2022 Open Enrollment General Information


If I want to keep my coverage the same as I have right now, what do I need to turn in?
Nothing! We only need a form if you want to make a change. The only exception to this rule is the In-Lieu Credit Program which requires a new enrollment form for every plan year.


Who are the medical insurance vendors for 2022?
Anthem Blue Cross (Anthem) and Kaiser Permanente (Kaiser) will remain the 2022 health vendors. A new pilot Traditional HMO plan is being offered by Anthem. This new HMO plan has identical benefits as the Select HMO plan, just a larger network including PAMF. All other medical plans are not changing and the existing plan designs are staying the same.


Are there any changes to the Dental and Vision plans?
The Delta Dental PPO plan increased their annual maximum out-of-pocket from $1,500 to $2,100 with no rate increase. VSP increased their frame allowance from $115 to $150 and added Walmart/Sam’s Club as a retail chain provider with no rate increase.


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/dependent, additional documents are required. These additional documents can be mailed through U.S. postal service, dropped off at the ORS (call or email for a drop-off appointment), or scanned and emailed to SJROpenEnrollment@SanJoseca.gov. Please include your full name when sending emails.


I am adding a dependent to my coverage, what should I send in?
If you are adding a new dependent, we need the birth certificate if s/he is your natural child. For other dependents, we need the birth certificate AND:
1) for a guardianship or an adoption, copies of your filed, stamped court papers.
2) for adding a spouse, we need a copy of your marriage license, and
3) for a Domestic Partner the state issued Certificate of Domestic Partnership.
4) If the child is older than age 19, we will also need proof of full-time student status for enrollment in dental and/or vision coverage.
In addition to the supporting documents listed above, you will need to complete and submit the Open Enrollment form (INS801).


My child is 24, can I still add them to my medical coverage?
Yes! Medical coverage is extended to dependents up to age 26. Dental and vision insurances stop at age
19 if your child does not continue their education. If your child is a full-time student, they can remain on your dental and vision coverage through age 24.


My child is 19, can they still be covered under my medical, dental and vision coverage?
Are they a full-time student? If yes, then your child can stay on your medical, dental and vision coverage. If they are not enrolled as a full-time student, then they can only be on your medical insurance until age 26.
We require proof of enrollment with an accredited university or trade school.


My child is a Full-Time Student, what documents should I send to ORS as proof of enrollment?
To cover your full-time student dependent on your dental and vision coverage, you must provide proof of enrollment from an accredited university or trade school. The proof must show that the student is enrolled in 12 or more units. Documentation must identify the following:
1. Name of student,
2. Name of school,
3. Current enrollment period, and
4. Number of credits (must be 12 or more).


What is Health In-Lieu (HIL) and Dental In-Lieu (DIL)?
Retirees now have an In-Lieu credit program. 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, then you can enroll in the Health InLieu or Dental In-Lieu credit program. These credits accumulate in an account for you. If in the future you decide to enroll in a City of San José medical/dental plan, you can use your in-lieu credits to pay premiums. Enrollment in the In-Lieu credit program does not carryover from year-to-year automatically. You must re-enroll for In-Lieu every year.

When will I get my new insurance cards?
New insurance cards should arrive by the end of January 2022. 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! This year we are accepting Medicare Plan changes electronically. Please note, changing your Medicare Plan coverage requires you to sign additional forms that cannot be completed on the web. ORS will contact you and send you these additional forms if they are needed in relation to your request change. If you are having trouble logging into your new Member Direct account, please email
Retirement.Dept@sanjoseca.gov call (408) 794-1000 or toll free at (1-800) 732-6477 and our IT Staff can assist you.


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 SilverSneakers.com/starthere.
Kaiser will offer their Silver and Fit gym benefits in 2022. To learn more about Silver and Fit, call (877) 427-4788 or visit SilverandFit.com


What are Kaiser’s Meals and Transportation benefits?
Kaiser’s Meals and Transportation benefits offers 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 their dependent(s) do not have Medicare coverage. Your coverage is split between a commercial (non-Medicare) plan and a Medicare Advantage plan.


I have other questions, how can I get them answered?
Email: Retirement.Dept@sanjoseca.gov or call ORS at: (408) 794-1000 or toll free at (1-800) 732-6477.