Submission of the requested information is mandatory. The information requested is collected pursuant to the California
Government Code (sections 20000 et seq.) and is used for administration of the CalPERS Board's duties under the Public
Employees' Retirement Law, the Social Security Act, and the Public Employees' Medical and Hospital Care Act, as the case
may be. Portions of this information may be transferred to other governmental agencies (such as your employer), physicians
and insurance carriers but only in strict compliance with current statutes regarding confidentiality. Failure to supply the
information may result in CalPERS being unable to perform its functions regarding your status.
You have the right to review your CalPERS membership files. For questions concerning your rights under the Information
Practices Act of 1977, please contact the CalPERS Customer Contact Center at 1-888-CalPERS (or 1-888-225-7377).
Section 7(b) of the Privacy Act of 1974 (Public Law 93-579) requires that any federal, State, or local governmental agency
requesting an individual to disclose a Social Security account number to inform the individual whether that disclosure is
mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it. Section
111 of Public Law 101-173 requires group health plans to collect and provide member Social Security numbers for the
coordination of federal and State benefits. Furthermore, the CalPERS health program requires each enrollee's Social Security
number for identification purposes and to verify eligibility for benefits.
The CalPERS health program uses Social Security numbers for the following purposes:
1. Enrollee identification for eligibility processing and eligibility verification
2. Payroll deduction and State contribution for State employees.
3. Billing of contracting agencies for employee and employer contributions.
4. Reports to CalPERS and other state agencies.
5. Coordination of benefits among health plans.
6. Resolution of member complaints, grievances and appeals with health plans.
IMPORTANT: It is your responsibility to notify your Human Resources office when there are any changes in your family
situation. Changes include domestic partnership termination, establishment of a parent-child relationship, acquisition of a
dependent child, change of address, marriage, divorce, legal separation, and death. Failure to notify your Human Resources
office may result in adverse consequences.
CalPERS Privacy Notice
The privacy of personal information is of the utmost importance to CalPERS. The following information is provided to you in
compliance with the Information Practices Act of 1977 and the Federal Privacy Act of 1974.
Information Purpose
The information requested is collected pursuant to the Government Code Sections (20000
et seq.) and will be used for administration of Board duties under the Retirement Law, the Social Security Act, and the Public
Employees' Medical and Hospital Care Act, as the case may be. Submission of the requested information is mandatory. Failure
to comply may result in the system being unable to perform its functions regarding your status.
Please do not include information that is not requested.
SSN
Social Security numbers are collected on a mandatory and voluntary basis. If this is CalPERS first request for disclosure of your
SSN, then disclosure is mandatory. If your SSN has already been provided, disclosure is voluntary. Due to the use of Social
Security numbers by other agencies for identification purposes, we may be unable to verify eligibility for benefits without the
number.
Social Security numbers are used for the following purposes:
1. Enrollee identification
2. Payroll deduction / state contributions
3. Billing of contracting agencies for employee /employer contributions
4. Reports to the CalPERS system and other state agencies
5. Coordination of benefits among carriers
6. Resolve member appeals, complaints, or grievances with health plan carriers
Information Disclosure
Portions of this information may be transferred to other state agencies (such as your employer), physicians, and insurance
carriers, but only in strict accordance with current statutes regarding confidentiality.
Your Rights
You have the right to review your membership files maintained by the system. For questions about this notice, our Privacy
Policy, or your rights, please write the CalPERS Privacy Officer at 400 Q Street, Sacramento, CA 95811 or call our Customer
Contact Center at 888-CalPERS (888-225-7377).
Privacy Information