OE Guide: Retirees

Welcome Retirees! Open Enrollment for your 2027 health benefits is here. The San Francisco Health Service System (SFHSS) administers your Medical, Vision, and Dental benefits.

This year, SFHSS encourages you to Find the Value in Your Benefits. Your plans include hidden gems that can help you meet your wellness goals—like using vision benefits for non‑prescription sunglasses, accessing acupuncture or chiropractic care without a referral, gym memberships and transportation to medical appointments included in the Medicare plans, and extra dental cleanings through Delta Dental’s SmileWay program. Review your plan’s Summary of Benefits to uncover perks you may not have known about.

Open Enrollment is your once‑a‑year chance to change your coverage without a Qualifying Life Event. Compare plans, add or drop dependents, switch coverage, or waive it altogether. 

Use the buttons below to view Important Dates and the schedule of Benefits Fairs.

MEDICAL

Blue Shield Medicare PPO expands Call the Car Service Nationwide 

Members who live outside of California can now book their 24 one-way transportations benefit to health-related appointments directly through Call the Car. This value-added benefit is one of many benefits that are not covered under Medicare, but included in your SFHSS administered benefits. To schedule a ride, Call the Car offers a mobile application (CTC-Go) or you can call them directly at (855) 200-7544 (TTY 711) 24 hours a day, seven days a week. Arrangements for transportation must be made at least 24 hours in advance.

Kaiser Permanente Senior Advantage Dialysis Support

New End-Stage Renal Disease (ESRD) dialysis support may help eligible members reduce Medicare Part B premium costs. 

Premiums for Some Non-Medicare Plans Increased at a Rate Higher Than The National Average 

Several health plans have significantly increased their premiums for Plan Year 2027 due to the rising cost of health care. We encourage our California based non-Medicare retirees to review all available medical plan options to see if a more affordable health plan can meet your needs.

DENTAL

Last fall, in response to both retiree and active employee concerns regarding the dental PPO network, SFHSS surveyed all City and County active employees to understand what matters most in a dental plan to issue a Request for Proposal (RFP) for our dental PPO business. Members overwhelmingly prioritized having a broad network of in‑network dentists. Through the RFP process, we learned that if we switched to another carrier, almost 30% of our members would be out-of-network, which would require more members to pay the out-of-network rate for services. The dental network for both active employees and retirees are the same. For that reason, SFHSS will not be pursuing an RFP for the retiree dental PPO plan.
 

1. Login to SF My Hub and select the Open Enrollment tile to review or make changes.
2. Complete your benefit elections and print or save your Confirmation Receipt of Submission for your records.
3. If you’re not making changes to your health benefits, nor adding or dropping dependents, and you don’t want to to have any Flexible Spending Account(s), then no action is needed. Your current elections will automatically carry over to the next plan year.
4. You will receive a Confirmation Email notice by early December of this year.

You can find more detailed instructions on how to navigate the online health benefits enrollment process here: SF My Hub Navigation Instructions.

Not sure which plan is best for you? 

You can schedule a personal consultation with a plan representative to ask about your specific situation to decide if you want to switch to another plan or keep the plan you have. Click the buttons below to schedule a consultation with a plan representative or you can call them directly under Key Contacts.

For Blue Shield Medicare PPO, please call (800) 370-8852.

Delta Dental is hosting two webinars for our members to ask questions. You can find them on our OE calendar above. 

Health Maintenance Organization (HMO)

An HMO is a medical plan that offers benefits through a network of participating physicians, hospitals and other healthcare providers working closely together to help coordinate your care. You select a Primary Care Physician (PCP) who will coordinate all non-emergency care and services including access to certain specialists, programs and treatments that are in the same medical group or network. You must live or work in a ZIP code serviced by the plan to enroll. Under these plans, there is no plan year deductible before accessing your benefits. Most services are available for a fixed dollar amount known as a "co-payment".

Preferred Provider Organization (PPO)

A PPO is a medical plan that provides access to a network of health care providers (doctors, hospitals, labs, pharmacies, etc.) known as preferred providers. You pay less when you to seek services from preferred providers. However, the plan allows you the option of seeing non-preferred providers, but requires you to pay a higher percentage of the bill. Generally, when compared to HMO medical plans, PPOs usually result in higher out-of-pocket costs and a deductible will apply to many services. Instead of having a fixed co-pay for medical services, your cost share may vary as a percentage of what the provider charges, known as a “coinsurance”. You will need to pay your plan year deductible prior to paying your coinsurance for the applicable service.

