good as Kaiser Summit Senior Advantage plan which some of you on Kaiser have now.

The coverage booklets for these plans can be found on the District website under Benefits: https://www.vcccd.edu/departments/human-resources/benefits

2) If you have Medicare, your Medicare coverage will not change. However, your District-paid additional coverage with SISC could introduce changes in the following areas, among others:

A) Benefits such as hearing, chiropractic, physical therapy, acupuncture, and days covered for stays in the hospital, rehab facilities, and nursing homes
B) Required pre-authorizations
C) Freedom to choose doctors or treatment facilities

3). Kaiser coverage will not be available to retirees living out-of-state, nor will any other type of managed care coverage.

4) Prescription coverages may be changed, and the provider will definitely be changed to Navitas instead of OptumRX. For example, we have been told that compound drug prescriptions will not be covered, but there seems to be some contradiction to that, and we are requesting clarification. There may be restrictions on brand name access, more prescriptions that require pre-authorization, or requirements to try less expensive drugs before authorization of doctors drug of choice, higher costs due to tier placement, more limited in-network pharmacy choices.

5) We do not know how Retirees over 65 who don’t have Medicare A & B will be served. They will be provided coverage until they are able to fully enroll for Medicare parts A & B.  We do not have details on the type of coverage or process for enrollment in Medicare yet. Those under age 65 will be provided access to the same plans as active employees get.

6) Spouses of deceased Retirees who were eligible for District paid benefits also received District paid benefits because CalPERS required it. District contract language does not require such coverage and those spouses may again have to find and pay for their own coverage.

New plan coverage will begin January 1, 2024 with new enrollment likely beginning October 1, 2023. You know what an ordeal the last transition was, and we have no reason to believe we will receive even as much help this time as was available last time.

WHAT TO DO NOW IN THE NEXT THREE MONTHS?

 1) Maximize all of your prescription refill opportunities starting now through the end of the year. (Fill as many as you can, as many times as you can.)  This is especially important with any compound medications or ones that you know will require approvals.

2) If you are considering treatments, elective procedures, new medical equipment, visits to specialists, or other medical services, it may be wise to consider them now, before January 1, if it is appropriate for you, especially in treatment areas that may disappear or be greatly reduced under the new plan.  An example of this is hearing aid coverage for those with Anthem plans.

3) If you are a spouse of a deceased Retiree who was eligible for District paid benefits and have been receiving spousal benefits while the District contracted with CalPERS, you may need to find and pay for your own benefits because the District is not contractually required to provide them under the new plan, and will probably no longer do so. Please explore your options for insurance now.

4) If you live outside California and are on Kaiser, you will need to find medical providers that are either covered by Blue Cross or, if you are over 65, by Medicare or by both.  You should also get whatever care you need no later than Dec. 31, 2023, so that the transition will be easier for you.

Susan Bricker, President
Ventura Community College District Retirees Asso.

VCCCDRA needs your help! Major change in benefits for surviving spouses!

HELP US LOCATE SPOUSES WHO QUALIFY!

From Gary Johnson

The Association became aware that under CalPERS rules the District must provide most spouses of deceased retirees District paid health benefits that are the same as their spouse would have received had they still been alive.

    This is contrary to the fact that previously such spouses only had access to District benefits if they chose to pay for them at their own expense.
    The District gave CalPERS a list of spouses to be notified of this major change in providing benefits and they should have received enrollment packets.
    However, we know that the list was incomplete, and we know that some ignored the opportunity because from past experience and notifications they believed that they were not eligible and concluded that this notification did not apply to them.
For a spouse to be eligible:
      • The retiree must have been eligible for lifetime District benefits (Tier I or Tier II)
      • The spouse must be a recipient of a monthly allowance pension through CalPERS or CalSTRS sufficient to cover the cost of the benefit
      • The spouse must enroll in Medicare Part A and Part B if they are eligible for Medicare. (Note: if deceased retiree was eligible for Medicare, then the spouse is eligible for Medicare)
      • The District will reimburse the spouse for the cost of Medicare Part B, plus any part B late enrollment penalties and surcharges for excessive income (IRMAA), and the District will pay for a Medical supplement health plan to Medicare Part B, including Part D drug coverage
RETIREES PLEASE RESPOND ASAP – DEADLINE IMMINENT
      • The spouse must enroll In a CalPERS health plan by October 31!  (This requirement may be waived under certain circumstances)
      • This surviving spouse benefit, that is, District paid coverage for the spouse, will last only as long as the District contracts with CalPERS for healthcare benefits
WE DO NOT HAVE ACCESS TO A LIST OF SPOUSES OF DECEASED RETIREES
      • If you know any of them or of them, contact them to see if they know of this opportunity. Then, forward their name and contact information to the Retirees’ Association for our records and possible assistance
      • If they are interested in more information and/or enrollment, have them contact both the Association and the District.
District:
Katy Lyon
Benefits Analyst – VCCCD
761 E. Daily Dr., Suite 200
Camarillo, CA  93010
805-652-5535
             or
Janice Endo
District Benefits Administrative Assistant
805-652-5531
Retirees’ Association:  VCCCDRA@gmail.com

