Retirees without Medicare

Active employees who are eligible to retire before the age of 65 are referred to as early retirees. If you are planning to retire but are not yet Medicare-eligible (age 65 or older or otherwise eligible for Medicare), your retiree health coverage will be determined by the San Francisco City Charter.

To be eligible for retiree health benefits, an employee must have been enrolled in a San Francisco Health Service System (SFHSS) administered plan at some time during active employment and have the years of City service mandated by the Charter. Your specific duration of service required by the Charter will vary depending on your date of hire and other factors. Service requirements for retiree health benefits and retiree pension benefits can differ and other restrictions may apply.

The transition of health benefits from active to retiree status is not automatic. SFHSS recommends that you visit us for an in-person consultation with one of our Benefits Analysts 30 days before your retirement date. We will advise you based on your individual situation.

Eligible new retirees must complete enrollment in retiree health coverage within 30 calendar days of their retirement date. If you do not enroll within 30 days, you can only apply for retiree benefits during the next Open Enrollment. New! Schedule a New Retiree Consultation. 

You must elect retiree coverage by submitting a Retiree Enrollment Form and supporting documents to SFHSS no later than 30 days after your official retirement date. If you do not submit the required documentation within 30 days, you will not have SFHSS retiree health coverage for yourself or covered dependents when your active employee benefits end. You must then wait until the next annual Open Enrollment period in October to enroll.

A great way to get a head start on how transitioning to retirement benefits works is to watch out Pre-Retiree video which provides a detailed overview of what you need to know and what you can do to make your transition as seamless as possible.

Be sure to check out 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 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. Other restrictions may apply.  

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

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

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

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

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

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

Retirees without Medicare can choose from Health Net CanopyCare HMO, Blue Shield of California Access+ HMO, Blue Shield of California Trio HMO, Kaiser Permanente HMO or Blue Shield of California PPO health plans.

Please note that Health Net CanopyCare HMO, Blue Shield of California HMO and Kaiser Permanente HMO require enrollees to live or work in a zip code serviced by their plan. Blue Shield of California PPO does not have service area requirements.

In addition to California, Kaiser Permanente HMO is also available in a limited number of areas in Oregon, Washington and Hawaii. Blue Shield of California PPO does not have service area requirements.

Families who have both Medicare eligible and non-Medicare eligible members may choose between Kaiser or UnitedHealthcare health plans. The non-Medicare members with UnitedHealthcare may be enrolled in one of UnitedHealthcare's EPO or PPO plans available to SFHSS members. Learn more about UnitedHealthcare's health plan option for split Medicare families here.

Blue Shield of California PPO Highlights

• Must not be eligible for Medicare
• Live anywhere in the world
• Access covered services worldwide
• Annual deductible must be reached before coverage begins
• Out-of-pocket coinsurance %
• Lower rate of employer coinsurance for out-of-network providers
• Reasonable and customary fee reimbursement limits

Kaiser Permanente Traditional HMO Highlights

• Must not be eligible for Medicare
• Must live in Kaiser service area
• In-network service only
• Out-of-pocket, fixed co-pays
• No deductible

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

Blue Shield of CA's Access+ HMO and Blue Shield of CA's Trio HMO Highlights

• Must not be eligible for Medicare
• Must live in service area
• In-network service only
• Out-of-pocket, fixed co-pays
• No deductible

Health Net CanopyCare HMO Highlights

• Must not be eligible for Medicare
• Must live in service area
• In-network service only
• Out-of-pocket, fixed co-pays
• No deductible

SFHSS recognizes that dental benefits are a very important part of your healthcare coverage and for maintaining your good overall health. Consequently, City and County of San Francisco employees 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, allow 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 dental 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.