CalPERS health benefits officers

NetValue HMO Plan

The Blue Shield NetValueSM HMO plan is designed to provide your employees and their families savings on rates, and has no or low copayments, comprehensive benefits, self-referral to specialists through the Access+ Specialist program, health management programs and value-added services. With NetValue, your employees save money.

We can offer this plan because the NetValue network is comprised of a smaller network of our HMO providers who meet quality and efficiency standards. This allows us to keep monthly rates low. NetValue is our fastest-growing HMO plan for CalPERS.

Blue Shield also offers a NetValue HMO Supplement to Original Medicare Plan to members who are enrolled in Medicare. Learn more about the NetValue HMO Supplement to Original Medicare Plan.

2012 Service Area

NetValue HMO is available in the following counties, employees and all their enrolled family members must live or work in a NetValue service area to select this plan. Click on a county to view a full listing of providers within the county.

Contra Costa*Nevada*San Joaquin*
El Dorado*Orange San Luis Obispo
FresnoPlacer*San Mateo
ImperialRiverside*Santa Clara
KernSacramentoSanta Cruz
KingsSan Bernardino*Ventura
Los Angeles*San Diego*Yolo
MaderaSan Francisco

* partial county – please check the NetValue HMO Evidence of Coverage for covered areas.

How to Select a Doctor

When employees enroll in the NetValue HMO plan, they will need to select a primary care physician (Personal Physcians) for themselves and their dependents. Employees and their covered dependents have the option to choose different NetValue Personal Physicians and medical groups.

To find out if their current doctor is in our network or to choose a new doctor, employees can go to blueshieldca.com/findaprovider. Choose Find a Doctor, under Choose a Plan, select CalPERS, and then choose CalPERS NetValue HMO. Need help? Employees can call dedicated Blue Shield Member Services team at (800) 334-5847 for personal assistance.

Covered Services and Copayments

This summary is only a brief description of the Blue Shield NetValue HMO 2010 plan benefits for CalPERS members. Please see the 2012 NetValue HMO plan Evidence of Coverage (PDF, 735KB) and the 2013 NetValue HMO Basic Evidence of Coverage (PDF, 544KB) for the exact terms and conditions of coverage, including plan limitations and exclusions.

Category DescriptionsMember Copayment and Limitations

 Hospital 


 Inpatient


 Includes blood and blood products - collection and storage of autologous blood

 No charge
 Outstanding No charge

 Physician Services


 Office/home visits

 $15/visit
 Allergy testing/treatment No charge
 Inpatient hospital visits No charge
 Surgery/anesthesia No charge
 Periodic health exam No charge
 Well-baby care No charge
 Gynecological exam No charge
 Immunization/inoculation No charge
 Vision screening No charge
 Hearing exam/testing No charge
 Access+ Specialist $30/visit
 Prescription drugs $5 generic, $15 brand name, $45 non-formulary/prescription - not to exceed a 30-day supply for short-term or acute illness; maintenance drugs after 3 months: $10 generic, $25 brand name, $75 non-formulary/prescription - not to exceed a 30-day supply
 Prescription by mail $10 generic, $25 brand name, $75 non-formulary/prescription - not to exceed a 90-day supply for maintenance drugs; $1,000 out-of-pocket annual maximum
 Diagnostic X-ray/lab No charge

 Durable medical equipment


 Including orthoses and prostheses

 No charge

 Emergency care


 No copyament needed if hospitalized or kept for observation and hospital bills for an emergency room observation visit

 $50/visit
 Urgent care $15/visit
 Ambulance services No charge

 Pregnancy and maternity care

 Prenatal/postnatal office visits

 No charge
 Infertility testing and treatment 50% of allowable amount

 Mental health



 Inpatient

No charge
 Outpatient $15/visit

 Vision Care 


 Eye refraction (this service is limited to one visit per calendar year for members age 18 and older - No limit on number of visits for members under age 18)

