2023 Open Enrollment General Information

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 a new spouse or dependent, additional documents are required. These additional documents can be mailed through U.S. postal service, dropped off at the ORS, or scanned and emailed to SJROpenEnrollment@SanJoseca.gov. (ORS cannot accept photos of your form, we can only accept scanned copies). Please include your full name in the subject line when sending emails.

Who are the medical insurance vendors for 2023?
Anthem Blue Cross (Anthem) and Kaiser Permanente (Kaiser) will remain the 2023 health vendors. There are no new plans being added for the 2023.

Are there any changes to the medical plans for 2023?
Yes. There are two benefit enhancements related to Kaiser Senior Advantage in California. The annual out-of-pocket maximum per member is changing from $1,500.00 down to $1,000.00. Additionally, Kaiser Senior. Advantage members are receiving $70.00 quarterly which can be used to purchase over the counter and wellness products through Kaiser.

What factors are used to determine the medical insurance rates each year?
Rates are driven by enrollment numbers, use of services, and intensity of services provided. The City works closely with insurance vendors to minimize rate increases to the extent possible. If you have questions about your 2023 coverage, please join one of the scheduled webinars or schedule a personal appointment with Anthem or Kaiser. Go to the Webinars & Appointments tab on openenrollment.sjretirement.com for more information.

Are there any changes to the Dental and Vision plans?
The Delta Dental PPO and the DeltaCare HMO plans are not changing. However, the eligibility for your dependent children to be on your dental coverage is changing. For the Delta Dental PPO, dependents can remain on your coverage until age 24, DeltaCare HMO they can remain on your plan until age 26 regardless of their student status. For the two VSP vision insurance plans, nothing is changing except that your dependent children can remain on these plans until age 24 regardless of their student status.

If I want to keep all of my coverages the same as I have right now, what do I need to turn in?
You don’t need to turn in anything unless you want to continue your enrollment in In-Lieu. In-Lieu requires a new enrollment form for every plan year.

I am adding a dependent to my coverage, what should I send in?
If you are adding a new dependent who’s your natural child, we only need their birth certificate. For other dependents, we need their birth certificate AND one of the following:
            1) a copy 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 the Open Enrollment form (INS801).

How long can my child be covered under my medical, dental and vision plans?
New in 2023, your child no longer needs to be a full-time student to be covered under you dental, vision, and medical plans. Your dependent children can remain on your insurance coverages as follows:
            • Medical insurance - all plans until age 26
            • Dental insurance - DeltaCare HMO until age 26 and Delta Dental PPO until age 24
            • Vision insurance – VSP Signature and Choice plans until age 24
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 tihe Health In-Lieu or Dental In-Lieu credit program. Credits can be used toward future medical premiums. In-Lieu credit cannot be paid out in cash. 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 2023. 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. 

Can I submit Medicare insurance changes through my online Member Direct account?
Yes, we accept Medicare Plan changes electronically. Please note, changing your Medicare Plan coverage requires you to sign additional forms that cannot be completed electronically. Upon receiving your Open Enrollment form, ORS will send you the Medicare forms that are needed in order to complete your requested change. If you have difficulties with accessing your Member Direct account, please email Retirement.Dept@sanjoseca.gov call (408) 794-1000 or toll free at (1-800) 732-6477.

What are Silver Sneakers and Silver and Fit?
Silver Sneakers is Anthem’s gym benefit that comes with your Medicare Advantage plan enrollment. To get more information, such as what gyms you can access for free, please call 1-888-423-4632 or visit www.SilverSneakers.com

Silver and Fit is Kaiser’s gym benefit that comes with your Medicare Advantage plan enrollment. To learn more about Silver and Fit, call (877) 427-4788 or visit www.silverandfit.com.

What are Kaiser’s Senior Advantage Meals and Transportation benefits?
Kaiser’s Senior Advantage Meals and Transportation benefits offer 84 meals and up to 24 one-way trips (50 miles per trip) per calendar year. For more information, please refer to the Meals and Transportation flyers posted on the ORS Open Enrollment website (openenrollment.sjretirement.com).

What is Medicare Part D?
Medicare Part-D is prescription drug insurance offered through Social Security. For some, Part-D is free, but if your modified adjusted gross income is above a certain amount, you may pay a Part D income-related monthly adjustment amount (Part D - IRMAA). The City of San José Medicare plans (Anthem and Kaiser Sr. Advantage) will handle your enrollment into Part D.

What is a Medicare Split-Plan?
A split-plan is our terminology for medical insurance coverage where one person on the health plan has Medicare coverage and the others covered on the plan do not have Medicare coverage. Your coverage is split between a commercial (non-Medicare) plan and a Medicare Advantage plan.

Who do I contact if I have questions?
For questions about medical plans, please join one of the scheduled webinars or schedule a personal appointment with an Anthem or Kaiser representative. Go to the Webinars & Appointments tab on openenrollment.sjretirement.com for more information. For other questions, email Retirement.Dept@sanjoseca.gov or call ORS at: (408) 794-1000 or toll free at (1-800) 732-6477.