Medical

General Information

Must be Retired for disability or service directly from active service with either 15 years of San José service or receive allowance that is at least 37.5% of final comp.  

POLICE & FIRE RETIREES

Also eligible if member separates from service after 7/5/92, but prior to retirement with 20 years of San José service and leaves contributions in the retirement plan and former member receives an allowance (i.e., applies & qualifies for retirement). 

Eligible retirees have two (2) medical providers available to choose from: Kaiser Permanente and Anthem Blue Cross. Visit your health plan's website to learn how benefits, claims, and payment of claims are covered, as well as the service limitations and exclusions that may apply. Some health plans are available only in certain counties and/or ZIP Codes. Contact the health plan before enrolling to make sure they cover your ZIP Codes and that their provider network is accepting new patients in your area. 

Open Enrollment is an annual process that occurs every November 1 through November 30. During this time, you can enroll or change health plans, add eligible dependents, delete dependents, or cancel coverage. Changes made during Open Enrollment become effective January 1st. 


QUALIFYING LIVE EVENTS 

A Qualifying Life Event (QLE) is a specific life event that allows City of San José Retirees to request their benefit elections be changed outside of the annual Open Enrollment period. Qualifying events include, but are not limited to, the events below. An INS100 form and proof of the QLE are required within 30 days from the date of the event. Benefit changes will start the first of the month following the date of the event. 

See: Qualifying Life Events Reference Guide


HEALTH IN-LIEU 

Retirees now have an In-Lieu credit program. If you are eligible to enroll in medical insurance, but you choose to not take the insurance through City of San José, you can enroll in the Health 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 Retiree medical plan coverage, you can use your in-lieu credits to pay premiums.  Enrollment in the In-Lieu credit program does not carry over from year-to-year automatically.  You must re-enroll for In-Lieu every year during Open Enrollment. 


RATES AND EMPLOYER CONTRIBUTIONS 

Retirement System pays 100% of lowest-cost plan that is available to active City employees.  If retiree does not choose the lowest cost plan, retiree pays the difference between that premium and the premium for the lowest-cost plan. Medical Rates can be found under the Non-Medicare, Medicare, and VEBA tabs. 


ABOUT OUR PLANS 

  • HMO - A Health Maintenance Organization (HMO) plan provides health care from specific doctors and hospitals under contract with the plan. You pay co-payments for some services, but you have no deductible, no claim forms, and a geographically restricted service area. 
     
  • PPO - A Preferred Provider Organization (PPO) is similar to a traditional "fee-for-service" plan, but you must use doctors in the PPO provider network or pay higher co-insurance (percentage of charges). You must usually meet an annual deductible before some benefits apply. You're responsible for a certain co-insurance amount and the medical plan pays the balance up to the allowable amount. 
     
  • SPLIT PLANS - A split plan means at least one family member is enrolled in a Medicare health plan and at least one family member is enrolled in a Non-Medicare health plan through the same health carrier. All family members must have the same health carrier.