 No charge
 Eyeglasses Not covered, except for eyeglasses that are necessary after cataract surgery

 Hearing-aid services


 Evaluation

 No charge
 Hearing aid (up to a maximum of $1,000 per member, every 36 months for both ears for the hearing-aid instrument and ancillary equipment) Charges in excess of $1,000
 Home health services No charge
 Physical/ occupational/ speech therapy
 Inpatient visits at a hospital or skilled nursing facility
No charge
 Outpatient and home visits $15/visit

 Skilled Nursing Facility

 Up to 100 days per calendar year

 No charge
 Hospice No charge

 Maximum calendar-year copayment

 Member

 $1,500

 Family $3,000

1. To a participating Access+ Specialist in the same medical group or IPA as their Personal Physician.

2. The mental health services administrator (MHSA), is a specialized health care service plan contracted by Blue Shield of California to administer all mental health and substance abuse services.

Following are some of the changes the CalPERS Health Benefits Committee and the Board of Administration have made to the Blue Shield healthcare plans for the plan year beginning January 1, 2012:

Preferred Centers for Knee and Hip Joint Replacement

As part of Blue Shield's commitment to keeping health coverage affordable, we are introducing a benefit change for knee and hip joint replacement. Blue Shield NetValue HMO plan members will be required to receive care for most elective knee and hip joint replacement procedures at one of 28 Blue Distinction Centers® throughout the service area in order to receive 100% hospital coverage.

Blue Distinction Centers are hospitals within Blue Shield's network that are nationally recognized by the BlueCross BlueShield Association for distinguished clinical care and processes. Facilities earn this designation based on rigorous, evidence-based, and objective criteria and input from physicians and medical organizations.

For the 2012 benefit year, the following Blue Distinction Centers will participate in the Blue Shield of California knee and hip preferred centers network:

Alta Bates/Summit Medical Center
Arroyo Grande Community
Community Medical Center Fresno
Doctors Medical Center Modesto
El Camino
Enloe Medical Center
Feather River
Hoag Hospital
Huntington Memorial Hospital
John Muir Medical Center Walnut Creek Campus
John F. Kennedy Memorial
Kaweah Delta
Loma Linda University
Lompoc
Long Beach Memorial
Medical Center at UCSF
Methodist Hospital of Sacramento
Mills Peninsula
Orange Coast Memorial
Providence Holy Cross
St. Joseph Hospital of Orange
St. Jude Medical Center
San Ramon Regional Medical Center
Sharp Coronado
Sharp Memorial
Torrance Memorial Medical Center
UC Davis Medical Center
ValleyCare Hospital

A travel benefit is also available for members who live more than 50 miles from a preferred center. These benefit changes include transportation, hotel accommodations, and other reasonable expenses for both the patient and a companion. For more details, please have members call Member Services at (800) 334-5847.

Pharmacy Benefits

To encourage the use of lower-cost and equally effective generic drugs, we are implementing the following pharmacy benefit changes in 2012:
  • Members will be required to pay the difference between a brand-name drug and a generic drug, plus the generic copayment, when the generic equivalent is available. (Exceptions for medical necessity are available via prior authorization; if approved, the applicable brand copay applies.)
  • Retail copayments for formulary brand-name and non-formulary brand-name drugs will increase by $5.00.
  • Copayments for 90-day mail-order prescriptions will be double the cost of 30-day retail prescriptions. For example, members will pay $5 for a 30-day supply of generic drugs at a retail pharmacy, but only twice this amount, or $10, for a 90-day supply through the mail-order pharmacy.
  • Non-formulary brand-name drugs and drugs used to treat erectile dysfunction do not accumulate towards the $1,000 mail service out-of-pocket maximum.

If you have questions about any of these benefit changes, please do not hesitate to contact your Account Manager.

