Article 4 - Eligibility

California Government Code — §§ 22800-22826

Sections (24)

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

(a)An employee or annuitant is eligible to enroll in an approved health benefit plan, in accordance with this part and the regulations of the board.

(b)Regulations may provide for the exclusion of employees on the basis of the nature, conditions, and type of their employment, including, but not limited to, short-term appointments, seasonal or intermittent employment, and employment of a like nature. However, no employee may be excluded solely on the basis of the hazardous

nature of the employment.

§ 22802

Amended by Stats. 2014, Ch. 28, Sec. 50. (SB 854) Effective June 20, 2014.

(a)An annuitant whose retirement allowance is not sufficient to pay his or her required contribution for the health benefit plan in which he or she is enrolled may only remain enrolled if the annuitant pays to the board the balance of the contributions plus the related administrative costs, as determined by the board.

(b)(1) The annuitant shall pay the complementary annuitant premium by remitting to the board quarterly payments in advance, or by alternative monthly payment as determined by the board.

(2)The board may charge each annuitant who elects to pay the complementary annuitant premium an

initial setup charge and a monthly maintenance charge, in amounts sufficient to ensure the ongoing support of the complementary annuitant premium program.

(3)If payments are not received by the 10th of the month for the following month, coverage shall be terminated and may not be resumed until the next open enrollment period.

(c)Upon receipt of a written application, the benefits provided by this section shall commence on the first day of the month following receipt of the application and the payment required by the board.

(d)The board has no duty to identify, locate, or notify any annuitant who may be eligible for the benefit provided by this section.

(e)Any complementary annuitant premium or any balance of unpaid health benefit plan premiums that

accrues and remains unpaid at the time of the death of an annuitant shall be paid in accordance with the sequence prescribed in Section 21506.

(f)All moneys received pursuant to this section shall be deposited in the Public Employees’ Contingency Reserve Fund in the account provided by subdivision (f) of Section 22910.

§ 22803

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

An out-of-state employee shall be eligible for enrollment, in accordance with reasonable rules as the board may prescribe, to receive the benefits provided by this part.

§ 22805

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

An employee receiving full-time service credit pursuant to Section 20900 may continue enrollment in a health benefit plan.

§ 22806

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

(a)With respect to state officers and employees, a permanent intermittent employee who has an appointment of more than six months and works at least half-time shall be eligible to enroll in a health benefit plan within 60 calendar days after having been credited with a minimum of 480 paid hours within a designated six-month period. The designated six-month periods are January 1 to June 30, inclusive, and July 1 to December 31, inclusive, of each calendar year. To continue benefits, a permanent intermittent employee must be credited with a

minimum of 480 paid hours in a designated six-month period or 960 paid hours in two consecutive periods.

(b)Permanent intermittent employees who are represented by State Bargaining Unit 6 may enroll in a health benefit plan within 60 calendar days following graduation from the academy of the Department of Corrections or the Department of the Youth Authority. To continue benefits, a permanent intermittent employee must be credited with a minimum number of hours, as provided in subdivision (a).

§ 22807

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

(a)Notwithstanding subdivision (b) of Section 22772, a contracting agency may, by resolution filed with the board, deem all permanent or regular employees, except members of the State Teachers’ Retirement Plan, who have an appointment of six months or longer but are employed less than half-time, to be employees subject to this part.

(b)Notwithstanding subdivision (b) of Section 22772, a contracting agency with employees who are members of the State Teachers’ Retirement Plan

may, by resolution filed with the board, deem any of the following to be employees subject to this part:

(1)Regular, permanent, probationary, or temporary employees or substitutes who have an appointment for at least a semester, for six months, or for half of the school year, but are employed less than half-time.

(2)Substitutes who have an appointment for 100 days or more in the school year.

§ 22807.5

Added by Stats. 2023, Ch. 195, Sec. 7. (SB 142) Effective September 13, 2023.

Notwithstanding subdivision (b) of Section 22772, a contracting agency that is a community college district may, by resolution filed with the board, deem all part-time faculty employees who have an appointment of at least one semester and whose teaching assignment with one or more community college districts equals or exceeds two courses or 40 percent of the cumulative equivalent of a minimum full-time teaching assignment, to be employees subject to this part.

§ 22808

Amended by Stats. 2012, Ch. 665, Sec. 148. (SB 1308) Effective January 1, 2013.

