Skip to main content
District

Health Insurance Information Hub

Health Insurance Information Hub

Welcome to the Health & Welfare Benefit Information Hub!

On August 6th, 2025, Amador County Unified School District (USD) and Amador County Office of Education (COE) Board of Trustees approved the recommendation to pursue Health & Welfare Benefits with CalPERS effective October 1st, 2025. Click here to watch the recording of this board meeting. 

Health Insurance Informational Session:

September 4th, 2025

ACUSD put on an all-staff meeting that went over CalPERS, Open Enrollment and answered frequently asked questions.  Review the presentation today:

Health Insurance Informational Session Presentation

Open Enrollment:

Begins Monday, September 8th

CalPERS' medical plans operate on a calendar year (January 1 to December 31). Because our current plan year ends on September 30, we will have two open enrollment periods to transition to the new schedule.

First Open Enrollment:

Dates: September 8, 2025, through September 18, 2025

Effective Dates: October 1, 2025, through December 31, 2025 (a three-month plan)

Second Open Enrollment:

Dates: September 29, 2025, through October 10, 2025

Effective Dates: January 1, 2026, through December 31, 2026 (a full-year plan)

Both enrollment periods will be held through the American Fidelity AF Enroll platform.

Prepare Today:

To help you prepare, please review the following resources:

We are also finalizing dates for upcoming Health Fairs during the first open enrollment period, where you can meet with plan vendors and ask questions to the experts. Additional information is available below in the California Public Employees’ Retirement System (CalPERS) section.

11-Month Rate Sheet Tool - FY26

To determine your new medical insurance rate for the upcoming year, use the 11-Month Rate Sheet Tool for FY26.

How to Use the Tool:

Open the tool by clicking the link above and make a copy.

Select your July 2025 plan from the dropdown menu to see your new rate.

If you are a new employee or are taking insurance for the first time in October, select "New" for your current plan.

Understanding the 11-Month Rate Calculation:

When employees who take medical insurance through the District return for the new school year, the District provides them with insurance coverage for July, even though they aren't actively working, and no medical deductions are applied to this premium. Think of this as an advance: The District pays for that July premium upfront as a benefit to you.

You'll then repay the District for that July premium over the course of your 11-month assignment. Because your July rate was based on your previous year's plan, you can use the tool provided to see the full breakdown of your medical rates for the new plan year that encompasses the July Premium. Simply select your July 2025 plan in the tool to find out what your new rate will be.

Health Fair

The Health Fair will be held on Wednesday, September 10, from 1:00 PM to 5:00 PM at the District Office.

This event is a fantastic opportunity to learn more about the health and wellness resources available to you. It's also a perfect time to ask questions and get information during our first open enrollment period, which runs from September 8th through September 18th. 

We'll have representatives from a variety of organizations and vendors, including:

  • CalPERS
  • American Fidelity
  • Alliant Insurance Services
  • Included Health
  • OptumRx
  • Kaiser
  • VSP - TBD
  • More to be announced upon confirmation

Our expert Payroll team will also be on hand with devices to assist you with enrolling and answering any questions you may have. In addition, we will hold a raffle with giveaways provided by our vendors.

Site Visits

Throughout open enrollment, ACUSD Payroll staff and American Fidelity representatives will be visiting each site to assist with enrollment and answer questions.

American Fidelity Products

American Fidelity provides additional insurance products that can be added during open enrollment, which include: Health FSA, Limited Purpose FSA, Dependent Care Account, Accident Plans, Cancer Coverage, Disability Insurance, Group Critical Illness Plans, Group Hospital Indemnity, Term Life, and Whole Life Insurance.

Waiving/Opting Out of Medical Coverage

CalPERS has no minimum participation requirement from employers, and therefore, employees will continue to be able to waive/opt out of coverage. To opt out, employees must decline coverage in the AF Enroll platform and submit an attestation form to payroll (payroll@acusd.org)

Cash-in-Lieu of Health Coverage

Eligible employees may receive a taxable cash payment in lieu of enrolling in ACUSD/ACOE’s group health plan. This is a conditional "eligible opt-out arrangement" designed to comply with all applicable regulations under the Affordable Care Act (ACA and your bargaining unit agreement.

Please note that due to the Affordable Care Act, ACUSD & ACOE are unable to provide cash-in-lieu of coverage for employees enrolled in a marketplace plan (i.e. Covered California).

Other Updates

CalPERS & Medicare:

An active employee's Medicare-eligible spouse cannot enroll in a CalPERS Medicare plan. They can only enroll in a basic health plan. The option to enroll a Medicare-eligible spouse in a CalPERS Medicare plan only applies to retirees.

Employee Address / P.O. Boxes:

CalPERS confirmed that they do not accept P.O. Boxes as an address to be used for plan eligibility. If a P.O. Box is on file with the District as your address, it will revert to the school’s address for plan eligibility. 