Pharmacy Benefits

In addition to offering a large pharmacy network that includes chains such as Walgreens, Longs, and Rite Aid, we feature a convenient mail-order prescription service. If your employees take medications for chronic conditions such as diabetes or high blood pressure, they can get up to a 90-day supply of their prescriptions by mail. They may save money on their copayment and there is no charge for shipping. We've recently revised the copayment structure to encourage mail-order purchases.

 

Prescriptions at Participating Pharmacies

Prescription DrugsMaintenance Drugs After 3 Months of Fill:
 $5 generic $10 generic
 $15 brand-name $25 brand-name
 $45 non-formulary/prescription - not to exceed a 30-day supply for short-term or acute illness, and maintenance medication for the first 3 months. $75 non-formulary/prescription - not to exceed a 30-day supply.

 

Prescriptions Through the Mail

Blue Shield provides access to pharmacy mail services through PrimeMail, offering your members the convenience of receiving up to a 90-day supply of covered maintenance drugs delivered to their home or office.

Mail-Service Prescription Drugs
 $10 generic
 $25 brand-name
 $75 non-formulary/prescription - not to exceed 90-day supply for mail order drugs which are taken over long periods of time (maintenance drugs; $1,000 out-of-pocket annual maximum)


To receive medications from PrimeMail, employees must download and complete the New Prescription Order Form and send it with their original prescription(s), and if applicable, the mail service copayment for each drug to:

PrimeMail Pharmacy
P.O. Box 27836
Albuquerque, NM 87125-7836

PrimeMail will fill prescriptions for covered maintenance drugs, according to an employee's physician's directions, up to the amount covered by the employee's pharmacy benefit. Maintenance drugs are used on an ongoing basis for treatment of long-term conditions, such as high blood pressure.

Employees can check the status of their order or order prescription refills by visiting www.myprimemail.com or by calling (866)346-7200. Employees who rely on TTY equipment can call (866) 346-7197.

If employees want to find out more about their personal Pharmacy copayments and benefits, they may:

  • Check their Evidence of Coverage (EOC) booklet
  • Call Member Services at (800) 334-5847
  • Log on to blueshieldca.com, click My Health Plan section to view plan summary, benefits and more

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Service Area by County

Contra Costa

IPA/Medical GroupsHospitals
  • Hill Physicians Medical Group Contra Costa County
  • John Muir Physician Network
  • Doctors Medical Center Pinole Campus
  • Doctors Medical Center San Pablo Campus
  • John Muir Behavioral Health Center
  • John Muir Medical Center Concord Campus
  • John Muir Medical Center Walnut Creek Campus
  • San Ramon Regional Medical Center

El Dorado

IPA/Medical GroupsHospitals
  • Hill Physicians Medical Group Sacramento
  • UC Davis Health System
  • Mercy General Hospital
  • Mercy Hospital of Folsom
  • Mercy San Juan Hospital
  • Methodist Hospital of Sacramento
  • UC Davis Medical Center

Fresno

IPA/Medical GroupsHospitals
  • Sante Community Physicians, Inc.
  • Clovis Community Hospital
  • Coalinga Regional Medical Center
  • Community Regional Medical Center
  • Fresno Heart and Surgical Hospital
  • Fresno Surgery Center
  • St. Agnes Medical Center
  • San Joaquin Valley Rehabilitation Center
  • Sierra Kings District Hospital

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Imperial

IPA/Medical GroupsHospitals
  • Imperial County Physicians Medical Group
  • El Centro Regional Medical Center
  • Pioneers Memorial Hospital

Kern

IPA/Medical GroupsHospitals
  • Bakersfield Family Medical Group
  • Gemcare Medical Group
  • Gemcare Medical Group Delano
  • Independence Medical Group
  • Bakersfield Memorial Hospital
  • Delano Regional Medical Center
  • Good Samaritan Hospital
  • Kern Medical Center
  • Kern Valley Hospital
  • Mercy Hospital Bakersfield
  • Ridgecrest Regional Hospital
  • San Joaquin Community Hospital
  • Tehachapi Hospital