An employee enrolled in a health benefit plan under this part shall be entitled to have his or her coverage and the coverage of any family members continued for the duration of a leave of absence, upon his or her application and upon assuming payments of the contributions otherwise required of the employer, if any of the following apply:

(a)A leave of absence is granted to the employee without pay under the State Civil Service Act and the rules or regulations of the Department of Human Resources, or other comparable leave.

(b)The employee is laid off and has not yet obtained other employment, for a period of up to one year.

(c)The employee is employed by the California State University and is granted a leave of absence for more than half-time.

§ 22809

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

An employee of a contracting agency and his or her family members may continue enrollment in a health benefit plan under this part if the employee is granted a leave of absence by the contracting agency for military duty. The coverage may continue for up to one year.

§ 22810

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

A Member of the Legislature may enroll in a health benefit plan. The contributions of the member shall be the total cost of his or her coverage and the coverage of any family members, less the amount contributed pursuant to Section 8901.6 by the state.

§ 22811

Amended by Stats. 2012, Ch. 665, Sec. 149. (SB 1308) Effective January 1, 2013.

Notwithstanding any other provision of this part, a former Member of the Legislature who has served six or more years as a Member of the Legislature may elect, within 60 days after permanent separation from state service, to enroll or continue enrollment in a health benefit plan and dental care plan provided to annuitants. Upon that election, the former member shall pay the total premiums related to that coverage and an additional 2 percent thereof for the administrative costs incurred by the board and the Department of Human Resources in administering this section.

The health and dental benefits shall be provided without discrimination as to premium rates or benefits coverage. A person who subsequently terminates his or her coverage under this section may not reenroll

pursuant to this section.

§ 22812

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

(a)A former legislative employee who separates from employment while enrolled in a health benefit plan provided by his or her employer, by reason of layoff, involuntary termination, or retirement may enroll in a health benefit plan within 60 days of separation from employment and, thereupon, shall be deemed to have been enrolled on the date of the separation from employment.

(b)An eligible survivor of a

legislative employee who was enrolled in a health benefit plan provided by the employer at the time of death may, within 60 days of the death of the employee, enroll in a health benefit plan and, thereupon, shall be deemed to have been enrolled on the date of the employee’s death.

§ 22814

Amended (as amended by Stats. 2022, Ch. 531, Sec. 1) by Stats. 2023, Ch. 159, Sec. 6. (SB 885) Effective January 1, 2024.

(a)A judge who retires pursuant to Chapter 11 (commencing with Section 75000) of Title 8, but is not yet receiving a pension, may continue their coverage and the coverage of any family members for the duration of the leave of absence, upon their application and upon assuming payment of the contributions otherwise required of the employer.

(b)(1) A judge who leaves judicial office pursuant to subdivision (b) of Section 75521 and has not attained 65 years of age may continue their coverage and the coverage of any family members upon assuming payment of the contributions otherwise required of the employer. The judge shall also pay an additional 2 percent of the premium amount to cover administrative expenses incurred by the system or the

Department of Human Resources.

(2)An election to continue coverage under this subdivision shall be made within 60 days of permanent separation. A retired judge who cancels that coverage may not reenroll.

(3)Upon attaining 65 years of age, a retired judge who has continuous and uninterrupted coverage pursuant to this subdivision shall be entitled to the applicable employer contribution.

(c)(1) A judge who retires pursuant to Section 75522.5, but is not yet receiving a retirement allowance, may continue coverage and the coverage of any family members upon assuming payment of all contributions, including those otherwise required of the employer. The judge shall also pay an additional 2 percent of the premium amount to cover the reasonable administrative expenses incurred by the system or the

Department of Human Resources.

(2)Upon commencement of the judge’s retirement allowance, the judge shall become an annuitant, as defined in subdivision (a) of Section 22760, and thereupon the judge may continue the judge’s health plan enrollment, enroll in a health benefit plan within 60 days of the commencement of the judge’s retirement allowance, or enroll during any future open enrollment period, without discrimination as to premium rates or benefit coverage.

(d)(1) The surviving spouse of a deceased judge who retired pursuant to Section 75522.5, but was not yet receiving a retirement allowance upon the judge’s death, may continue coverage and the coverage of any family members upon assuming payment of all contributions, including those otherwise required of the employer. The surviving spouse shall also pay an additional 2 percent of the premium amount

to cover the reasonable administrative expenses incurred by the system or the Department of Human Resources.

