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Certifying Your Medicare Status
 
If CalPERS is unable to obtain your Medicare information from the CMS and cannot automatically enroll you in a CalPERS Medicare health plan, you must certify your Medicare status to continue your CalPERS health coverage.
 
Complete and submit the Certification of Medicare Status (PDF) form with supporting documentation certifying one of the following choices:
 
Enrolled in Medicare Part A and Part B (Submit a copy of your Medicare card or SSA documentation.)
Ineligible for Medicare either in your own right and/or through the work history of a current, former, or deceased spouse (Submit SSA documentation.)
Deferring enrollment in Medicare Part B due to your or your spouse's employment (Submit proof of active group health insurance through current employer.)
If you do not meet these requirements, you'll receive a notice of cancelation of health coverage for yourself and all enrolled dependents the month you turn 65. Your CalPERS health coverage will automatically be canceled the first day of the month after you turn 65.
 
See Cancelation of CalPERS Health Coverage for information on reinstating your health coverage.

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