EMPLOYEE BENEFITS
The Right Career, Right Here

MEDICAL, DENTAL, & VISION

 

WHO IS ELIGIBLE FOR INSURANCE?

The County of Monterey offers a cafeteria-style benefits package for its employees including health, dental, and vision insurance. Employees have 31 days from their date of hire to enroll into insurance or 30 days to make a change to their plan based on a qualifying event. Employee deductions are taken once a month on a pre-tax basis.

WHO QUALIFIES?

Permanent employees working at least 40 hours per pay period (0.5 full-time equivalent) are eligible for health, dental, and vision insurance and the Flexible Spending Account (FSA) provided through the County. Permanent employees, regardless of hours worked, may apply for the Dependent Care Assistance Program (DCAP).

 

REQUIRED DOCUMENTS FOR ENROLLED DEPENDENTS

Employees are required to provide supporting documents to verify the identity and relationship of their enrolled dependent(s).

  • Spouse – Marriage Certificate and Social Security Card.
  • Domestic Partner – Certificate of Domestic Partnership and Social Security Card.
  • Child - Birth Certificate and Social Security Card.
  • Stepchild - Birth Certificate, Marriage Certificate (to establish the relationship between the employee and the child’s parent), and Social Security Card.

HEALTH INSURANCE

The County of Monterey contracts with CalPERS to provide health insurance for eligible employees and their eligible dependents. Employees have the option to enroll into health insurance within 31 days of hire/rehire, during Open Enrollment, within 30 days upon becoming eligible for benefits, or due to an eligible qualifying event. A list of qualifying events is outlined below in the Qualifying Events section.

Plan eligibility is based on the employee’s residential zip code. Employees can use the Health Plan Search by Zip Code to find which plans they are eligible for. Employees may also use their employer’s address to establish plan eligibility.

 

WHAT PLANS ARE AVAILABLE WHERE I LIVE?

The plans listed below are available to employees in Monterey County. To view the 2026 Summary of Benefits for these plans click on the plan names. For all other medical plans, visit the CalPERS website or contact your Benefit Coordinator for support.

*Only certain ZIP codes within Monterey County are eligible to enroll in the Kaiser Permanente medical plan. You can use the County’s ZIP code to become eligible for Kaiser Permanente coverage.

**The PORAC PPO plan is available to you if you are in a safety position and have a PORAC membership.

If you live outside of Monterey County, use the CalPERS zip code finder tool to identify which plans are available to you. The results will show all available HMO Plans and PPO plans in your area.

PROVIDER NETWORK

Knowing which providers are available in your insurance network is important. PPOs have different coverage levels, deductible, and annual maximum if you access service from an in-network provider vs. an out-of-network provider. HMOs only provide benefit coverage if you access service through an in-network provider. Choosing an in-network provider can save you money. It is also a good idea to check your provider list before seeking services, as doctors can join or leave a plans network at any time during the year. Below are the links to the provider search tools for our most common insurance plans.

*You must create an account with Included Health to access the provider search tool. For additional assistance with Included Health, contact their customer service representatives at 1-855-633-4436. If you are enrolled in a plan not listed above, please contact your Benefit Coordinator for assistance.

 What are the differences between a PPO and HMO?

PPO Plans

Being enrolled in a PPO gives you access to a network of health care providers (doctors, hospitals, labs, pharmacies, etc.) known as preferred providers. It does not require you to select a Primary Care Physician and allows you access to many types of services without receiving a referral or advance approval. You are encouraged to seek services from preferred providers to ensure your coinsurance and co-payments are counted toward your calendar year out-of-pocket maximums. You are allowed the option of seeing non-preferred providers but requires you to pay a higher percentage of the bill. It sets limits to the amount preferred providers can charge you for services.

HMO Plans

Being enrolled in an HMO gives you access to health providers (doctors, medical groups, hospitals, labs, and pharmacies, etc.) that contract with the HMO to provide services at a fixed price. Most HMOs require you to select a Primary Care Physician who will work with you to manage your health care needs. They require advance approval from the medical group or health plan for some services, such as treatment by a specialist or certain types of tests. This plan generally, requires you to obtain care from providers who are a part of the plan network and it requires you to pay the total cost of services if you obtain care outside the HMO’s provider network without a referral from the health plan (except for emergency and urgent care services).

