Be sure to read the information from the County as it includes information that supplements the correspondence received from CalPERS. Information from the County includes a Benefit Statement listing the CalPERS health plan and other benefits you receive as an employee of Contra Costa County. Be sure to compare health plan information on this benefit statement to the benefit statement you received from CalPERS.
If making changes, please submit the Open Enrollment change form(s) to Employee Benefits no later than 5:00 p.m., October 11, 2013. Change form(s) are two pages; you are required to initial and date
the first page in addition to completing sections 1 through 21 on the form. CALPERS HBD-12 & HBD- 12A forms are AVAILABLE FOR USE BY ACTIVE EMPLOYEES ONLY. RETIREES MUST MAKE CHANGES DIRECTLY WITH CALPERS by calling CALPERS AT 1-888-225-2377.
CalPERS Enrollment Change Forms:
CalPERS HBD-12 Enrollment Change Form
CalPERS HBD- 12A Declaration Form
2014 CalPERS Rates for Health and Dental
Active Members of IAFF- CCCFPD
Active Members of IAFF- ECCFPD
Active Members of DAIA
Active Members of UCOA
Active Members of UFM and DSM
Active Members of DSA
The Open Enrollment period for other benefit programs with Contra Costa County such as dental plans, Health Care Spending Account (HCSA), Dependent Care Assistance Program (DCAP) and the Premium Conversion Plan is tentatively scheduled from October 7, 2013 through November 1, 2013. Information regarding Contra Costa County Open Enrollment will be furnished at a later date.
Submit forms to:
Contra Costa County
Employee Benefits Service Unit
651 Pine Street, 5th Floor
Martinez, CA 94553
Back to top