For Retirees 80 years or Older Who are Covered by the Settlement Agreement

Gary Johnson reminds us that for Retirees covered by the Settlement  Agreement, especially those of you 80 years or older, the move to CalPERS may trigger reimbursement opportunities for medical and prescription expenses. The Association will be studying this over the next few months. If such opportunities exist for reimbursement, the application time will not be for about a year.

We advise you to retain all of your medical and prescription receipts during this first year of transition to CalPERS in case reimbursement opportunities  materialize.

IMPORTANT NOTICE TO VCCCDRA RETIREES Regarding What You Need To Know About CalPERS and OPTUMRx Thus Far…

The following was emailed today by Rene Rodriguez, President, to retirees for whom we have email addresses.

Gary Johnson and Marta Freixas have put together the important things you need to know about CalPERS and OptumRx as the starting date of September 1 for CalPERS insurance plans approaches.

 Retirees Be Aware!!!

We are all entering a different health benefit world than we have experienced in our history with the District, particularly for those of us on Medicare plans. We have been warned by other Community Colleges contracting with CalPERS that the District will be less able to assist or intercede for us than we are accustomed to.  We will be more on our own interacting with CalPERS, Medicare, Anthem, OptumRx and Kaiser.  We will be more dependent on on-line sources for information.

As they become available, study carefully all CalPERS, Medicare, Anthem, OptumRx and Kaiser documents that apply to you.  There are rules, access requirements, limitations, reimbursement responsibilities and prerequisites we must understand and figure out how to work with to get the best use of the plans.

Medicare Supplement Plans:  Transfer your prescription enrollment to OptumRx

Everyone on a Medicare Supplement Plan thus far has received a letter from OptumRx that states that by 8/28/2020 those on Choice and Care Plans must call OptumRx at 1-866-420-4471 and request to transfer your current Anthem prescription coverage to OptumRx so they can enroll you through Medicare and accept responsibility for your coverage.  If you do not do this, you will lose all coverage, both medical and prescription.

CalPERS Basic Care Level Plan:

If you received a letter from CalPERS stating that you are delinquent in paying your monthly premium of $125.48, do not be alarmed.  You will not be covered by this plan until 9/1/20 and prior to the unfortunate tone of this letter, neither CalPERS nor the District has provided any information as to the due dates or options for paying this premium.  If you do not understand the best payment option for you, call CalPERS at 1-888-225-7377.  Also, call and ask the District if they are paying for half of the Care Plan premium as previously indicated during negotiations at 805-652-5535.

Prescriptions with OptumRx:

You need to call OptumRx at to find out how your prescription information will be transferred from IngenioRx to OptumRx.  Call 1-866-420-4471 if you have a Medicare Supplement Plan, and 1-855-505-8110 if you have a Basic plan.  For a new start with prescriptions, especially if you want to take advantage of cost savings with a 90 day supply and to coordinate your refills coming due at the same time, your best option may be to have all of your doctors provide full new prescriptions and refill numbers to OptumRx on 9/1/2020, or as soon as possible afterward.

Make sure you fill prescriptions with an OptumRx Network Pharmacy.  The best savings will be with designated “Preferred 90” pharmacies for Medicare plans, and “Select 90” Pharmacies for Basic plans.

