- 2022 Anthem Blue Cross – CalPERS: PERS Platinum Basic PPO Plan
- 2022 Anthem Blue Cross – CalPERS: PERS Gold Basic PPO Plan
- 2022 Anthem Blue Cross – CalPERS: Traditional HMO Plan
- 2022 Anthem Blue Cross – CalPERS: Select HMO Plan
- 2022 Blue Shield – CalPERS: Trio+ HMO
- 2022 Blue Shield – CalPERS: Access+ HMO
- 2022 Kaiser Permanente- CalPERS: TRADITIONAL HMO
- 2022 Sharp Health Plan – CalPERS: Sharp Performance Plus HMO
- 2022 UnitedHealthcare – CA Signature Value Alliance HMO L1
- 2022 Western Health Advantage – CalPERS: Western Health Advantage (HMO)
To be eligible for cash-in-lieu, employees must provide proof of coverage of other minimum essential coverage. Employees hired after 7/1/2020 are not eligible for cash-in-lieu (see acceptable proof).
In order to receive cash-in-lieu payment effective January 1, 2022, I understand that this completed form and proof of coverage must be received no later than October 29, 2021. There will be no retroactive payment for late submissions.
- Cash-in-Lieu must be submitted online (sample) via Informed K12.