Benefit Information
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Annual Open Enrollment
Open enrollment for the medical, dental and vision plans is held in the Fall each year. If you would like to change your medical or dental insurance plan, or if you want to add or delete dependents (for medical, dental and vision insurance), you can do so during open enrollment.

The open enrollment period for the PayFlex Flexible Spending Plan and supplemental insurance plans is also in the fall.

Contact Information for Benefit Providers

Download the contact information for the City's benefit providers

You may also contact Julie Schmidt in Human Resources at (949) 361-8324 for more information on any of the City's benefit plans.

Health Benefit Plans Available





For 2014, the City of San Clemente will have twelve medical plans available through CalPERS for full-time, job-share, and benefited part-time employees:

HMO MEDICAL PLANS:
  • Anthem Blue Cross Select HMO (NEW)
  • Anthem Blue Cross Traditional HMO (NEW)
  • Blue Shield Access + HMO
  • Blue Shield NetValue HMO
  • Health Net Salud y Mas HMO (NEW)
  • Health Net SmartCare HMO (NEW)
  • Kaiser Permanente California HMO
  • Sharp Performance Plus HMO (San Diego County) (NEW)
  • UnitedHealthcare Alliance HMO (NEW)


PPO MEDICAL PLANS:
  • PERS Choice PPO (Anthem Blue Cross)
  • PERS Select PPO (Anthem Blue Cross)
  • PERS Care PPO ( Anthem Blue Cross)
For more information on the available medical plans, please see the CalPERS Health Benefits Summaries and the Evidence of Coverage Documents on this page, or click on the links in the CalPERS sections below.


DENTAL PLANS:
  • Delta Care HMO
  • Delta Dental Premier
VISION PLAN:
  • VSP (Vision Service Plan)

2014 Employee Health Rates

2014 Health Rates for employees who live in the counties of: Riverside, Orange, Imperial, and San Diego.

2014 Health Rates for CASA benefited part-time employees.

Find a Provider in the Medical, Dental, and Vision Plans or Find Out Which Medical Plans Are Offered In Your Area

To find a provider in one of the City's plans, click on one of the links below to visit the website.

Blue Cross website to locate providers in the Anthem Blue Cross Select HMO or Anthem Blue Cross Traditional HMO plans.

Blue Cross website to locate providers in the PERS Select, PERS Choice, and PERS Care PPO plans.

Blue Shield website to locate providers in the Blue Shield NetValue and Blue Shield Access+ HMO plans.

Health Net website to locate providers in the Health Net Salud y Mas and Health Net SmartCare HMO plans.

Kaiser website to locate providers and facilities in the Kaiser HMO plan.

Sharp website to locate providers in the Sharp Performance Plus HMO plan.

UnitedHealthcare website to locate providers in the UnitedHealtcare Alliance HMO plan.

Delta Dental website to locate providers in the Delta Care HMO or Delta Premier Dental plans.

VSP website to locate providers in the VSP vision plan.

To find out which medical plans are available in your area, click on the link below to visit the CalPERS website. You can choose your medical plan based on either your home or work ZIP Code.

CalPERS Health Plan Zip Code Search website.

2014 Summary of Benefits and Coverage (SBC) Documents for the City's Health Plans

MEDICAL PLANS:

2014 Anthem Blue Cross Select HMO Summary of Benefits & Coverage.

2014 Anthem Blue Cross Traditional HMO Summary of Benefits & Coverage.

2014 Blue Shield Access+ HMO Summary of Benefits & Coverage.

2014 Blue Shield NetValue HMO Summary of Benefits & Coverage.

2014 Health Net Salud y Mas HMO Summary of Benefits & Coverage.

2014 Health Net SmartCare HMO Summary of Benefits & Coverage.

2014 Kaiser Summary of Benefits & Coverage.

2014 PERS Care Summary of Benefits & Coverage.

2014 PERS Choice Summary of Benefits & Coverage.

2014 PERS Select Summary of Benefits & Coverage.

2014 Sharp Performance Plus HMO Summary of Benefits & Coverage.

2014 UnitedHealthcare Alliance HMO Summary of Benefits & Coverage.


DENTAL & VISION PLANS:

2014 Delta Dental Premier Summary of Benefits & Coverage.

2014 Delta Care DHMO Summary of Benefits & Coverage.

2014 VSP Vision Evidence of Coverage and Summary of Benefits & Coverage.

CalPERS Health Benefits Summary for all Medical Plans

The City's medical insurance for full-time, job-share, and benefited part-time employees is provided through CalPERS. This document contains a high-level summary of the various health plans available, and compares covered services, co-payments, and benefits for each CalPERS health plan. It also provides information about plan availability by county and a chart summarizing the key differences between a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO). Remember, however, that you should refer to each plan’s Evidence of Coverage (EOC) booklet for the exact terms and conditions of coverage for a specific plan. The EOC's can be viewed on the HR Intranet, or requested directly from the provider. Please refer to the Benefit Provider contact list on this page for the contact information for your plan. The general number for CalPERS customer service is (888) 225-7377.