2026 CalPERS HEALTH BENEFIT SUMMARY

For an in-depth comparison of all health plans offered, please review the appropriate Health Benefit Summary. Please note that the plans available to you is based on your Zip code and/or Employer Zip Code.

2026 HEALTH INSURANCES RATES

Employee health deductions rates are determined by their bargaining unit, region and FTE level and are outlined in the four documents below.

Note: Employees in all bargaining units except H and S will receive half the County contribution towards their insurance if their FTE falls between .5-.79.

HEALTH PLANS AVAILABLE IN MONTEREY COUNTY IN 2026

 Plan Name   PERS Platinum
PPO
 PERS Gold
PPO
  PORAC 
PPO
  Blue Shield Access+ HMO
Kaiser Permanente Anthem Select HMO
Administered By
 Blue Shield
 Blue Shield Anthem
Blue Cross
 Varies
 In Network Deductible
Member / Family
 $500 / $1,000 $1,000 / $2,000* $300 / $900
  N/A
Out -of-pocket Deductible
Member / Family
  $2,000 / $4,000  $2,500 / $5,000  $600 / $1,800
  N/A
In Network Maximum Coinsurance Member / Family $2,000 / $4,000 $3,000 / $6,000 $3,000 / $4,000
 $1,500 / $3,000
 Preventative care  $0  $0  $0
  $0
 Primary care physician (PCP)  $20 copay  $10 copay  $10 copay  $15 copay
 Specialist  $35 copay  $35 copay  $35 copay  $15 copay
 Urgent Care
  $35 copay  $35 copay  $35 copay  $15 copay
 Emergency Room $50 copay; 10% coinsurance after deductible is met  $50 copay; 20% coinsurance after deductible is met  20% coinsurance after deductible is met  $50 copay
Outpatient hospitalization 10% coinsurance  20% coinsurance  20% coinsurance  No charge
Inpatient hospitalization $250 deductible per admission; then 10% coinsurance  20% coinsurance  20% coinsurance  No charge
Virtual Appointments Included Health
 Included Health
 LiveHealth Online $15 Varies

 

*You may be able to reduce your in-network deductible to $500 for individual and $1000 for family.
For a full plan summary comparison review the CalPERS 2025 Health Benefit Summary.

DENTAL INSURANCE

Monterey County contracts with Benefit & Risk Management Services, Inc. (BRMS) to administer their employee dental insurance plan. Employees whose spouse is also employed by the County of Monterey cannot have double coverage. Dependent children whose parents are both employed by the County of Monterey cannot have double coverage and all eligible children must be enrolled under one parent. The Monterey County Dental Plan eligibility, coverage, and administration procedures can be found in the Monterey County Dental Plan Document.

 

Dental Plan Administrator:

Benefit & Risk Management Services, Inc. (BRMS)

80 Iron Point Circle, Suite 200

Folsom, CA 95630

1-844-428-2647

VISION INSURANCE

Monterey County contract with Vision Service Provider (VSP) to administer their employee vision insurance plan.  Employees and their dependents should give the employee’s employee ID number with four 0s in front of it instead of their SSN to look up their profile with VSP, example: 000-03-1000. Employees whose spouse is also employed by the County of Monterey cannot have double coverage. Dependent children whose parents are both employed by the County of Monterey cannot have double coverage and all eligible children must be enrolled under one parent. 

A summary of vision coverage can be found HERE.

To find a vision provider in your area, use the VSP Find a Doctor tool.

 

CVS Caremark PHARMACY BENEFITS

Effective January 1, 2026, CVS Caremark (CVS) will be the pharmacy benefits manager for the following medical plans:

  • PERS Gold PPO
  • PERS Platinum PPO
  • Anthem Blue Cross Select HMO
  • Anthem Blue Cross Traditional HMO
  • United Healthcare Signature Value Alliance HMO
  • United Healthcare Signature Value Harmony HMO

CVS will manage retail, mail-order, and specialty pharmacy services, offering members an enhanced experience though a nationwide pharmacy network, digital tools, and improved customer service. 

Customer Care is available 24 hours a day, 7 days a week. 

