Represented and excluded employees who reside in an area with no Health Maintenance Organization (HMO) option available through the CalPERS Health Program. (State annuitants living in California are also eligible to participate in the RHCEP. Their reimbursements are based on the type of plan in which they are enrolled. See item 16).
No enrollment form is required - enrollment is automatic, based on residence zip code. To determine zip code eligibility, please click here or you may contact DPA for assistance at (916) 327-1439 or 327-1092.
Employees must be enrolled in a CalPERS-approved health plan in an area where there is no contracted HMO available - e.g., PERSCare, PERS Choice.
The RHCEP applies to active employees and State annuitants living in California.
Employees enrolled in Medical Reimbursement Accounts under the FlexElect program are eligible to participate in this program. However, employees may not be reimbursed for the same medical expense from both programs.
Employees enrolled in the cash option of the FlexElect program are not eligible for this program.
Permanent Intermittent (P.I.) employees who qualify for health benefits are eligible for this program, subject to the same program criteria as full-time employees.
Employees on an active leave whose health benefits are continued are eligible.
Deductibles and co-insurance costs for eligible employees and their enrolled dependents are reimbursable expenses. A deductible is the annual amount of out-of-pocket expenses that a State employee must pay before the health plan begins paying for expenses. Co-insurance is the cost sharing by the health plan and State employee of medical expenses at a specified ratio. For example, the co-insurance ratio for PERSCare is typically 90% for the health plan, and 10% for the employee. PERS Choice generally has an 80% plan / 20% employee co-insurance ratio.
Effective January 1, 2001 portions of premium subsidies are reimbursable under the RHCEP. The premium subsidies are included in the annual maximum allocated to eligible employees - currently $1500 per fiscal year. Premium subsidies will be subject to taxation.
Yes. In order to receive a reimbursement from the RHCEP, employees must first incur expenses that qualify for reimbursement.
No reimbursement of eligible medical expenses will be processed unless it is documented on an Explanation of Benefits form (EOB), which is provided by the health plan.
Application Software, Inc. (ASI) processes all claims for reimbursement on behalf of DPA. Employees must submit a completed RHCEP Claim Form (DPA 678) and a copy of their Explanation of Benefits (EOB) to:
Deductible and co-insurance reimbursements are "tax neutral" and will not affect employees' state or federal tax base. However, the payment of the premium subsidies to employees will be subject to taxation.
The maximum amount of reimbursable expenses for active employees participating in the RHCEP is determined through collective bargaining agreements. All contracts currently provide up to $1,500 per employee, per fiscal year. Employees may also qualify for an additional, secondary reimbursement as described in Item 13.
All requests for reimbursement under the RHCEP for each fiscal year (ending June 30th) must be received by ASI no later than the following September 15th.
The State Controller's Office will mail out reimbursement checks once a month. Payment of premium subsidies is currently issued annually by the State Controller's office at the end of each fiscal year (after the runout period of Septemver 15th). The premium payment will be distributed from each employee's respective department, similar to a payroll warrant. The Program is not available through Electronic Fund Transfer (EFT) or Direct Deposit.
As a result of collective bargaining agreements, active employees are eligible for a secondary reimbursement following the September 15th deadline each fiscal year. Any unused portion of an employee's maximum reimbursement allotment remaining at the end of the fiscal year will be "rolled" into a pool of money by each collective bargaining unit. Employees of each bargaining unit who have been reimbursed their maximum amounts will have the opportunity to request reimbursement of expenses exceeding the fiscal year maximum from their specific bargaining unit pool. This secondary reimbursement will be computed on a proportionate basis to the amounts claimed by all eligible employees in the bargaining unit, and the total available funds in the bargaining unit account.
All excluded employees will be combined into one pool for the secondary reimbursement.
It is anticipated that the secondary reimbursement for each fiscal year will be completed no later than October 30th of the subsequent fiscal year.
Any unused money in a collective bargaining unit pool will roll over into the same collective bargaining unit pool for use in the secondary distribution process the following year.
RHCEP reimbursements for eligible State annuitants are dependent on the type of plan they are enrolled in (Basic Plan or Supplement to Medicare Plan). For details regarding RHCEP reimbursements for annuitants, please contact DPA Benefits at (916) 327-1439 or 327-1092.