2014 Health Benefit Summary

Click Here to visit the CalPERS website


CalPERS Health Program Guide

The City's medical insurance for full-time, job-share, and benefited part-time employees is provided through CalPERS. The Health Program Guide describes CalPERS Basic health plan eligibility, enrollment, and choices. It provides an overview of CalPERS health plan types and tells you how and when you can make changes to your plan (including what forms and documentation you will need). It also describes how life changes or changes in your employment status can affect your benefits and eligibility.

2014 Health Program Guide

Click Here to visit the CalPERS website


CalPERS 2014 Evidence of Coverage Booklets for the Medical Plans

2014 Anthem Blue Cross Select HMO Evidence of Coverage Booklet.

2014 Anthem Blue Cross Traditional HMO Evidence of Coverage Booklet.

2014 Blue Shield Access+ HMO Evidence of Coverage Booklet.

2014 Blue Shield NetValue HMO Evidence of Coverage Booklet.

2014 Health Net Salud y Mas HMO Evidence of Coverage Booklet.

2014 Health Net SmartCare HMO Evidence of Coverage Booklet.

2014 Kaiser HMO Evidence of Coverage Booklet.

2014 PERS Care PPO Evidence of Coverage Booklet.

2014 PERS Choice PPO Evidence of Coverage Booklet.

2014 PERS Select PPO Evidence of Coverage Booklet.

2014 Sharp Performance Plus HMO Evidence of Coverage Booklet.

2014 UnitedHealthcare Alliance HMO Evidence of Coverage Booklet.

Get Help Choosing a Medical Plan

CalPERS Health Plan Chooser for help in choosing a medical plan

CalPERS 2014 medical plans website.

Link to the CalPERS website containing Videos Presenting the 2014 medical plans.


CalPERS Medical Plans Notice of Privacy Practices

Please contact CalPERS at (888) 225-7377 if you'd like to request a copy of the Notice of Privacy Practices for any of the medical plans (Kaiser, Blue Shield or Anthem Blue Cross).

CalPERS Guide to Medicare Enrollment

The City's medical insurance for full-time, job-share, and benefited part-time employees is provided through CalPERS. The CalPERS Medicare Enrollment Guide provides information about how Medicare works with your CalPERS health benefits for active employees and retirees).

2014 CalPERS Medicare Enrollment Guide

Click Here to visit the CalPERS website


Delta Care USA Dental HMO

This is the Dental HMO Program offered to full-time, job-share, and benefited part-time City employees. Full-time CASA employees are also eligible. The customer service number is (800) 422-4234.

Evidence of Coverage document

Evidence of Coverage Supplement - Age 26 Dependent Information

"Choosing Your Plan" document that compares the two dental plans available

Click Here to visit the Delta Care website

Delta's notice of Privacy Practices

Click here to visit Delta's website for important privacy and legal notices regarding the dental plans.

Delta Dental 2012 Annual Report

Delta Dental Premier

This is the Dental Premier Program offered to full-time, job-share, and benefited part-time City employees. Full-time CASA employees are also eligible. The customer service number is (800) 765-6003.

2014 Evidence of Coverage document

"Choosing Your Plan" document that compares the two dental plans available

Summary of Benefits and Coverage document (SBC)

Click Here to visit the Delta Dental website

City of San Clemente's Notice of Privacy Practices for Delta Dental Premier Plan

Delta's notice of Privacy Practices

Click here to visit Delta's website for important privacy and legal notices regarding the dental plans.

Delta Dental 2012 Annual Report

Covered California Health Insurance Marketplace

What is Covered California?


Each State is required to have a Health Insurance Marketplace Program as part of the Affordable Care Act (ACA), and this is California’s Program. Through Covered California, individuals can compare different health insurance plans and learn if they qualify for federal financial assistance that can lower the cost of health insurance. Individuals will also be able to find out if they are eligible for health programs like Medi-Cal. Individuals can shop online, over the phone or in person to find out about their health care insurance options.

Click the image below to visit the Covered California website.

Covered California

PayFlex Flexible Spending Plan & City of San Clemente Flexible Benefits Plan

As part of the City's Flexible Benefits Plan, PayFlex provides the Flexible Spending plan offered to full-time and benefited part-time City Employees. The customer service number for the PayFlex Health or Dependent Care Flexible Spending Plans is (800) 284-4885.

Summary Plan Description for the City's Flexible Benefits Plan which includes the Flexible Spending Plan

Summary of Material Modifications Jan 2011

PayFlex Debit Card Substantiation

Click Here to visit the PayFlex website

PayFlex's Notice of Privacy Practices


VSP Vision Plan

This is the vision plan effective 1/1/08. The Plan is offered to full-time, job-share, and benefited part-time City employees. Full-time CASA employees are also eligible. The customer service number is (800) 877-7195.