(2)Upon commencement of the surviving spouse’s monthly allowance, the surviving spouse shall become an annuitant, as defined in subdivision (b) of Section 22760, and thereupon the surviving spouse may continue the surviving spouse’s health plan enrollment, enroll in a health benefit plan within 60 days of the commencement of the surviving spouse’s monthly allowance, or enroll during any future open enrollment period, without discrimination as to premium rates or benefit coverage.

§ 22815

Amended by Stats. 2012, Ch. 665, Sec. 151. (SB 1308) Effective January 1, 2013.

(a)The following persons are eligible for enrollment as provided in this section:

(1)A Member of the Legislature or an elective officer of the state whose office is provided by the California Constitution who meets all of the following conditions:

(A)Has at least eight years of credited service.

(B)Permanently separates from state service on or after January 1, 1988, and more than 10 years before his or her minimum age for service retirement, or is an inactive member of the Legislators’ Retirement System pursuant to Section 9355.2.

(C)Elects to remain a member of a state retirement system supported in whole or in part by state funds, other than the University of California Retirement System.

(2)An exempt employee who meets all of the following conditions:

(A)Has at least 10 years of credited state service that includes at least two years of credited service while an exempt employee.

(B)Permanently separates from state service on or after January 1, 1988, and more than 10 years before his or her minimum age for service retirement.

(C)Elects to remain a member of a state retirement system supported in whole or in part by state funds, other than the University of California Retirement System.

(b)During the period he or she is not yet receiving a retirement allowance, a person described by subdivision (a) may continue enrollment in a health benefit plan or dental care plan without discrimination as to premium rates or benefit coverage, upon assuming payment of the contributions otherwise required of the former employer on account of his or her enrollment and the employee contribution. The person shall also pay an additional 2 percent of the premium amount to cover administrative expenses incurred by the system or the Department of Human Resources. An election to continue coverage under this section shall be made within 60 days of permanent separation.

(c)A person who receives coverage pursuant to this subdivision, and subsequently terminates that coverage, may not be allowed to reenroll and may not enroll as an annuitant pursuant to subdivision (d).

(d)Upon retirement and receipt of a retirement allowance, a person described in subdivision (b) may elect to continue enrollment in a health benefit plan or dental care plan without discrimination as to premium rates or benefit coverage, at which time the state shall assume payment of the employer contribution and the person shall thereafter be deemed an annuitant.

(e)The board has no duty to locate or notify any person who may be eligible to enroll pursuant to this section.

§ 22816

Amended by Stats. 2012, Ch. 665, Sec. 152. (SB 1308) Effective January 1, 2013.

(a)A person who meets all of the criteria of an annuitant, as defined in subdivision (f) or (g) of Section 22760, other than the condition of receiving a retirement allowance under a retirement system supported in whole or in part by state funds, may continue enrollment in a health benefit plan or dental care plan provided to annuitants without discrimination as to premium rates or benefits coverage, upon assuming payment of the contributions otherwise required of the former employer on account of his or her enrollment and the employee contribution. The person shall also pay an additional 2 percent of the premium amount to cover administrative expenses incurred by the system or the Department of Human Resources. An election to continue coverage under this section shall be made within 60

days of permanent separation.

(b)A person who receives coverage pursuant to this subdivision who subsequently terminates that coverage may not reenroll. However, termination under this subdivision does not affect an annuitant’s rights under Section 22817. The benefits authorized by Section 22817 and this section are separate and distinct benefits.

(c)The board has no duty to locate or notify any person who may be eligible to enroll pursuant to this section.

§ 22817

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

(a)An annuitant, as defined in subdivision (f) or (g) of Section 22760, may, upon assuming payment of the employee contribution, enroll in a health benefit plan or dental care plan without discrimination as to premium rates or benefit coverage, at which time the state shall assume payment of the employer contribution.

(b)The board has no duty to locate or notify any person who may be eligible to enroll pursuant to this section.

§ 22818

Amended by Stats. 2005, Ch. 418, Sec. 17. Effective January 1, 2006.

(a)In order to receive any benefit provided by this part, an employee or annuitant shall provide, upon request of the board, any of the following:

(1)Proof in a manner designated by the board that the employee or annuitant and his or her domestic partner have filed a valid Declaration of Domestic Partnership pursuant to Section 298.5 of the Family Code or have established a valid domestic partnership, as defined by his or her contracting agency in accordance with subdivision

(b)of Section 22771.

