Annual Health Plan Changes

We’re working to give members more choices for affordable health plans and to ensure our benefit coverage provides equitable, high-quality health care. We realize that any changes to health plans impact your decisions during Open Enrollment. We will communicate all changes to plans and premiums to you prior to Open Enrollment in the fall.

2025
2024

We’re providing you with changes to health plans for 2025 that were approved by the CalPERS Board of Administration. There are no other changes to our health plans or benefits except those described here. For a full list of available health plans and premiums, view the Plans & Rates page.

There's no action for you to take now.

Basic Plans

Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO)
Health Plan	Changes
Anthem Blue Cross Del Norte	Third-party administrator transition removes Anthem Blue Cross Del Norte plan; no longer part of CalPERS health plan offerings¹
Blue Shield Trio	Expansion into: Contra Costa county 3 ZIP codes in Shasta county
Health Net Salud y Más	Expansion into Imperial county
Kaiser Permanente	Expansion into 14 ZIP codes in Monterey county
UnitedHealthcare SignatureValue Harmony	Expansion into: Napa county 50 ZIP codes in Contra Costa county 2 ZIP codes in Solano county

Preferred Provider Organization Plans (PPO)
Health Plan	Changes
PERS Gold	Blue Shield of California will be the new Third-Party Administrator for all PPO plans. For members in a basic plan they are partnering with Included Health to provide member services, including answering inquiries, guiding members to the most appropriate in-network and high-quality providers, and providing care coordination services for members, particularly those with complex health conditions. Included Health will also expand access to care through their supplemental virtual primary care and behavioral health care services. There are no changes to copays, coinsurance, or deductibles with this transition to Blue Shield. You can learn more about this announcement from the article recently posted on PERSpective.
PERS Platinum	Blue Shield of California will be the new administrator for all PPO plans. For members in a basic plan, they are partnering with Included Health to provide member services, including answering inquiries, guiding members to the most appropriate in-network and high-quality providers, and providing care coordination services for members, particularly those with complex health conditions. Included Health will also expand access to care through their supplemental virtual primary care and behavioral health care services. There are no changes to copays, coinsurance, or deductibles with this transition to Blue Shield. You can learn more about this announcement from the article recently posted on PERSpective.

Medicare Plans

Health Plan	Changes
PERS Gold Supplement to Medicare Plan	Blue Shield of California will be the new Third Party Administrator for all PPO plans. For Medicare members, provider networks and care coordination provided by their doctors will not change. There are no changes to copays or coinsurance with this transition to Blue Shield. You can learn more about this announcement from the article recently posted on PERSpective.
PERS Platinum Supplement to Medicare Plan	Blue Shield of California is the new Third Party Administrator for all PPO plans. For Medicare members, provider networks and care coordination provided by their doctors will not change. There are no changes to copays or coinsurance with this transition to Blue Shield. You can learn more about this announcement from the article recently posted on PERSpective.
UnitedHealthcare Medicare Advantage Edge	Exits all counties; no longer part of CalPERS health plan offerings²
Western Health Advantage MyCare Select	Exits all counties; no longer part of CalPERS health plan offerings²

Benefit Design Changes

Benefit	Changes
Doula Benefit for all Pregnant and Postpartum Members	New benefit for all pregnant and postpartum Basic plan members to receive health education, advocacy, physical and emotional non-medical support before, during and after pregnancy, miscarriage, stillbirth, and abortions.
Travel Benefit for Medically Necessary Care	Standardized travel and lodging coverage for eligible medically necessary services including, but not limited to abortion services, gender affirming care, complex surgeries, and cancer care that cannot be accessed within 50 miles from the member’s residence for all Basic and Medicare plan members, up to $5,000 per occurrence. This includes transportation, lodging, and meals for the member and a companion (both parents/guardians when patient is under 18).