TELEHEALTH SERVICES

LiveHealth Online is available to employees enrolled in an Anthem Health Plan. If you have the flu, a sinus infection, a cold, a fever, or other common health issues, you can have video visits 24/7 with a board-certified doctor using LiveHealth Online. A doctor can even send a prescription to your pharmacy. All you need is a smartphone, tablet, or computer with a camera. LiveHealth Online is also available for mental health issues, and you can make an appointment with a psychologist or licensed therapist in four days or less. The cost to use this service is the same cost as your regular office visit. For information on how to access services, please visit Livehealthonline.com or call the customer service number on the back of your medical insurance card.

Teladoc is available to employees enrolled in a Blue Shield plan. Talk to a doctor anywhere you are by phone or video. Members have 24/7 access to U.S. board-certified physicians, including pediatricians and family doctors, for $0 copayment. Blue Shield Trio members also have access to speak with a mental health professional by phone or video. You can connect with a doctor in minutes, usually 1 hour or less response time. Additionally, you can make an appointment in advance that fits into your schedule. For information on how to access Teladoc services, please visit the Blue Shield website or call them at 800-835-2362.

The My Doctor Online App is available to employees enrolled in Kaiser Permanente. Answer some questions online and get advice and treatment from a clinician within 2 hours, 7 am to 7 pm daily. You can also schedule or change phone, video, or in-person appointments through the My Doctor Online App. For more information about the My Doctor Online App, please visit the Kaiser Permanente website or call them at 800-464-4000.

 

24/7 NURSE HELPLINES

If you have questions about a particular health condition or if you need a trained nurse to help you determine whether or not care is needed, contact your plan's dedicated nurse helpline. Registered nurses are available to answer your medical questions 24 hours a day, seven days a week.

Anthem Plans: 1-800-700-9185

Blue Shield Plans: 1-877-304-0504

Kaiser Permanente Plans: 1-866-454-8855

For all other plans, contact the customer service number on the back of your medical insurance card for assistance.

 

COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives employees and their families who lose their insurance benefits the right to continue group health benefits. Employees have the option to enroll into insurance with COBRA if the loss of coverage was due to voluntary or involuntary job loss, cancellation of insurance due to FTE reduction below a 0.5 FTE, death, divorce, retirement, or when an enrolled child turns 26 years of old.  In most circumstances COBRA can last up to 18 months and can be terminated upon subscriber request. The cost for COBRA is 102% of the premium and employees and their dependents have 60 days from the notification of loss of coverage or last day of coverage to enroll.

QUALIFYING EVENT

Employees can enroll in, cancel or make changes to their benefits when they experience a qualifying event. A list of qualifying events has been provided below along with the types of elections and changes they can make. Employees have 31 days from their hire date or rehire to make benefit elections and have 30 days for all other qualifying events. Employees should notify their Benefit Coordinator of their benefit elections within the deadline or they forfeit the ability to make those changes until they experience another qualifying event.

  • New Hire / Rehire – The employee is able to enrollment into health, dental, vision insurance, FSA, and/or DCAP for themselves and their eligible dependents
  • Separation – Termination of all benefits
  • Physical Address Change – An employee may switch their insurance plan if they moved from one insurance region to another. Example: Moving from Santa Cruz to Marina. If an employee moves they should update their address on ESS and contact their department HR to see if the move constitutes a region change.
  • Birth/Adoption – An employee may add the new child to insurance and/or increase FSA election or enroll/increase their DCAP election.
  • Death – An employee must notify their department HR that their dependent is no longer eligible for insurance.
  • Marriage – An employee may add the new spouse to insurance and/or increase FSA election.
  • Divorce – An employee is required to notify their department HR office of the divorce within 30 days of the divorce being finalized. The spouse will be removed from insurance.
  • Gain other Coverage – An employee and/or their eligible depends may cancel insurance from the County.
  • Loss of Coverage – An employee and/or their eligible depends may enroll into insurance through the County
  • FTE Change – An employee is eligible to enroll into insurance if their FTE changes from .49 or below to an FTE of .5 and above. Insurance will be terminated if an employee’s FTE reduces below a 0.5. 

INSURANCE WHILE ON A LEAVE OF ABSENCE

While an employee is in a working, paid leave, or protected leave status the County will apply County contribution toward their insurance premium. If an employee moves into an unpaid protected leave status (such as Family Medical Leave Act) they will need to pay their monthly insurance contributions to Employee Benefits. If the employee moves into an unpaid unprotected status they have 30 days to elect to cancel coverage for themselves or their dependents, or may continue coverage by paying the full premium cost of their insurance.

For more information, employees should contact their Benefit Coordinator directly. 

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