(2)A marriage certificate.

(3)A signed statement indicating that the employee or annuitant agrees that he or she may be required to reimburse the employer, the health benefit plan, and the system for any expenditures made for medical claims, processing fees, administrative expenses, and attorney’s fees on behalf of the family member, if any of the submitted documentation is found to be inaccurate or fraudulent.

(b)The employee or annuitant shall notify the employer or the board when a marriage is dissolved or a domestic partnership has terminated, as required by subdivision (c) of Section 299 of the Family Code, or as required by his or her contracting agency in accordance with subdivision (b) of Section 22771.

§ 22819

Amended by Stats. 2005, Ch. 418, Sec. 19. Effective January 1, 2006.

(a)A family member of a deceased employee of a contracting agency who is validly enrolled or is eligible for enrollment hereunder on the date of the employee’s death is deemed to be an annuitant under Section 22760, pursuant to regulations prescribed by the board.

(b)A contracting agency shall remit the amounts required under Section 22901 as well as the total amount of the premium required from the employer and enrollees hereunder in accordance with regulations of the

board. Enrollment of the annuitant and eligible family members shall be continuous following the death of the employee, or the effective date of enrollment, so long as the surviving family members meet the eligibility requirements of Section 22775 and regulations pertinent thereto. Failure to timely pay the required premiums and costs or the cancellation of coverage by the annuitant shall terminate coverage without the option to reenroll. The contracting agency may elect to require the family members to pay all or any part of the employer premium for enrollment.

(c)This section shall apply to a contracting agency only upon the filing with the board of a resolution of its governing board electing to be subject to this section.

§ 22819.1

Added by Stats. 2010, Ch. 639, Sec. 24. (SB 1139) Effective January 1, 2011.

(a)A family member of a deceased annuitant who retired from a contracting agency prior to the effective date of the agency’s contract to provide health coverage under this part, and who was validly enrolled in the agency’s health plan on the day prior to the effective date of the contract under this part, but who does not receive an allowance in place of the annuitant, is deemed to be an annuitant for purposes of Section 22760, pursuant to regulations prescribed

by the board.

(b)A contracting agency shall remit the amounts required under Section 22901 as well as the total amount of the premium required from the employer and enrollees in accordance with regulations of the board. Enrollment of the eligible family members shall be continuous following the death of the annuitant, or the effective date of enrollment, as applicable, so long as the surviving family members meet the eligibility requirements of Section 22775 and any regulations promulgated with respect to that section. Either a failure to timely pay the required premiums and associated costs of the coverage or the cancellation of coverage shall terminate the coverage without the option to reenroll. The contracting agency may elect to require the family members to pay all or any part of the employer premium for enrollment.

(c)This section shall apply to a contracting agency only

upon the filing with the board of a resolution of its governing board electing to be subject to this section.

§ 22820

Amended by Stats. 2021, Ch. 186, Sec. 11. (SB 634) Effective January 1, 2022.

(a)Upon the death, on or after January 1, 2002, of a firefighter employed by a county, city, city and county, district, or other political subdivision of the state, a firefighter employed by the Department of Forestry and Fire Protection, a firefighter employed by the federal government who was a resident of this state and whose regular duty assignment was to perform firefighting services within this state, or a peace officer as defined in Section 830.1, 830.2, 830.3, 830.31, 830.32, 830.33, 830.34, 830.35, 830.36, 830.37, 830.38, 830.39, 830.4, 830.5, 830.55, or 830.6 of the Penal Code, if the death occurred as a result of injury or disease arising out of and in the course of their official duties, the surviving spouse or other eligible family member of the deceased firefighter or peace officer, if uninsured, is deemed to be an

annuitant under Section 22760 for purposes of enrollment. All eligible family members of the deceased firefighter or peace officer who are uninsured may enroll in a health benefit plan of the surviving spouse’s choice. However, an unmarried child of the surviving spouse is not eligible to enroll in a health benefit plan under this section if the child was not a family member under Section 22775 and regulations pertinent thereto prior to the firefighter’s or peace officer’s date of death. A notification of the death of any firefighter or peace officer subject to this section may come from any reliable and verifiable source. Upon request, the employer of the deceased firefighter or peace officer shall provide to the board within 10 business days any updated contact information for a surviving spouse or family member who may be eligible for enrollment in a health benefit plan under this section.

