Types of Medical Plans
HMO (Health Maintenance Organization)
An HMO* is a specific type of healthcare plan that sets guidelines under which doctors a patient can see. Traditionally, the monthly premium is higher than a PPO plan but there are less out-of-pocket expenses to the employee when the plan is used. The patient must choose a primary care physician (PCP) who is a member of the HMO. Referrals from the PCP are usually required when seeking services by a specialist. Unless an emergency, services provided by non-member providers are the patient’s full responsibility.
*Additional plans may be available, depending on your home address.
Blue Shield Access+ HMO, Group # W0051411
Mail-Order Prescription Instructions
You will you need to go through your Blue Shield account to access the mail-order (90-day) prescription benefits.
- Log into your Blue Shield of California account(opens in new window)
- Click on the "Be Well" tab
- Click on the "Pharmacy" box
- Scroll down to the Pharmacy networks - click on "Mail service pharmacy" box
- You will get a pop-up that indicates you are leaving blueshieldca.com website - click "Continue"
- You will be directed to the CVS Caremark website and you can place a new mail-order prescription or re-order past prescriptions
Please note: If you have not re-ordered a previous prescription in 2022, you will need to place a new order (previous refill requests from your doctor will still be in effect), as previous prescriptions will have a new Rx number.
If you have any questions or difficulties, please contact CVS Caremark directly at (866) 346-7200.
PPO (Preferred Provider Organization)
A PPO plan gives the patient more flexibility to see the provider of their choice. If the provider is “in-network”, the plan will pay more. Monthly premiums are less, but when the plan is used, you may incur more expenses than with an HMO. View Anthem Blue Cross CalPERS Benefits Medical Plans(opens in new window) for 2024 Summary of Benefits for Platinum and Gold plans.
PPO plans available in this area are*:
PERS Gold, Group # DB010A
PERS Gold 2024 Summary of Benefits and Coverage (PDF)
PERS Gold 2024 Gold Evidence of Coverage (PDF)
Note: PERS Gold is considered a California Only plan, however there is a resource to access out of state services. Employees that are enrolled in PERS Gold PPO and reside in the State of California they are eligible to use the BlueCard Program available through the national Blue Cross and Blue Shield Association. The BlueCard Program allows PERS Gold Members who are traveling or temporarily outside California (i.e. college student) and require medical care or treatment to use local Blue Cross and/or Blue Shield Plan participating providers throughout the United States at any time.
To locate a Blue Cross and/or Blue Shield Plan participating provider, they may:
- Call the toll-free BlueCard Provider Access number at 1-800-810-BLUE (1-800-810-2583).
- Ask your Physician or provider if he or she participates in the local Blue Cross and/or Blue Shield Plan.
- Access the Blue National Doctor and Hospital Finder using the Find a Doctor or Hospital link on the Blue Cross and Blue Shield Association website at www.bcbs.com(opens in new window).
- Request a Preferred Provider directory by calling 1-877-PERS-PPO (1-877-737-7776).
*Depending on your home address, other plans may be available to you. Contact the Benefits office if you would like to discuss your options.