Medical Plans
At North Orange County Community College District, we are committed to not only enhancing your well-being but also empowering you to live your healthiest life. We offer a comprehensive range of health benefits designed to support your physical, mental, and emotional wellness.
North Orange Community College District has an agreement with the State of California, Public Employees Retirement System (CalPERS) to participate in the State's health insurance plans.
NOCCCD Health Plans
The District provides 11 different health plans to choose from through CalPERS. The Affordable Care Act (ACA) requires most Americans to have qualifying health insurance called "minimum essential coverage." Under the ACA's individual shared responsibility provision (also known as the "individual mandate"), most Americans must maintain minimum essential coverage. Currently, the individual mandate is still in effect, but the individual penalty has been set to zero.
All of CalPERS' health plans meet the minimum essential coverage requirement.
Opportunities for Enrollment or Making Mid-Year Changes
Eligible employees can enroll or make mid-year changes to their health plans in any of the following situations given timely submission of required documentation to the Benefits Office within the specified timeframe.
As a new hire, the earliest coverage effective date for eligible employees is the first of the month following receipt of their enrollment materials to the Benefits Office when received within 60 days from the date of hire.
If the enrollment request is received more than 60 days after the date of hire, a 90-day waiting period will be required before coverage begins.
If an eligible employee experiences a Qualifying Life Event, they can enroll and/or make mid-year changes to their health plan given the timely submission of all required materials to the Benefits Office within 60 days of the Qualifying Life Event.
If an employee misses this 60-day window, the next opportunity to make health plan changes will be during the District's Open Enrollment period, which happens annually.
What is a Qualifying Life Event?
Qualifying Life Events may include:
- Marriage or registration of a domestic partner
- Divorce or legal separation from a spouse
- Birth, adoption, placement for adoption, or legal guardianship of a child
- Death of a spouse/domestic partner or child
- Child's loss of eligibility due to age
- Employee or spouse has a change in employment status that results in gaining or losing eligibility of benefits coverage. You must submit proof of gain or loss of coverage.
- Full-time/part-time employment change resulting in an insurance eligibility change
- Commencement of or return from an unpaid leave of absence
- Change for an individual eligible for Medicare or Medicaid
- Qualified Medical Child Support Order/National Medical Support Notice
Every year from mid-September to mid-October, NOCCCD conducts Open Enrollment for all benefit eligible employees to enroll, change, and/or waive their health plans. All changes requested during Open Enrollment take effect on January 1st of the next plan year.
NOCCCD PPO Plans
The District offers two (2) PPO (Preferred Provider Organization) and nine (9) HMO (Health Maintenance Organization) plan options. Learn the difference between PPO and HMO to make sure you choose the plan best suited for your needs.
PERS Platinum & PERS Gold
Effective January 1, 2025, Blue Shield of California is the new administrator for the CalPERS PPO plans. CalPERS is partnering with Blue Shield and Included Health to provide personalized health care services.
NOCCCD HMO Plans
The District offers nine (9) HMO plan options. Some of the plan providers that offer HMO plans have more than one available option. For additional information on all available plans, please visit the CalPERS Health Plans website.
Pharmacy Services
Effective January 1, 2026, CVS Caremark (CVS) will replace OptumRx as the Prescription Benefit Manager (PBM) for the following CalPERS Basic Health Plans:
- Anthem Blue Cross Traditional
- Anthem Blue Cross Select
- Health Net Salud y Mas
- PERS Gold
- PERS Platinum
- Sharp Health Performance Plus
- UnitedHealthcare SignatureValue Alliance
- UnitedHealthcare SignatureValue Harmony
For additional information on this transition, please visit the CalPERS Health Plan webpage.
Pharmacy Resources
Dependent Eligibility
When adding dependents to your health plan, you will be required to submit the following:
| Eligible Dependent | Required Documentation |
|---|---|
| Spouse |
|
| Registered Domestic Partner |
|
| Children (up to age 26) |
|
| Children (up to age 26) with parent-child relationship |
|
| Certified disabled dependent children, age 26 and older |
|
Choosing the Right Health Plan For You
Plan Availability
CalPERS health plans and monthly premiums are determined by an employee's residential zip code or work zip code.
The CalPERS Health Plan Search tool lets you find and compare plans in your area; see member satisfaction ratings; view side-by-side plan, benefit, and copay comparisons; and search for primary care doctors and specialists.
HMO vs PPO
When it comes to choosing a health plan that fits your needs, it is important to consider the different factors. The following chart will help you understand some important differences among health plan types.
| HMO | PPO | |
|---|---|---|
| Accessing Health Care providers | Contracts with providers to provide services at a fixed cost | Gives you access to a network of providers known as preferred providers |
| Selecting a Primary Care Physician (PCP) | Most HMOs require you to select a PCP who will manage your healthcare needs | PPO members have an assigned PCP but do not need to go through their PCP |
| Seeing a Specialist | Requires advance approval from a medical or health group for some services | Allows you access to many types of services without receiving referral or advanced approval |
| Obtaining Care | Generally requires you to obtain care from providers who are a part of the plan network Requires you to pay the total cost of services if you obtain care outside the HMO’s provider network without a referral from the health plan (except for emergency and urgent care services) | Encourages you to seek services from preferred providers to ensure your coinsurance and copayments are counted toward your calendar year out-of-pocket maximums Allows you the option of seeing non-preferred providers, but requires you to pay a higher percentage of the bill |
| Paying for Services | Requires you to make a small copayment for most services | Limits the amount preferred providers can charge you for services Considers the PPO plan payment plus any deductibles and copayments you make as payment in full for services rendered by a preferred provider |
Glossary of Terms
A guide for medical terms commonly used in health coverage and insurance