Endnotes

1Regardless of the health plan you enroll in, continuity of care coverage as outlined by the Department of Managed Health Care may be available to you if your current doctor, medical group, or hospital is not available and you meet certain eligibility criteria. This means you may be able to continue to receive the medical and behavioral health services and medicines you need. Check with your health plan or call the Department of Managed Health Care at 1-888-466-2219 for more information about continuity of care options. For members who have had a provider disruption and do not qualify for DMHC Continuity of Care provisions, Blue Shield will also provide 12 months of office visits with out of network providers at the in network benefit.

2Regardless of the health plan you enroll in, continuity of care coverage may be available to you if your current doctor, medical group, or hospital is not available and you meet certain eligibility criteria. This means you may be able to continue to receive the medical and behavioral health services and medicines you need. Check with your health plan or Centers for Medicare & Medicaid Services at cms.gov for more information about continuity of care options.

We’re providing you with information on the 2024 health plan changes approved in November 2022 (PDF) and March 2023 (PDF) by the CalPERS Board of Administration.

There’s no action for you to take now.

These proposals become part of our rate development process when we set health premiums. The Pension & Health Benefits Committee approved final premiums in July 2023.

Health plans indicated below will have changes in 2024. There are no other changes to our health plans or benefits except those described here. For a full list of our available health plans, view the Plans & Rates page.

Basic Plans

Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO)
Health Plan	Changes
Anthem Blue Cross Select	Pharmacy mail-order program with opt-out option guiding members to use home delivery for non-specialty maintenance medications
Anthem Blue Cross Traditional	Exits Glenn County* Pharmacy mail-order program with opt-out option guiding members to use home delivery for non-specialty maintenance medications
Blue Shield Access+ EPO	Expansion into Del Norte and San Benito counties
Health Net Salud y Más	Pharmacy mail-order program with opt-out option guiding members to use home delivery for non-specialty maintenance medications
Health Net SmartCare of California	Exits all counties; no longer part of CalPERS health plan offerings*
Sharp Health Plan Performance Plus	Pharmacy mail-order program with opt-out option guiding members to use home delivery for non-specialty maintenance medications
UnitedHealthcare SignatureValue Alliance	Expansion into 12 counties for public agencies and schools members: Alameda, Contra Costa, Marin, Merced, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma, and Stanislaus Pharmacy mail-order program with opt-out option guiding members to use home delivery for non-specialty maintenance medications
UnitedHealthcare SignatureValue Harmony	Expansion into Santa Clara and Santa Cruz counties Pharmacy mail-order program with opt-out option guiding members to use home delivery for non-specialty maintenance medications
Western Health Advantage	Pharmacy mail-order program with opt-out option guiding members to use home delivery for non-specialty maintenance medications

*Regardless of the health plan you enroll in, continuity of care coverage is available to you even if your current doctor, medical group, or hospital is not available. This means you’ll continue to receive the medical and behavioral health services and medicines you need. Check with your health plan or call the Department of Managed Health Care at 1-888-466-2219 for more information about continuity of care options.

Preferred Provider Organization (PPO)
Health Plan	Changes
PERS Gold	Site of care lab services incentive waives coinsurance when members use preferred lab providers for routine lab tests Pharmacy mail-order program with opt-out option guiding members to use home delivery for non-specialty maintenance medications Basic PPO out-of-network deductible will increase from $1,000 to $2,500
PERS Platinum	Site of care lab services incentive waives coinsurance when members use preferred lab providers for routine lab tests Pharmacy mail-order program with opt-out option guiding members to use home delivery for non-specialty maintenance medications Basic PPO out-of-network deductible will increase from $500 to $2,000

Medicare Plans

Health Plan	Changes
Anthem Blue Cross Medicare Preferred PPO	New supplemental benefits: Personal Emergency Response System (PERS) devices and in-home support services
Kaiser Permanente Senior Advantage Summit	Expansion into eight out-of-state regions: Colorado, Hawaii, Georgia, Northwest (Oregon, Washington), Mid-Atlantic (Virginia, Maryland, District of Columbia), and Washington
UnitedHealthcare Medicare Advantage Edge	Changing from $0 to a $50 copay for emergency room visits
Western Health Advantage MyCare Select	Expansion into Humboldt County