Benefit Summary for the Plan

Evidence of Coverage Document for the Plan

Click Here to visit the VSP website

VSP's notice of privacy practices

VSP Grievance Processes

Retirement Plan for Miscellaneous Employees - California Public Employees' Retirement System (CalPERS)

Full-time non-safety employees participate in CalPERS. The City is also a member of the Social Security system, with the employee and the employer contributing to Social Security.

CalPERS can be contacted at (888) 225-7377.

Click Here to visit the general CalPERS website

Click Here to login to the the MyCalPERS website to access your personal medical and retirement information through CalPERS.


Retirement Plan for Full-time Safety Employees - California Public Employees' Retirement System (CalPERS)

Full-time Marine Safety employees participate in the CalPERS retirement program. The City is also a member of the Social Security system, with the employee and the employer contributing to Social Security.

CalPERS can be contacted at (888) 225-7377.

Click Here to visit the CalPERS website

Click Here to login to the the MyCalPERS website to access your personal medical and retirement information through CalPERS.


Social Security and Medicare

All employees contribute to Medicare, and all full-time and job-share City employees contribute to Social Security.

Click Here to visit the Social Security Administration website

Click Here to visit the Medicare website

ICMA Deferred Compensation Plans

ICMA-RC provides deferred compensation plans for eligible employees.

Click Here to visit the ICMA website

Life Insurance and Accidental Death and Dismemberment (AD&D) Insurance provided by The Standard Insurance Company (Employer Paid)

The City provides Full-time, Job-Share, and Benefited Part-time Employees group life insurance and accidental death and dismemberment insurance (AD&D) through The Standard Insurance Company.

Employees are also able to purchase voluntary insurance through various providers.

For more information about life insurance or AD&D insurance, please contact Julie Schmidt in Human Resources at 361-8324.

Life Insurance Certificate for Class 1 - Executive Management

Life Insurance Certificate for Class 2 - Mid-Management

Life Insurance Certificate for Class 3 - Full-time

Life Insurance Certificate for Class 4 - Benefited Part-time .75 FTE

Life Insurance Certificate for Class 5 - Job-share

Life Insurance Certificate for Class 6 - Benefited Part-time .50 FTE

Life Insurance Certificate for Class 7 - Full-time General Marine Safety

Long Term Disability (LTD) Insurance for Full-time Employees provided by The Standard Insurance Company

The City provides the City Manager, Executive Managers, Mid-Managers, and Confidential Employees Long Term Disability Insurance (LTD) through The Standard Insurance Company.

Full-time general employees who are dues paying members of SCCEA are covered under Long Term Disability (LTD) Insurance at no cost to the employee.

For more information about LTD insurance, please contact Julie Schmidt in Human Resources at 361-8324.

Long Term Disability Insurance Certificate for Class 1 - City Manager, Executive Managers, Mid-Managers, and Confidential Employees.

Long Term Disability Insurance Certificate for Class 2 - Full-time General Employees who are dues paying members of SCCEA.

CalPERS Long Term Care Program

The CalPERS Long-Term Care (LTC) Program is now open to new applicants. This will be the first time the CalPERS LTC Program has been open to new applicants since 2008, and the first time that applications will be continually received. The LTC Program offers flexible coverage options to help participants preserve assets while maintaining quality of life, including:
  • Plan options that allow you to tailor coverage to suit needs and budget
  • Benefits that make it easier to receive care at home
  • Options designed to keep up with the rising costs of receiving long-term care
California public employees, retirees, their spouses, parents, parents-in-law, and adult children and adult siblings, between the ages of 18 and 79 are eligible to apply. Participation in CalPERS retirement or health benefit programs is not required. Current CalPERS Long-Term Care Program participants interested in applying for the new product design must complete an application and undergo underwriting. You can learn more about CalPERS Long-Term Care coverage options, or download an application kit, by visiting the CalPERS Long Term Care website. or by calling (800) 908-9119.

Employee Assistance Program (EAP)

The HorizonCare EAP is an employee assistance program offered to full-time, job-share, and benefited part-time employees that offers support, guidance and resources to help you and your family resolve personal issues and meet life's challenges. Full-time, job-share, and benefited part-time employees can call the help line 24 hours a day and it is a confidential program provided at no cost.

Brochure and contact information for the Employee Assistance Program.


Employee Benefits Brochure

A high level summary of the various benefits offered to City of San Clemente Employees.

Click here to download the brochure


City of San Clemente
City Hall | 100 Avenida Presidio, San Clemente, CA 92672 | Phone (949) 361-8200  |  FAX (949) 361-8285
Community Development | 910 Calle Negocio, Suite 100, San Clemente, CA, 92673 | Phone (949) 361-6100  |  FAX (949) 361-8281
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