Kings

IPA/Medical GroupsHospitals
  • Sante Community Physicians, Inc.
  • Central Valley General Hospital

  • Corcoran District Hospital

  • Hanford Community Medical Center

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Los Angeles

IPA/Medical GroupsHospitals
  • Access Medical Group

  • AKM Medical Group

  • All Care Medical Group

  • Allied Physicians of California

  • Altamed Health Services

  • Applecare Medical Group St. Francis Region

  • Applecare Medical Group Whittier

  • Applecare Medical Group Downey

  • Applecare Medical Group Select

  • Associated Hispanic Physicians IPA

  • Bella Vista Medical Group IPA

  • Brookshire IPA

  • Centinela Valley IPA

  • ECMG Avalon Medical Group

  • ECMG Greater L.A. Healthcare

  • ECMG Greater San Gabriel Valley Physicians

  • ECMG Mabuhay Medical Group

  • ECMG Mid Citites IPA

  • ECMG Pasadena Primary Care Physicians

  • ECMG PCP IPA

  • Facey Medical Foundation San Gabriel

  • Facey Medical Foundation

  • Facey Medical Group, Inc.

  • Family Care Specialists Montebello

  • Family Care Specialists IPA

  • Family Health Alliance

  • Global Care Medical Group, Inc.

  • Good Samaritan Medical Practice Association

  • Greater Covina Medical Group, Inc.

  • Healthcare L.A., Inc.

  • Hispanic Physicians IPA

  • Korean Medical Group

  • MaxiMed IPA

  • Memorial Health Care IPA

  • Pacific IPA

  • Physicians Healthway IPA

  • Promed Health Network of Pomona Valley

  • Prospect Professional Medical Group IPA

  • Prudent Medical Group

  • Regal Glendale Physicians Alliance

  • Seoul Medical Group Integrated Physicians Services

  • Serra Community Medical Clinic

  • St. Vincent IPA Medical Group

  • Torrance Hospital IPA

  • Alhambra Hospital Medical Center

  • Antelope Valley Hospital Medical Center

  • Aurora Las Encinas Hospital, LLC.

  • Beverly Hospital

  • BHC Alhambra Hospital

  • Brotman Medical Center

  • Catalina Island Medical Center

  • Centre for Neuro Skills Los Angeles

  • Children's Hospital of Los Angeles

  • Citrus Valley Medical Center LC Campus

  • Citrus Valley Medical Center QV Campus

  • City of Hope National Medical Center

  • College Hospital

  • Community Hospital of Long Beach

  • Downey Regional Medical Center

  • East Los Angeles Doctors Hospital

  • East Valley Hospital Medical Center

  • Foothill Presbyterian Hospital

  • Garfield Medical Center

  • Glendale Adventist Medical Center

  • Glendale Memorial Hospital and Health Center

  • Good Samaritan Hospital

  • Greater El Monte Community Hospital

  • Henry Mayo Newhall Memorial Hospital

  • Hollywood Presbyterian Medical Center

  • Huntington Memorial Hospital

  • Kindred Hospital

  • Kindred Hospital La Mirada

  • Kindred Hospital San Gabriel Valley

  • Kindred Hospital Baldwin Park

  • Kindred Hospital South Bay

  • Kindred Hospital South Bay Tri City Campus

  • LAC USC Medical Center

  • Lakewood Regional Medical Center

  • Long Beach Memorial Medical Center

  • Marina Del Rey Hospital

  • Memorial Hospital of Gardena, Inc.

