CalPERS Health Plan Information 2014
CalPERS Medical Premiums 2014
CalPERS Basic Health Plans
Deciding on a health plan for you and your family can seem challenging and difficult. There are significant differences between HMOs and PPOs, and knowing those differences can make your decision a little easier. For a full listing of health plan options, refer to the Health Benefit Summary provided by CalPERS.
Health Maintenance Organization (HMO)
HMOs offer members a range of health benefits, including preventive care. The HMO will give you a list of doctors from which you select a primary care provider (PCP). Your PCP coordinates your care, including referrals to specialists. Other than applicable co-payments, you pay no additional costs when you receive pre-authorized services from the HMO's contracted providers. If you obtain care outside the HMO's provider network without a referral from the health plan, you will be responsible for the total cost of services, except for emergency and urgent care.
Kaiser Permanente CA (Kaiser)
Anthem Blue Cross (Anthem HMO Select, Anthem HMO Traditional)
Blue Shield (Blue Shield Access +, Blue Shield Net Value)
Health Net (Health Net Salud y Mas, Health Net SmartCare)
Preferred Provider Organization (PPO)
Unlike an HMO, where a primary care provider directs all your care, a PPO allows you to select a primary care provider and specialist without referral. A PPO is similar to a traditional "fee-for-service" health plan, but you must use doctors in the PPO network or pay higher co-insurance (percentage of charges). In a PPO health plan, you must meet an annual deductible before some benefits apply. You are responsible for a specific co-insurance amount, and the health plan pays the balance up to the allowable amount.
When you use a non-participating provider you are responsible for any charges above the amount allowed.
Anthem Blue Cross (PERS Choice, Select, Care)
PORAC (Safety Members Only)
Contacting Your Health Plan
To obtain up-to-date contact information for the health plans, please refer to the CalPERS Health Benefit Summary or go to CalPERS On-Line at www.calpers.ca.gov. Contact your health plan with questions about: identification cards, verification of provider participation, service area boundaries (covered ZIP Codes) or Individual Conversion Policies. Your plan benefits, deductibles, limitations, and exclusions are outline in your health plan's Evidence of Coverage booklet. You can obtain the Evidence of Coverage by contacting your health plan directly.