Medical Insurance

Plan Providers

Click here to visit Kaiser Permanente's website

1-800-464-4000
Group #887 (Northern CA)
Group# 230179 (Southern CA)

Kaiser NORCAL and SOCAL have service area zip code requirements. Please verify that your zip code is in the following files prior to submitting your Open Enrollment form: 
Medicare Non-Medicare

Kaiser NORTHWEST has service area zip code requirements. Please verify that your zip code is in the following files prior to submitting your Open Enrollment form:  
Medicare Non-Medicare 

Kaiser HAWAII has service area zip code requirements. Please verify that your zip code is in the following files prior to submitting your Open Enrollment form:  
Medicare Non-Medicare 

 

Click here to visit Anthem's website

Anthem MEDICARE Customer Service
(833) 848-8730
Anthem MEDICARE Rx Pharmacy Customer Service
(833) 285-4630

Anthem First Impressions
Phone: (833) 848-8729

Anthem PPO Plans are nationwide and do not require a California residence.

Click here to visit Anthem's website

Anthem NON-MEDICARE Commercial Customer Service
(844) 963-0448
Anthem Commercial NON-MEDICARE Rx Pharmacy Customer Service
(833) 261-2460

NOTE: You can also email your question to our Anthem Concierge Service Representative:

Tanya Astar
Email: Tanya.Astar@anthem.com
Phone: (408) 794-1044

Anthem HMO has service area zip code requirements. Please verify that your zip code is in the following file prior to submitting your Open Enrollment form: 
Non-Medicare

Anthem HMO Plans are for members who reside in California.
Anthem PPO Plans are nationwide and do not require a California residence.

Non-Medicare

Rates

• Member Only Rates
• Member + Spouse Rates
• Member + Child(ren) Rates
• Member + Spouse + Child(ren) Rates
• KP Hawaii and Northwest Rates

Plan Comparison

• Non-Medicare Plan Comparison

Anthem Blue Cross

Plan Summaries

• Anthem $20 Copay Traditional HMO Summary of Benefit
• Anthem $20 Copay Select HMO Summary of Benefit
• Anthem $1500 Deductible Select HMO Summary of Benefit
• Anthem $100 Deductible Classic PPO Summary of Benefit
• Anthem $100 Deductible Select PPO Summary of Benefit
• Anthem $2500 Deductible Classic PPO HSA Compatible Summary of Benefit

Kaiser California

Plan Summaries

• Kaiser NorCal $25 Copay HMO Summary of Benefits
• Kaiser NorCal $1500 Deductible HMO Summary of Benefits
• Kaiser NorCal $3200 High Deductible HMO Summary of Benefits
• Kaiser SoCal $25 Copay HMO Summary of Benefits
• Kaiser SoCal $1500 Deductible HMO Summary of Benefits
• Kaiser SoCal $3200 High Deductible HMO Summary of Benefits

Kaiser Hawaii and Northwest

Plan Summaries

• Kaiser Hawaii $15 Copay Benefit and Payment Chart
• Kaiser NW Summary of Medical Benefits

Annual Plan Summary of Benefits and Coverage (SBCs)

• KPNW $25 Copay SBC

For information on plan services and wellness resources from our providers, visit the “Additional Benefits” Tab! 

Medicare

VEBA

Health In-Lieu

Health In-Lieu and Dental In-Lieu Premium Credit Program 

Annual Re-enrollment is Required! 

Effective March 31, 2017 (P&F) and June 16, 2017 (FCERS), members and their surviving spouses, surviving domestic partners, and/or children who are eligible for medical insurance coverage may, instead of receiving such coverage, choose to receive a credit for an amount equal to twenty-five percent (25%) of the monthly premium of the lowest cost medical plan and the lowest cost dental plan. Such credited amounts can only be applied toward the cost of such person's healthcare premiums actually incurred in future years.  

Frequently Asked Questions (FAQ) 

Question: If my spouse and I are both eligible for insurance through the City of San Jose (either as a retiree and/or as an employee) can I enroll in the retiree In-Lieu Credit program and get insurance through my spouse? 

Answer: Eligible retirees who receive healthcare coverage as a dependent of another City employee or retiree are eligible for the single in-lieu premium credit. He or she is not eligible for the family in-lieu premium credit. 

Question:  If I accumulate credits but I am unable to use them because my health insurance premiums are zero, can I receive my In-Lieu credits as a cash payment? 

Answer: In no event can a member, surviving spouse, surviving domestic partner, and/or eligible dependent receive the in-lieu credits as cash. In-Lieu credits may only be applied to the cost of future premiums for coverage. If a member and/or the member's eligible dependents do not use the accumulated credits while eligible for healthcare coverage, any remaining credits will be forfeited.  

Question: If I am enrolled in the retiree Health-In-Lieu credit program when I turn 65, do I have to enroll in Medicare Parts A&B? 

Answer: Any member who is eligible for healthcare benefits and who waives coverage will not be required to enroll in Medicare Parts A&B when they turn 65. However, if such member later chooses to enroll in a healthcare plan, he or she will be required to enroll in Medicare Parts A&B and any charges or penalties imposed by Medicare associated with enrollment outside the "initial enrollment period" shall be borne by such member. 

Question: If I enroll in the In-Lieu credit program and subsequently pass away, can my eligible dependents use my accumulated credits if they are eligible for medical coverage after my death? 

Answer: Yes. The credits are earned by the family and can be used by your eligible dependents to cover future medical insurance premiums. 

Question: Since dental insurance is a no-cost benefit for eligible retirees, how can I use my Dental In-Lieu credits? 

Answer:  Accumulated Dental in-lieu credits can be applied to future medical insurance premiums. 

Question: Why do I have to re-enroll in the In-Lieu Credit program each year?  

Answer: Annual re-enrollment is mandated by the San Jose Municipal Code. You must submit an annual Open Enrollment form to continue your enrollment in the In-Lieu Credit program each year.  

Question: Where do I go to see my In-Lieu credit balance?   

Answer: Your In-Lieu credit balances are shown on your monthly pay stub. Your stub includes your lifetime balance (if you have been in the program for more than one year) as well as your accumulated balance for the current year. 

Question: Where can I see the monthly In-Lieu credit amounts?   

Answer: Both the dental in-lieu and medical in-lieu monthly credit amounts are shown at the bottom of each page of the medical rate sheets and are posted on www.sjretirement.com. In-Lieu credits differ based on the level of coverage for which you are eligible i.e. Member Only, Member + Spouse/Domestic Partner, Member + Child(ren), and Member + Spouse/Domestic Partner and Children.  

Forms

Forms Will Be Accepted Beginning November 1^st

Open Enrollment Change Forms

• INS 801 Open Enrollment Election Form
• INS 802 Open Enrollment VEBA Election Form

Medicare Forms

• Anthem Medicare Advantage PPO Enrollment Form
• Kaiser NorCal Senior Advantage Enrollment Form fillable
• Kaiser SoCal Senior Advantage Enrollment Form fillable
• Kaiser NW Medicare Advantage Enrollment Form fillable
• Kaiser HI Senior Advantage Group Enrollment Form fillable
• Kaiser Senior Advantage Disenrollment Form

Additional Benefits

For information on additional plan benefits, please visit the main ORS web site. 

For Additional Benefits for Police & Fire members, click here 

For Additional Benefits for Federated members, click here