The State Worker

CalPERS nears end of health insurance audit

Photo illustration
Photo illustration Associated Press

More than a year since it began, CalPERS’ intensive review of its health insurance rolls has entered its final stages.

Auditors have started verifying the insurance eligibility of dependents on the plans of retired public agency workers and will soon turn its attention to dependents of active and retired school employees

Retired public agency employees have until Nov. 20 to submit the verification documents to the contractor, HMS Employer Solutions. Dependent eligibility verification for dependents of active and retired school employees begins Dec. 1. with a Jan. 20, 2015, deadline to submit their documentation.

The fund expects the review, which started in May 2013, to wrap up next spring.

CalPERS hired HMS to contact all of the system’s health insurance subscribers with at least one dependent on their plan and ask them for proof of dependent eligibility for the coverage, such as a copies of a marriage certificate and tax filings. The company then reviews the documents to verify eligibility. CalPERS says the paperwork is secured and confidentially handled as required by law and will be destroyed when the project is finished.

Notice of the audit has been enough to prompt some policyholders to remove ineligible ex-spouses or children 26 or older, for example. Members voluntarily dropped nearly 6,700 ineligible dependents from their plans as of May, CalPERS says, saving the system more than $41 million.

Otherwise, CalPERS is removing ineligible people from the rolls. The fund also has the option to file criminal charges against subscribers who knowingly scam the system.

CalPERS says that several letters have been sent to both public agency and school retirees let them know about the process and deadlines. Fund staff will soon report to CalPERS Board of Administration on the project’s progress.

Who is eligible for coverage? CalPERS says the list includes:

▪ Current spouse/registered domestic partner.

▪ Natural, adopted, step or registered domestic partner's children up to age 26.

▪ Disabled children of any age if they were enrolled prior to age 26.

▪ Children up to age 26 for whom the subscriber has assumed a parent-child relationship and is considered the primary care parent.

About 1.4 million active and retired government workers and their dependents receive medical insurance through a CalPERS-administered plan.

Call Jon Ortiz, Bee Capitol Bureau, (916) 321-1043.