CalPERS open enrollment period:

Given the limited information available on plans, the timing of the availability, and the quick deadlines for decisions, it is possible that some retirees chose a health care plan that does not best serve their needs.  CalPERS has an open enrollment period yearly between October 1 and December 31 where you can change your enrollment from your initial choice to another plan.  If this is you, take a more detailed look at the options and take advantage of this quick opportunity to change your mind.

Medicare Doctors/ Medicare Assignment:

Make sure your healthcare providers take Medicare, and know whether or not they accept “Medicare Assignment”.  “Assignment” means the provider accepts the Medicare approved amount as full payment for covered services, which saves you money by not being responsible for the difference between what Medicare paid and what the provider bills.  An increasing number of Doctors, and especially specialists and anaesthesiologists, do not accept Medicare.  Be sure to learn how the doctors you choose, and the hospitals you utilize, handle Medicare.  In addition, be aware that some of the doctors working and caring for you in hospitals do not take Medicare even if the hospital itself does.

HOW TO TELL IF YOU HAVE SUCCESSFULLY ENROLLED IN A CALPERS PLAN

If you have Medicare Part A and Medicare Part B and have successfully enrolled in either PERS Choice Supplement to Medicare or PERSCare Supplement to Medicare, you will have received two insurance cards.  One will be from Anthem for a PERS Supplement Plan, and one will be from OptumRx.   If you have not received your Anthem card, please call 1 (877) 737-7776. If you have not yet received your OptumRx insurance card, please call 1 (866) 420-4471.  You MUST be enrolled in both plans.

If you have no Medicare or Medicare Part A only and are enrolled in either PERS Choice Basic Plan or PERSCare Basic Plan, you should have received only one card from Anthem for a PERS Basic Plan.  If you haven’t yet received your card, please call  1 (877) 737-7776.

Because of current issues with the postal service,  your cards may merely be delayed.  We currently have no way for those of you who need to check on your OptumRx enrollment to achieve that without calling.  However, for those of you with online Anthem access, you can check to see if your enrollment with  PERS Choice or PERSCare was successful by:

    1. Logging into your current Anthem account;
    2. Hover your mouse over “My Plan”; and
    3. Select ID Cards from the drop-down menu
    4. Two Anthem cards should show for each person enrolled.  One is for our current plan, and one has CalPERS in the upper right.  If you find your CalPERS card here, you are have successfully enrolled in a Medical plan.  These cards can be downloaded and printed.
    5. If you go back to “My Plan” and select Benefits from the drop-down menu, you should see that the words “California Public Employees Retirement System” appear to the right of our current plan.  It will also show an effect date of Sept. 1, 2020
    6. If your card shows the word “Supplemental” in the upper right in addition to CalPERS, you must check your enrollment in OptumRx too!

 

CalPERS and OptumRx INFORMATION ON THE VCCCDRA BLOG: blog.vcccdra.org

Blogmaster Carmen Guerrero and Marta Freixas have created some pages in the Pages category of the Blog on the right hand side of the Home Page when you first enter the Blog.  Just scroll down until you see the “Pages” category, and select the desired page.   Here you can get a copy of the PERS Care Medicare Supplement plan, or a copy of the  PERS Choice Basic Plan, plus you can download a copy of the expanded Select90 and Preferrred90 pharmacy list. Explore these pages to see what other valuable information is available to you here.

 

URGENT MESSAGE FOR VCCCDRA RETIREES

The following message was emailed to retirees by Rene Rodriguez, President on August 21, 2020, and U.S. mailed to retirees without an email address on the same date.

PLEASE NOTE THAT we just learned from the District that 180 retirees entitled to lifetime healthcare have yet to enroll in a CalPERS health plan which is due to take effect on September 1.  Our current Anthem and Kaiser health plans are due to terminate on August 31. 

If by chance you are one of these retirees that has not enrolled in a CalPERS health plan, you need to contact CalPERS first thing on Monday when they open for business by calling 1-888-225-7377 to enroll in a CalPERS health plan.  Explain that you are a retiree from the Ventura County Community College District, and that you are entitled to healthcare benefits from the District.  Have your social security number ready to identify yourself.

