2025 Open Enrollment General Information
Who are the medical insurance vendors for 2025?
Anthem Blue Cross (Anthem) and Kaiser Permanente (Kaiser) will remain the 2025 health vendors.
Are there any changes to the medical plans for 2025?
The IRS announced increases for the high-deductible health plans (HDHP) again in 2025, with a minimum annual deductible of $1,650 for self-only plans and $3,300 for family.
For Kaiser plans, Glucagon-like peptide-1 (GLP-1) receptor agonist drugs will only be prescribed for the treatment of type 2 diabetes and will no longer be prescribed for weight loss without a morbidly obese diagnosis.
Medicare Prescription Out-of-Pocket Maximum is being reduced from $8000 to $2000 and carriers will be offering a Prescription Payment Program. Kaiser will self-administer their plan and Anthem will be partnering with SimplicityRx.
There are no new or discontinued plan options for 2025.
What factors are used to determine the medical insurance rates each year?
We are continuing to see healthcare increases this year for a variety of reasons including inflation, COVID-19, labor shortages, rising medical costs, and medical and pharmacy claims. If you have questions about your 2025 coverage, please join one of the scheduled webinars or schedule a personal appointment with Anthem or Kaiser. The appointment schedule and links are posted here.
Are there any changes to the Dental and Vision plans?
No. There are no changes to Dental or Vision for 2025.
Can I submit my Open Enrollment form electronically?
Yes! Open Enrollment change forms can be submitted electronically through your Member Direct account at https://memberdirect.sjretirement.com (click Member Portal Login on the website). Please note for some changes, such as adding new spouse/dependent, additional documents are required. These additional documents can be mailed through U.S. postal service, dropped off at the ORS office, or submitted through MemberDirect via the Message Center (under Communications). ORS cannot accept photos of your form, we can only accept scanned copies.
If I want to keep all my coverages the same as I have right now, what do I need to turn in?
If you are enrolled in a Kaiser, Anthem, Delta or VSP plan and are not adding or removing dependents, there is NO need to submit anything. Both Health In-Lieu and Dental In-Lieu elections require annual re-enrollment, so YES you will need to submit forms to re-enroll for In-Lieu elections.
I am adding a dependent to my coverage, what should I send in?
If you are adding a new dependent, we only need their birth certificate if they are your natural child. For other dependents, we need their birth certificate AND:
1) copies of your filed, stamped court papers for a guardianship or an adoption.
2) a copy of your marriage license for new a spouse.
3) a copy of your state issued Certificate of Domestic Partnership for a Domestic Partner.
In addition to the supporting documents listed above, you will need to complete and submit an Open Enrollment form (INS801).
My child is 19, can they still be covered under my medical, dental, and vision insurance?
Yes, your dependent children can now remain on your insurance coverages as follows:
- DeltaCare HMO and all Medical plans until age 26
- Delta Dental PPO and VSP vision insurance until age 24
Their coverage will be terminated at the end of their birth month when they are no longer eligible. To add dependent children to your coverages you must submit an Open Enrollment form (INS801).
What is Health In-Lieu (HIL) and Dental In-Lieu (DIL)?
If you are eligible to enroll in medical and/or dental insurance but you choose to not take the insurance through the City of San José, you can enroll in the Health In-Lieu or Dental In-Lieu credit program. Credits can be used toward future medical premiums. In-Lieu credit has no cash value. Enrollment in the In-Lieu credit program does not carryover from year-to-year automatically. You must re-enroll for In-Lieu every year by submitting an Open Enrollment form (INS801).
When will my new insurance cards arrive?
New insurance cards will arrive by the end of January 2025. If you need your new card before it arrives in the mail, please contact the provider and they can issue a temporary card. Please note, you will only get new cards if you are changing to a new medical insurance provider. Additionally, cards are only issued for medical insurance not for dental and vision coverage.
I have other questions; how can I get them answered?
Kaiser and Anthem hold webinars and office hours weekly! Please visit the “Webinars & Appointments” section for more information on dates and times (link at the top right of this page). You can also email SJROpenEnrollment@sanjoseca.gov, call ORS at: (408) 794-1000, or toll-free at (1-800) 732-6477.