To request a change in address, you can do so through the Employee Portal or by reaching out to HumanResources@acusd.org

Qualifying Events:

If an employee has a qualifying life event, they need to alert Payroll and make an insurance change within 30 days of the event.

For a full list of events, view the CalPERS Health Program Guide

No Surprise Act:

Emergency Care at Out-of-Network Facilities

If you're on a CalPERS Gold plan and have an emergency, you can’t be balance billed even if you go to an out-of-network hospital. You’ll only pay your normal in-network cost-sharing, and the provider must negotiate payment with the insurer.

Non-Emergency Care at In-Network Hospitals (but Out-of-Network Providers)

If you go to an in-network hospital but are unknowingly treated by an out-of-network anesthesiologist or radiologist, you cannot be balance billed. Again, you’ll just pay in-network rates.

California Public Employees’ Retirement System (CalPERS)

Why are we transitioning?

Background and Need for Transition:

In October 2023, Amador County USD and COE transitioned the administration of our Health & Welfare benefits from CVT to NewFront. This shift moved us from a traditional insurance pool to a self-insured model, with the goal of achieving greater flexibility and control over our benefit rates, plan design, costs, and the option for employees to opt out.

However, this self-insured model has also exposed the USD and COE to increased financial risk associated with higher-than-expected medical claims. In the 2023-24 fiscal year, we incurred over $1.2 million in excess claims and other self-insured related expenditures, and a similar amount is projected for the 2024-25 fiscal year. Additionally, we experienced a significant 15% premium increase for our Anthem plans, even after NewFront initially proposed a much larger 40% increase.

The combination of rising premium costs and annual excess claims exceeding $1.2 million has made our current self-insured model financially unsustainable. As a result, the USD and COE began an exhaustive search spanning over 10 months to find a new provider. Due to our large excess claims and high volume of waivers/opt-outs, the majority of groups that were approached “declined to quote,” and so we were left with either CalPERS or remaining self-insured. With self-insurance equating to a 72%+ increase in rates and self-insurance as a model being unsustainable with high risk exposure, the recommendation to the board was to transition to CalPERS.    

Alliant Links & Information:

Alliant Website
Alliant Presentation – Introduction to Alliant
Alliant Presentation – Medical Benefits Discussion (May 14 Mtg.)

 

Questions? Contact our payroll team!
Email: payroll@acusd.org
Phone: (209) 257-5425

 

Archived Meetings

Meeting Regarding CalPERS Decision:

This was a meeting held on August 6th, 2025, for Union Leaders and USD & COE staff who signed up for meetings. At this meeting, Alliant was in attendance with USD & COE staff and provided information regarding our search for a new provider, self-insurance renewal information, and other ancillary options leading to the CalPERS recommendation. This is a great opportunity to learn more about why the USD and COE recommended CalPERS to the board.

  • Date: Wednesday, August 6th, 2025
  • Time: 3:00 PM - 4:30 PM
  • Meeting recording
    • Passcode: !1AxC*^p
  • Attendees: Alliant, ACUSD & ACOE Staff
  • Topics:
    • Review of Available Insurance Options
      • Self-Insured Renewal
      • CalPERS
    • Review of Ancillary Plans
      • Dental, Vision & EAP
    • Questions from staff regarding transition

 

Meeting with CalPERS

This was a meeting held on May 29th, 2025, for all USD & COE staff. At this meeting, CalPERS was in attendance and provided information regarding the various plans, offerings, and benefits of being with CalPERS. This is a great opportunity to hear from CalPERS.

  • Date: Thursday, May 29th, 2025
  • Time: 3:45 PM - 5:15 PM
  • Meeting Recording 
    • Password: %Rj8v9$0
  • Attendees: CalPERS (including Alliant, ACUSD & ACOE Staff)
  • Topics:
    • Review of Plan Options / Rates
    • Review of Products & Services
    • Opportunity for Questions to CalPERS Representative(s)

Update Meeting
Subject: This was a meeting held on May 14th, 2025, for all USD & COE staff. At this meeting, Alliant was in attendance and provided information regarding updates around various groups, our benefits survey, and more. This conversation was prior to CVT declining to quote, but it did have some other useful information surrounding the benefits search process.

  • Date: Wednesday, May 14th, 2025
  • Meeting Recording
  • Topics:
    • Updates from CVT Conversations
    • Updates on SISC Status
    • Information regarding CalPERS
    • Updated Timeline of Next Steps
    • Survey Results
    • Other

Introduction to Alliant Insurance Services, Inc.
Subject: The USD and COE will host an informational meeting for all staff to discuss a potential transition to Alliant from NewFront as our Broker of Record for Dental, Vision, and Voluntary Benefits. Learn more about Alliant Insurance Services, Inc.

California’s Valued Trust (CVT)

Meeting scheduled for May 28, 2025. 