Please note that there may be a substantial hold time, but you must make this call to make sure you make the transition from our current Anthem and Kaiser plans, to the CalPERS health plans.

You should have received a packet of information from CalPERS in mid-July that included an enrollment form for a CalPERS health plan, and you should have received a letter from Katy Lyon soon after that included information about these health plans.

The above telephone number is the number that you should call first so that you can get direction from CalPERS as to what you must do now.  If you feel that you need to contact the District office, call Katy Lyon at (805) 652-5535 or Janice Endo at (805) 652-5531, or email them at klyon@vcccd.edu or Janice_endo1@vcccd.edu (there is an underscore “_” in Janice_endo1).  If you feel the Retirees’ Association can be of service to you, please respond to this email vcccdra@gmail.com or call (805) 499-6162.

SECONDLY, THIS IS VERY IMPORTANT:  Please note that if any issues come up regarding enrollment in the prescription drug plan OptumRx, YOU MUST RESOLVE THESE ISSUES WITH OPTUMRX or risk loss of not only OptumRX, but also loss of the medical plan that you have enrolled in.  Again, you will be left without the entire CalPERS insurance package if you do not resolve the issues with OptumRx.

Whatever the reason, if you are one of the retirees having to enroll at such a late date, the important thing is for you to begin the enrollment process with CalPERS right away by calling them at the number provided.  Once you receive the enrollment forms, if you are unable to complete them by yourself, ask a family member or trusted friend to help you, or email me or call me at 805-499-6162, and I, or a colleague, will do our best to assist you.

Please be well and stay safe.

Sincerely,

Rene G. Rodriguez
VCCCDRA President

Notes taken at the CalPERS Health Plans Zoom Meeting–7/18/2020

The following is the content of an email received by Rene Rodriguez from Lester Tong and posted here with Lester’s permission.

Rene,
This afternoon (July 17, 2020), 3:00pm till 5:00pm, I attended the “CalPERS Health Plans – Informational Zoom Meeting” (along with 218 others) presented by Katy Lyon.  I found it to be very helpful but with a lot of distractive questions from the audience.  This Zoom Meeting was recorded and will be made available for playback at the District’s Benefit website at
Look for the section “CalPERS MEDICAL”, then subsection “Retirees”.
Under the “CalPERS Live Webinar – Recording 6/30/2020” will be the Zoom meeting of 7/17/2020 (when they get it posted).  I would encourage all retirees to go to this website and review the CalPERS MEDICAL section.
Also, there was a chat session during the Zoom meeting and I saved all the chat to a file (see attached)
Also, to define the Retiree Tier 1 to 4 go to: https://www.vcccd.edu/departments/human-resources/benefits/retirement
Here are the highlights from my notes:
__ MES Vision & Delta Dental will remain the same and separate from CalPERS Medical.
__ Everyone must submit the CalPERS Application form by mail or FAX (800) 959-6545.
__ Only CalPERS has this form and it should be mailed directly to you (I got my packet on Jul 9).
__ Anthem CalPERS “Find Care tool” for a doctor, pharmacy, hospital, or urgent care center is at
__ If you are over 65 and do not have both Medicare parts A & B, then you default to the “BASIC” or B Plan.
__ “2020 Health Benefit Summary” booklet compares all the health plans.  It was mailed to everyone.  Also can be downloaded from the District’s Benefit website (see link above).
__ For the “Retiree Monthly Contributions” in Ventura County, see Region 2 that was mailed to you.
__ CalPERS Health Benefit is by Calendar Year which is January 2021.  Therefore, deductibles amounts reset to zero in January.
__ Also deductibles amounts are reset in September 2020 when we start with CalPERS Health Benefit.
__ Medicare part B monthly premiums will be reimbursable with proof of payment starting September 2020.  Reimbursements will be handled by a 3rd party.  VCCCD can not pay these premiums directly as it is prohibited by law.
–Lester Tong
Classified Retiree, June 2016

 

CLARIFICATION of Language on Blog Post of May 18th

Clarification of language involving Medicare in an email sent out on May 18, 2020 and published on the BLOG titled “Negotiations Outcome and Update on Retirees, the District, and CalPERS”

In this document, we recommended that you DO NOT make decisions or changes in your benefits (including Medicare) until you are well informed…

We feel that this statement needs clarification.