Click the following buttons to learn about the different HMO and PPO plans SFHSS offers.

SFHSS requires all retirees and dependents who are eligible for Medicare to enroll in Medicare Part A and Part B.

Medicare is a federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS) for people age 65 or older, or under age 65 with a Social Security-qualified disability. The Social Security Administration (SSA) is the federal agency responsible for Medicare eligibility, enrollment, and premiums. You can visit cms.gov to learn more about CMS. 

The different parts of Medicare help cover specific types of services:

• Medicare Part A: Hospital Insurance
• Medicare Part B: Medical Insurance
• Medicare Part D: Prescription Drug Coverage

SFHSS Rules require you and your eligible covered dependents to enroll in Medicare Part A and Part B as soon as you become eligible. Failure to enroll by the required deadlines may result in penalties assessed by the Social Security Administration (SSA) and changes to or loss of your SFHSS medical coverage.

If you enroll in an SFHSS Medicare medical plan, you are automatically enrolled in the plan's group Medicare Part D prescription drug coverage. Because your SFHSS medical plan already includes enhanced group Medicare Part D coverage, you should not enroll in an individual Medicare Part D plan.

All SFHSS members are required to enroll in Medicare as soon as they become eligible or may face penalties.

If you are enrolled in Medicare, do not enroll in any outside Medicare Part D plan. Prescription drug coverage is already included in your SFHSS medical plan. Enrolling in an outside Part D plan will terminate your SFHSS medical coverage.

SFHSS offers two vision plans for members and dependents who are enrolled in a SFHSS medical plan. Vision coverage is provided through Vision Service Plan (VSP). 

Vision Service Plan – Basic

The VSP Basic Plan is included with all SFHSS medical plans. You are eligible for one vision exam each year and either one set of contact lenses or one pair of eyeglass frames and lenses every other calendar year. Your eligible dependent children are covered in full for polycarbonate prescription lenses.

Vision Service Plan – Premier

You may upgrade to the VSP Premier Plan, which includes coverage for either one set of contact lenses or one pair of eyeglass frames and lenses every calendar year. The VSP Premier Plan provides a higher allowance for frames and lenses or contact lenses. If you upgrade to the VSP Premier Plan, your dependents will also be enrolled in the VSP Premier Plan.

No Medical Plan = No Vision Benefits

If you do not enroll in an SFHSS medical plan, you and your dependents are not eligible to enroll in VSP Vision Care plans offered through SFHSS. You and your dependents must choose the same vision plan option.

SFHSS offers three dental plan options for our members to choose from. Two are Dental Health Maintenance Organization (DHMO) plans and one is a Dental Preferred Provider Organization (DPPO) plan.

DHMO Dental Plans

Similar to medical HMOs, Dental Health Maintenance Organization (DHMO) plans require you to receive all of your dental care from their network of participating dental providers. These networks are smaller than dental PPO networks. Before you elect a DHMO plan, make sure the plan’s network includes your chosen dentist, and that dentist is accepting new patients.

Under DHMO plans, services are covered either at no cost or with a fixed co-pay. Out-of-pocket costs for these plans are generally lower than PPO plans. 

Dental PPO Plan

A Dental PPO plan allows you the flexibility to visit any in-network or out-of-network dentist. The plan covers a higher percentage of the costs for covered services when you go to an in-network PPO dentist. Out-of-network providers may bill you for the difference between your co-insurance and Delta Dental's reimbursement, which is based on a coverage limit for the service.

Well-Being Benefits

Your health plan offers many free or low-cost benefits to support preventive care, healthy living, mental health, and overall well-being. For more information, click the Well-Being Benefits button below. 

Employee Mental Health Benefits

Your health plan provides Mental Health and Substance Abuse Disorder resources. To explore confidential support, self-care tools, benefits, and educational resources click the Employee Mental Health Benefits button below. 

Mental Health and Substance Abuse Services

Your health plan offers many free or low-cost benefits to support you and your mental health and help you with substance use concerns. For more information visit sfhss.org/using-your-benefits/using-your-benefits-retirees/mental-health.

For urgent mental health issues, members should call 911 or go to the nearest hospital emergency room.

Telephone or In-Person Office Support

We strongly encourage you to enroll online. If online enrollment is not an option, you may:

• Fax your Open Enrollment Application Form and supporting documents to (628) 652-4701
• Deliver them in person to our Drop Box, available from 9 a.m. to 4:30 p.m. at 1145 Market Street, 3rd Floor, San Francisco, CA 94103

Our SFHSS Benefits Analysts are available by phone or in-person to assist members.