(b)Upon notification, the board shall promptly

determine eligibility and shall forward to the eligible spouse or family member the materials necessary for enrollment. In the event of a dispute regarding whether a firefighter’s or peace officer’s death occurred as a result of injury or disease arising out of and in the course of their official duties as required under subdivision (a), that dispute shall be determined by the Workers’ Compensation Appeals Board, subject to the same procedures and standards applicable to hearings relating to claims for workers’ compensation benefits. The jurisdiction of the Workers’ Compensation Appeals Board under this section is limited to the sole issue of industrial causation and this section does not authorize the Workers’ Compensation Appeals Board to award costs against the system.

(c)(1) Notwithstanding any other provision of law, and except as otherwise provided in subdivision (d), the state shall pay the employer contribution

required for enrollment under this part for the uninsured surviving spouse of a deceased firefighter or peace officer for life, and the other uninsured eligible family members of a deceased firefighter or peace officer, provided the family member meets the eligibility requirements of Section 22775 and regulations pertinent thereto.

(2)The contribution payable by the state for each uninsured surviving spouse and other uninsured eligible family members shall be adjusted annually and be equal to the amount specified in Section 22871.

(3)The state’s contribution under this section shall commence on the effective date of enrollment of the uninsured surviving spouse or other uninsured eligible family members. The contribution of each surviving spouse and eligible family member shall be the total cost per month of the benefit coverage afforded to them under the plan less the portion

contributed by the state pursuant to this section.

(d)The cancellation of coverage by an annuitant, as defined in this section, shall be final without option to reenroll, unless coverage is canceled because of enrollment in an insurance plan from another source.

(e)For purposes of this section, “surviving spouse” means a spouse who was married to the deceased firefighter or peace officer on the deceased’s date of death and either was married for a continuous period of at least one year prior to the date of death or was married to the deceased prior to the date the deceased firefighter or peace officer sustained the injury or disease resulting in death.

(f)For purposes of this section, “uninsured” means that the surviving spouse is not enrolled in an employer-sponsored health plan under which the employer

contribution covers 100 percent of the cost of health care premiums.

(g)The board has no duty to identify, locate, or notify any surviving spouse or eligible family member who may be or may become eligible for benefits under this section.

§ 22822

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

No person is eligible for enrollment in a health benefit plan pursuant to this part as a family member if he or she becomes a family member of a surviving spouse of a deceased member of the system after the date of the member’s death.

§ 22823

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

(a)Notwithstanding Section 10270.5 of the Insurance Code, an employee who is enrolled in a board-approved health benefit plan sponsored by an employee organization that is the exclusive representative pursuant to the Ralph C. Dills Act (Chapter 10.3 (commencing with Section 3512) of Division 4 of Title 1) and who terminates his or her membership in the respective employee organization shall become ineligible for enrollment in the health benefit plan.

(b)Notwithstanding

subdivision (a), the employee may continue enrollment in the employee organization health benefit plan until he or she is notified by the employee organization of the loss of eligibility. Upon notification of the loss of eligibility, the employee within 60 days may change his or her enrollment to another health benefit plan for which the employee is eligible.

§ 22825

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

(a)An annuitant is not eligible to participate in a health benefit plan offered by the California Association of Highway Patrolmen unless the annuitant was enrolled in the California Highway Patrolmen Health Benefits Trust for a minimum of five years as an active employee.

(b)Notwithstanding subdivision (a), an annuitant that retires for disability before becoming eligible for service retirement may enroll in a health benefit plan offered by the California Association of

Highway Patrolmen if otherwise eligible.

(c)Former members of the California State Police are eligible to participate in a health benefit plan offered by the California Association of Highway Patrolmen, pursuant to subdivision (a) or (b). Former members of the California State Police who transferred to the California Highway Patrol and retired before January 1, 2003, are exempt from the five-year requirement.

(d)This section only applies to persons who first became employees of the California Highway Patrol on or after January 1, 1994.

§ 22826

Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.

For purposes of this part, service credit shall be determined according to the rules of the retirement system provided by the employer in which the employee participates. In the case of elected officials not eligible for participation in a retirement system, service credit shall be determined according to the number of years in office. In the elected official’s final year of office, a completed term of office shall be sufficient to earn one year of service credit for that final year of office.