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Mandatory Open Enrollment Forms

Deferred Compensation Open Enrollment Forms

Placer County offers two voluntary deferred compensation programs under IRS Code 457 and 401(k) through MassMutual and CalPERS/VOYA. These plans allow you to set aside additional money for retirement on a pre-tax basis with a minimum contribution of $10 per pay period.

CalPERS/VOYA    https://calpers.voyaplans.com
Richard Berg           richard.berg@voya.com

MassMutual            www.massmutual.com/serve
David McCray        davidmccray@massmutual.com

CalPERS 401k New Enrollment Form
CalPERS 457 Beneficiary Change Form
CalPERS 457 New Enrollment Requires Beneficiary Form
MassMutual 401k New Enrollment with Beneficiary Form
MassMutual 457 New Enrollment with Beneficiary Form

Health Open Enrollment Forms

Placer County provides group health insurance through HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations).

HMOs generally pay 100% of the cost of care after a co-payment, but require you to use in-network providers and have your care coordinated through a designated Primary Care Physician.

Anthem Blue Cross (Select & Traditional)
(855) 839-4524 www.anthem.com/ca/calpers/HMO

Blue Shield Access+
(800) 334-5847 www.blueshieldca.com/calpers

Health Net SmatCare
(888) 926-4921 www.healthnet.com/calpers

Kaiser Permanente
(800) 464-4000 www.kp.org/calpers

United Healthcare
(877) 359-3714 www.uhc.com/calpers

Western Health Advantage
(888)942-7377 www.westernhealth.com/calpers

PPOs generally pay a percentage of the cost of care after co-pay and deductible requirements are met. The services of in-network providers are paid at a higher percentage than out-of-network providers.

PERSCare / PERS Choice / PERS Select
(877) 737-7776 www.anthem.com/ca/calpers

PORAC (DSA/Safety Mgmt Only)
(800) 937-6722 www.porac.org

2018 Health Benefit Summary

Affidavit of Parent Child Relationship

CalPERS Declaration of Health Form

CalPERS Physician Selection Form

CalPERS Zip Code Election Form

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