Our intent is for retirees not to make any decisions merely at the urging of the District.  If you, on your own, decide that Medicare is a good choice for you and your family, then you should not hesitate to enroll in Medicare, especially when you become eligible at the age of 65, otherwise, you will be required to pay a 10% penalty on premiums for each year after that.

The VCCCDRA has also recommended in the past, on various occasions, that spouses of retirees should enroll in Medicare if they are eligible to do so, when they turn 65.  The reason for this is that spouses of retirees will not be covered by District paid healthcare benefits once the retiree passes away.  

COMMUNITY COLLEGES’ EXPERIENCES CONTRACTING WITH CALPERS FOR HEALTH BENEFITS

Report from the VCCCDRA Benefits Committee

     The following are comments from the experiences reported by the Human Resources Offices of eight Community College Districts and Cal Poly, San Luis Obispo which expose a variety of difficulties the District and Retirees are going to encounter trying to work with CalPERS.  The points made are self-explanatory and the common denominator is the pervasive, critical displeasure and aggravation experienced in working with CalPERS once a Resolution (Contract) has been signed.

The report also summarizes insights into why CalPERS states that at least 32 Employers terminated their contracts with CalPERS in the last four years.

In the Chancellor’s 5-11-20 packet of materials to be sent to all Retirees is a response to “Areas of Concern” noted in the 80 plus letters of appeal and protest sent by Retirees to Trustees and the Chancellor in late April.  “Concern” number 8 is much more significant than the number of letters which raised it, especially for the number of older Retirees in the VCCCD retired population, namely “The change to CalPERS will cause problems that Retirees are not prepared to manage”.

The Chancellor’s response…

“CalPERS can be contacted through phone, email, and the website.  In addition, District HR personnel and our Burnham representatives can assist with questions in order to facilitate getting needed help.  The District will work with the retirees to provide medical benefits according to the plan requirements of the negotiated provider specified in the Agreements with the Unions.  The District will meet its contractual obligations to our active and retired employees.”

should be true, as a given, but compared to the reports of sister Community College Districts, and their experiences with CalPERS, the response is unfortunately unrepresentative of reality.

LOS ANGELES COMMUNITY COLLEGE DISTRICT

      • Supplemental tech staff is crucial to field questions and work with specific plans as each presents their own set of problems.  LACCD has 15 techs.
      • CalPERS communication is very difficult because there is no dedicated health insurance liaison between CalPERS and any contracting institution.
      • There is only one source phone number to call and that number is the same for all participants.
      • Messages or trouble shooting usually takes 2-3 weeks for a call back.

FOOTHILL-DEANZA COMMUNITY COLLEGE DISTRICT

      • Would like to move away from CalPERS due to rising premium and coverage element costs and no ability to negotiate cost changes.
      • Problems with “value based purchasing” costs with businesses in different geographical boundaries.
      • Problems with balance billing when a member is treated in in-network hospital by out-of-network doctor.
      • Initial Resolution Contract is very tricky to understand (i.e. CalPERS had deftly created wording which hid the fact that surviving dependents would be excluded from coverage).  College has had to absorb substantial costs for survivor benefits they had promised and believed would be covered as intimated in initial discussions between the District and CalPERS.

SAN MATEO COMMUNITY COLLEGE DISTRICT

      • Went from Anthem to CalPERS when college faced financial difficulty and did not have adequate reserves.  Accepted $10 million offer from CalPERS to shift.
      • Are now back to drawing down reserves again due to continued CalPERS premium increases and the fact that there is no negotiability or approval process for the District with CalPERS decisions.
      • Have had to hire four Human Resources employees to work through differing plans, policies, and issues.
      • Difficult to communicate with CalPERS as you cannot speak to the same person and it takes a while for them to get back.  No one seems to know how to handle issues.  (i.e. It recently took three months to successfully transfer a faculty already in CalPERS from another Community College to San Mateo.  meanwhile the new faculty member had to pay medical and prescription bills and had difficulty being reimbursed).
      • Would like to return to Anthem but it is expensive to leave CalPERS because of financial penalties.

