Common use of Medical Insurance Under PEMHCA Clause in Contracts

Medical Insurance Under PEMHCA. The City agrees to maintain its contract with the Public Employees’ Retirement System (“PERS”) providing medical insurance coverage through the Public Employees’ Medical and Hospital Care Act (PEMHCA) plans. Eligibility of active represented employees and retired employees to participate in this program shall be in accordance with state law and regulations promulgated by PERS. An eligible unit member will be enrolled in the CalPERS PEMHCA Bay Area Kaiser Plan with employee-only coverage, unless the unit member submits an Employee Benefits enrollment form for a different PEMHCA health plan for enrollment of self and dependents, if any. The two (2) exceptions are 1) if a unit member has waived coverage, or 2) if a unit member is enrolled in PEMHCA under another health plan, as CalPERS does not permit dual enrollment. Eligible unit members may waive coverage in accordance with Section 8.5 of this Article and only if they submit evidence of coverage through an alternate group health plan provided by another employer or provider. Any new member who has not waived coverage and does not submit enrollment forms within sixty (60) days of eligibility will be enrolled in the CalPERS Bay Area Kaiser employee-only plan (“1 – Party”) by default. If dependent information is on file, the new member will be enrolled in the default CalPERS Bay Area Kaiser for member and spouse or family coverage for member, spouse, and dependent children. Any member requesting to change from the default CalPERS Bay Area Kaiser plan will be subject to the CalPERS PEMHCA enrollment waiting period of ninety (90) days, unless the plan change has been approved by CalPERS as a result of their Appeals process.