 

Retiree Information

With the USD & COE transitioning to CalPERS, effective October 1, 2025, retiree medical insurance options will be available through CalPERS.  
What This Means for You:

  • All retirees who retired from STRS or PERS within 120 days of retiring from USD or COE or your permanent separation from either entity are eligible to enroll in health insurance coverage through CalPERS.
  • CalPERS will be mailing detailed information directly to you in the coming weeks. This will include:
    • Instructions on how to enroll
    • Plan options and coverage details
    • Important deadlines and next steps

No immediate action is required from you at this time regarding CalPERS Health. Please watch for the packet from CalPERS and read through it carefully once received.

CalPERS Medicare Enrollment Guide for Retirees

Current & Potential Options:

  • Retiree's First: We recognize that many retirees have transitioned to Retiree's First. However, with our transition to CalPERS, the USD & COE will no longer be able to utilize these services, and to continue coverage with the USD or COE, you will need to transition to CalPERS.
  • Dental & Vision: The USD and COE will be continuing their Dental and Vision plan options through Alliant, which will continue your current offerings. Alliant recently presented rates, which saw a slight increase for the plan year beginning October 1, 2025. 
    • Dental Rates:
      • $84.16/month for single coverage
      • $152.43/month for two-party coverage
    • Vision Rates:
      • $14.06/month for single coverage
      • $40.22/month for two-party coverage
    • If you would like to keep your Dental and/or Vision coverage, please reach out to Payroll@acusd.org or (209) 257-5425 as soon as possible. At this time, we are reviewing billing options for these benefits and will follow up with additional details if there are any changes to how premiums will be collected.

Frequently Asked Questions

  •  Yes, these are separate deductible amounts.

  • Two or more people count as a family in relation to the family deductible. On page 32 of the PERS Gold Evidence of Coverage Document, it states: “If your plan has Family coverage, there is an individual Deductible within the Family Deductible. This means an individual Family Member can meet the individual Deductible before the entire Family meets the Family Deductible.”

  • September 16 - October 11, 2025, with changes taking effect January 1, 2026.

    1. PERS Gold: Mark Twain Medical Center in San Andreas, Marshall Medical Center in Placerville, and Mercy Hospital of Folsom
    2. PERS Platinum: Mark Twain Medical Center in San Andreas, Sutter Amador Hospital in Jackson, Marshall Medical Center in Placerville, and Mercy Hospital of Folsom.

  • These do not apply to us as they are for PORAC, which is for Safety Members.

  • That is correct, Sutter Amador Hospital is out-of-network for PPO Gold. You can still use their services, but you would pay the out of network Co-pay and Co-insurance rates.

  • With all of CalPERS plans, if you have an emergency you can seek care. And the plans can be used.

  • That is correct, you can still go to the hospital, but will pay the out-of network cost.

  • Mark Twain Hospital in San Andreas

  • It is all based on Zip Code, but in Amador County for Active Employees there is only one option.

  • Yes, CalPERS has no minimum participation requirement (No Opt-Out Cap)

  • To opt-out/waive coverage, you must decline coverage in American Fidelity & provide signed Attestation Form to Payroll.  This is required annually to opt-out.

  • Depending upon each employee's full-time/part-time status and bargaining unit agreement, cash-in-lieu may or may not be available.  Cash-in-lieu is also dependent upon meeting eligibility requirements with attestation and compliance with the Affordable Care Act.

  • Yes, you may opt-out if you have enrolled in a minimum essential coverage (MEC) health insurance plan, which could be Covered California or a marketplace plan.  

  • No, Covered California and marketplace plans are federally and state-subsidized plans targeted toward individuals who may not have access to insurance. The Affordable Care Act (ACA) does not allow employers to provide a financial benefit to employees to encourage the purchase of a subsidized plan. Because of this, ACUSD & ACOE are unable to provide cash-in-lieu to employees enrolled in marketplace plans. This is a part of the attestation form verification.

  • No, CalPERS confirmed that they do not accept P.O. Boxes as an address to be used for plan eligibility.  If a P.O. Box is on file with the District as your address, it will revert to the school’s address for plan eligibility.  To request a change in address, you can do so through the Employee Portal or by reaching out to HumanResources@acusd.org

  • If an employee has a qualifying life event, they need to alert Payroll (payroll@acusd.org) and make an insurance change within 30 days from the event.
    For a full list of events, view the CalPERS Health Benefits Guide available on the Health Insurance Change Information Hub.

  • Yes, because of the No Surprise Act, the out-of-network facility would need to inform you prior to services that you are out of network and will have a bill. 
    With the No Surprise Act:

    • Emergency Care at Out-of-Network Facilities
    • If you're on a CalPERS Gold plan and have an emergency, you can’t be balance billed even if you go to an out-of-network hospital. You’ll only pay your normal in-network cost-sharing, and the provider must negotiate payment with the insurer.
    • Non-Emergency Care at In-Network Hospitals (but Out-of-Network Providers)
    • If you go to an in-network hospital but are unknowingly treated by an out-of-network anesthesiologist or radiologist, you cannot be balance billed. Again, you’ll just pay in-network rates.