Employee Benefits Portal
Learning about your options: Before you make any decisions about your health plan, you need to understand what each plan offers. The 2024 Health Benefit Summary booklet is the place to go for this information. It will detail what is covered by each plan, any costs associated with them (like copayments or deductibles), and how to use the plan (like whether you need referrals to see specialists).
When can you make changes to your plan: The Health Program Guide describes how and when you can make changes to your plan (including what supporting documents you will need). It also describes how life changes or changes in your employment status can affect your benefits and eligibility.
Requesting a change to your health plan: You’ll need to fill out the Health Benefits Plan Enrollment Form.
Submitting your form: The completed form needs to be returned to your HR department (hr@cityofpaloalto.org) along with any supporting document(s) (for example, if you're adding a new dependent to your plan, you need to provide proof of their relationship to you – see “The Health Program Guide” above for required documents).
Key takeaway: It's crucial to review the health plan information carefully and submit your enrollment or change form correctly and on time to ensure you have the coverage you need.
HMO (Health Maintenance Organization)
Lower Costs: HMOs typically have lower monthly premiums and lower out-of-pocket costs like copays.
Primary Care Physician (PCP) Required: You must choose a PCP who acts as a gatekeeper for your care. You need referrals from your PCP to see specialists.
Network Restrictions: You can generally only see doctors and hospitals within the HMO's network, except in emergencies.
Less Flexibility: HMOs offer less flexibility in choosing providers and may require pre-authorization for certain procedures.
PPO (Preferred Provider Organization)
Higher Costs: PPOs usually have higher monthly premiums and may require you to meet a deductible before coverage kicks in.
No PCP Required: You don't need a PCP and can see any doctor you want, although staying within the network results in lower out-of-pocket expenses.
More Flexibility: PPOs offer more flexibility to see specialists without referrals and provide some coverage for out-of-network care if needed.
Deductibles and Coinsurance: You'll likely have a deductible to meet, and after that, you may share the cost of care through coinsurance (e.g., you pay 20%, the plan pays 80%).
Which is Right for You?
HMO: If you prioritize lower costs and don't mind having a PCP coordinate your care, an HMO might be a good fit.
PPO: If you value flexibility and want the freedom to choose your own doctors, even if it means higher costs, a PPO might be a better choice.
Important Note: The specifics of HMO and PPO plans can vary, so it's crucial to review the plan details carefully before making a decision.
Spouse
Registered domestic partner
Children (natural, adopted, domestic partner’s, or step) up to age 26
Children, up to age 26, if the employee has assumed a parent-child relationship and is considered the primary care parent
Certified disabled dependent children age 26 and older
The City of Palo Alto offers a cash incentive program to employees who have other medical insurance options. If you're a regular employee and you (and/or your dependents) are covered by another health plan (like through your spouse's job or an association), you can waive the City's health insurance and enroll in the Medical Waiver Program to receive $284 per month.
Here's how it works:
You have options: You can waive coverage for yourself, your spouse/domestic partner, or your dependents and submit the Waiver of City of Palo Alto Medical Coverage Affidavit to enroll in the program.
Get paid to opt out: If you enroll in the Medical Waiver Program, you'll get a monthly payment of $284.
Examples of waivers eligible for this payment are:
Employee waives all applicable City medical coverage; or
Employee is eligible to enroll his or her spouse or registered domestic partner and waives medical coverage for the spouse or registered domestic partner; or
Employee has additional eligible dependents and waives family-level medical coverage.
Employee must provide proof of alternate coverage for all individuals that are being waived.
Medical Waiver Policy
Your coverage will begin on the first day of the following month in which you turn in your completed enrollment package. You have 60 days from the date of the life event to turn in your completed enrollment package.
NOTE: It is your responsibility to verify that your doctor is accepting the plan you select. After using tool below, it is highly recommended that you call your medical provider to confirm that they accept the medical plan you are selecting.
Please use the links below to search for doctors and networks provided by each plan.
You can access your plan information, including your medical card, by creating an online account on your Health Plan providers website. For Example: If you have Kaiser, please go to Kaiser's Website to create an account.
All health plan websites and contact information can be found the CalPERS Plan & Rates page.
As an employee at the City of Palo Alto, you have access to comprehensive medical plans for you and your family through the CalPERS Health Benefits Program.
The CalPERS Health Benefits Program is a nationally recognized leader in the healthcare industry. They help us deliver quality, equitable, and affordable health care for our employees. CalPERS is the largest purchaser of public employee health benefits in California, and the second largest public purchaser in the nation after the federal government
MEDICAL BENEFITS