SANTA MONICA COMMUNITY COLLEGE DISTRICT

      • Are attempting to leave CalPERS but it is difficult to do so because of terms of Resolution Contract.  To contract with CalPers you must hire attorneys who understand CalPERS and the health care system to work through the loopholes and “traps’ CalPERS puts into its Resolutions.  District lawyers are not prepared for the task.
      • Plan terms of use and payment are dictated by geographical area.  The costs for different people in the same plan will differ based on the geographical area where they live.
      • District has no control over the plan structure or benefits.
      • There is no dedicated contact person to work with the staff or covered employees and you talk to someone different every call.
      • There is no communication from CalPERS to the client base, should issues arise, that could affect many members.
      • CalPERS may know about an issue affecting an employee(s) but does not notify until the issue comes from the member.

OHLONE COMMUNITY COLLEGE DISTRICT & NORTH ORANGE COUNTY COMMUNITY COLLEGE DISTRICT

Both left CalPERS due to rising premium costs, dissatisfaction with service, and no control.

KERN COUNTY COMMUNITY COLLEGE DISTRICT

      • Left CalPERS to contract with Self Insured Schools of California (SISC).
      • CalPERS did not fit the District needs or those of groups within the District.
      • Cost adjustments were too high and there was no ability to negotiate.
      • CalPERS holds all of the power once you sign the Resolution Contract.
      • If you decide to go to CalPERS make sure you have a specialized law firm that understands government contract details, health contracts, health negotiations, and powers of negotiation.
      • Communication with CalPERS is non-existent for all intents and purposes once the Resolution is signed.
      • There is no dedicated person to assist with troubleshooting, answering questions, or seeking information.
      • Often receive confusing and different answers.
      • SISC comes with a dedicated team with your plan so you have easy access to information and problem solving. Employees have not complained about SISC as compared to complaints on the difficulties in service and pharmacy issues with CalPERS and OptumRx.

CAL POLY, SAN LUIS OBISPO

      • Are looking to leave CalPERS for another health care coverage.
      • CalPERS is not flexible and you cannot negotiate or have any control over benefits or cost adjustments.

SAN ANTONIO COLLEGE DISTRICT

      • Classified staff left CalPERS 12/31/19.  College had been with CalPERS since founding in 1946.
      • Rising costs – no control over costs.
      • Once on CalPERS, the District has no relationship with retirees.  They are on their own and District cannot intercede to help.
      • Many States do not have CalPERS networks.  So out-of-network costs are high with no limits.
      • Always CalPERS way or the highway.  Very tiring.  No say, no power, no influence over anything.
      • CalPERS owns all information and will not share.  Cannot keep track of retirees.
      • CalPERS PPO not available in many other States (Oregon/Washington OK).  Must submit receipts for reimbursement.
      • Staff consistently involved with reimbursement issues in the retiree Medicare coverage in the Supplemental Plan.
      • Once retiree is transferred to CalPERS coverage in the Supplemental Plan, they are disconnected from College assistance.
      • Can offer no assistance.  Hard on older retirees.
      • Unhappy with retiree treatment.
      • Had care level – use cafeteria choice with fixed District contribution (10K).
      • No Union role but salary.
      • Moved to SISC.
      • Premium increases (composite) 10%, 10%, 23%, 3%, 13%.  Couldn’tpredict from year to year.
      • District works through CalPERS, not Anthem.

EMPLOYERS LEAVING CALPERS:

2016  (13)  Ohlone Community College District – too expensive

2017  (9)    Gavilan Joint Community College District – too expensive

2018  (9)

2019  (?)    Mt. San Antonio College – too expensive, too many                        aggravations, dissatisfaction

PRIMARY REASONS CITED FOR LEAVING CalPERS per Burnham

NOTE:  This information for leaving CalPERS was presented to the ASCC/District Benefits Committee by Burnham (9-5-19) at the request of the Committee and reasons given here are CalPERS’ brief statement of reasons.  Interviews with employers as listed in the beginning of this document provides a much more detailed list of complaints.

      • Lack of flexibility/ difficult to work with  (8)
      • PPO Plans turning into HMO-like plans (1)
      • Rates too high/ too expensive  (26)
      • Other post employer benefits (OPEB) liability concerns (5)