Retirees with Medicare

If you are age 65 or older or otherwise eligible for Medicare (e.g. disability or End State Renal Disease (ESRD), SFHSS requires that you enroll in Medicare as soon as you are eligible before you enroll in SFHSS-administered benefits.

The Social Security Administration may take up to three months to process your Medicare enrollment so be sure to apply for Medicare at least three months BEFORE your 65th birthday.

Enrollment must take place within 30 days of the initial retirement date, no later than 30 days after a qualifying event, or during the annual Open Enrollment period in October.

Be sure to read through our New Retiree Enrollment page for a summary of the most important deadlines and next steps on initiating the process of transitioning from active employee benefits coverage to retiree benefits coverage.

An employee must meet age and minimum service requirements and have been enrolled in SFHSS health benefits at some time during active employment to be eligible for retiree health coverage. SFHSS calculates service (service requirements may vary).

If hired on or after January 9, 2009, Proposition B applies. If a retiree chooses to take a lump sum pension distribution, retiree health premium contributions will be unsubsidized and paid at full cost. 

Newly eligible retirees must enroll in retiree medical and/or dental coverage within 30 days of their retirement date.

To enroll, you must provide SFHSS with a completed enrollment application and all required eligibility documentation, including retirement system paperwork.

Members eligible for Medicare must provide proof of Medicare enrollment. Medicare applications take three to four months to process by Social Security, so apply in advance of your 65th birthday. If you do not meet the required deadlines, you must wait until the next Open Enrollment period, which takes in October.

New retiree coverage will take effect on the first day of the month following the retirement effective date.

Depending on your retirement date, there may be a gap between when your employee coverage ends and your retiree coverage begins. Setting your retirement date at the end of the month will help avoid a coverage gap. 

Contact Member Services team at (628) 652-4700 three months before your retirement date to prepare for enrollment in retiree benefits.

You must notify SFHSS of retirement even if you are not planning to elect SFHSS coverage on your retirement date.

Retirees with Medicare can choose from UnitedHealthcare Medicare Advantage PPO or Kaiser Permanente Senior Advantage HMO plans. Please note that Retiree medical plan coverage and premium costs differ from active employee medical plans and premiums.

Please note that Kaiser Permanente Senior Advantage HMO requires retirees to live in a zip code serviced by the plan. In addition to California, Kaiser Permanente Senior Advantage HMO is also available in a limited number of areas in Oregon, Northwestern Washington and Hawaii. UHC's Medicare Advantage PPO does not have service area requirements.

UnitedHealthcare Medicare Advantage PPO Highlights

• Must be eligible for Medicare
• Live anywhere in the USA
• One ID card for all your covered services and prescription drugs from a network of 68,000 pharmacies nationwide
• Out-of-pocket; fixed co-pay
• No deductible
• Obtain service from any willing Medicare provider in the USA

Your Medicare dependents will be enrolled in UnitedHealthcare (UHC) Medicare Advantage PPO. Your non-Medicare dependents can be enrolled in UHC Non-Medicare PPO (administered by UHC). UHC Medicare members who live in California also have the option of enrolling non-Medicare dependents in the UHC Doctors Plan EPO or UHC Select Plan EPO.

The Medicare PPO Plan RFP is now complete and has concluded since the Health Service Board voted to approve the staff recommendation on June 18, 2024. Learn about the change to the Medicare PPO Plan here.

For more information on the RFP, please visit https://sfhss.org/RFPs. 

Kaiser Permanente Senior Advantage Plan Highlights

• Must be eligible for Medicare Part B
• Must live in Kaiser Permanente service area
• In-network service only
• Out-of-pocket, fixed co-pays
• No deductible
• One ID card for all your covered services and prescription drugs

Your Medicare dependents will be enrolled in Kaiser Permanente Senior Advantage. Your non-Medicare dependents will be enrolled in Kaiser Permanente HMO Plan.

SFHSS recognizes that dental benefits are a very important part of your healthcare coverage and for maintaining your good overall health well into your retirement.  Retirees have three dental plans to choose from: Delta Dental PPO, DeltaCare USA DHMO or UnitedHealthcare Dental DHMO.

Unlike the active employee dental plans, retirement dental plans have different premiums and coverage levels. To learn more, refer to SFHSS' Retiree Guide (see below) for the current plan year.

PPO-style dental plans, like Delta Dental PPO, allows you to visit any in-network or out-of-network dentist. DHMO (short for Dental Health Maintenance Organization) plans require you to receive all your dental care from within a network of participating doctors.

Before you retiree and transition from your current dental plan into one of our retiree dental plans, take note that you may be eligible to continue your employee dental plan for an additional 18 months using COBRA before enrolling in a dental plan for retirees. Many members elect this option in order to complete major or higher-cost dental care under a plan with a higher annual deductible before starting their retiree dental plan.

All SFHSS retirees and their dependents who are enrolled in an SFHSS medical plan are automatically enrolled in VSP Basic Plan at no additional cost.

We also offer an enhanced plan called the VSP Premier Plan at an additional cost based on the number of members enrolled in coverage. Please note that the VSP Premier Plan premiums for retirees differ from the active employee Premier Vision Plan and premiums.

If you do not enroll in a medical plan, you and your dependents cannot access VSP Vision Care benefits.

San Francisco Health Service System (SFHSS) recognizes the importance of supporting members in establishing their families. In 2016, SFHSS established the City and County of San Francisco Adoption and Surrogacy Assistance Plan. This plan provides a one-time benefit of reimbursement of up to $15,000 to an eligible employee or eligible retiree for qualified expenses incurred in connection with either an eligible adoption or eligible surrogacy. 

To learn more about the Plan, its terms, qualifications and limitations, please click below.