  • Methodist Hospital of Southern California

  • Monterey Park Hospital

  • Northridge Hospital Medical Center Roscoe Campus

  • Olympia Medical Center

  • Pacific Alliance Medical Center

  • Palmdale Regional Medical Center

  • Pomona Valley Hospital Medical Center

  • Presbyterian Intercommunity Hospital

  • Promise Hospital of East Los Angeles Suburban Campus

  • Promise Hospital of East Los Angeles

  • Providence Holy Cross Medical Center

  • Providence Little County of Mary Medical Center San Pedro

  • Providence Little County of Mary Medical Center Torrance

  • Providence St. Joseph Medical Center

  • Providence Tarzana Medical Center

  • Ronald Reagan UCLA Medical Center

  • San Dimas Community Hospital

  • San Gabriel Valley Medical Center

  • Santa Monica UCLA Medical Center

  • Silver Lake Medical Center Ingleside Campus

  • St. Francis Medical Center

  • St. John's Health Center

  • St. Mary's Medical Center

  • St. Vincent Medical Center

  • Tarzana Treatment Center

  • Torrance Memorial Medical Center

  • Tri City Regional Medical Center

  • USC Kenneth Norris Jr. Cancer Hospital

  • Valley Presbyterian Hospital

  • Verdugo Hills Hospital

  • White Memorial Medical Center

  • Whittier Hospital Medical Center

Madera

IPA/Medical GroupsHospitals
  • Sante Community Physicians, Inc.

  • Children's Hospital Central California

  • Madera Community Hospital

Nevada

IPA/Medical GroupsHospitals
  • Sierra Nevada Medical Associates

  • Sierra Nevada Memorial Hospital

  • Tahoe Forest Hospital

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Orange

IPA/Medical GroupsHospitals
  • Mission Heritage Medical Group

  • Mission Hospital Affiliated Physicians

  • St. Joseph Heritage Medical Group

  • St. Joseph Hospital Affiliated Physicians

  • St. Jude Affiliated Physicians

  • St. Jude Heritage Medical Group

  • Anaheim Regional Medical Center

  • Chapman Medical Center

  • Children's Hospital at Mission

  • Children's Hospital of Orange County

  • Coastal Communities Hospital

  • Fountain Valley Regional Hospital and Medical Center

  • Hoag Hospital Irvine

  • Hoag Memorial Hospital Presbyterian

  • Hoag Orthopedic Institute

  • Kindred Hospital Brea

  • Los Alamitos Medical Center

  • Mission Hospital Regional Medical Center

  • Mission Hospital Laguna Beach

  • Orange Coast Memorial Medical Center

  • Placentia Linda Hospital

  • Saddleback Memorial Medical Center

  • Saddleback Memorial Medical Center San Clemente

  • St. Joseph Hospital

  • St. Jude Medical Center

  • University of CA Irvine Medical Center

  • Western Medical Center Anaheim

  • Western Medical Center Santa Ana

Placer

IPA/Medical GroupsHospitals
  • Hill Physicians Sacramento

  • Sierra Nevada Medical Associates

  • UC Davis Health System

  • UC Davis Health System Auburn

  • Sutter Auburn Faith Hospital

Riverside

IPA/Medical GroupsHospitals
  • Hemet Community Medical Group Family Seniors

  • Hemet Community Medical Group Hemet

  • Hemet Community Medical Group Meadowview

  • Hemet Community Medical Group Menifee

  • Hemet Community Medical Group Prime Partners

  • Hemet Community Medical Group Temecula

  • Inland Valley IPA - Coachella Valley

  • Inland Valley IPA - Temecula Valley

  • Prospect Health Corona
  • Riverside Medical Clinic
  • Tri-Valley Medical Group
  • Vantage IPA Riverside
  • Corona Regional Medical Center

  • Eisenhower Medical Center

  • Hemet Valley Medical Center

  • John F. Kennedy Memorial Hospital

  • Kindred Hospital Riverside

  • Menifee Valley Medical Center

  • Palo Verde Hospital

  • Parkview Community Hospital Medical Center

  • San Gorgonio Memorial Hospital

  • Southwest Healthcare System

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Sacramento

IPA/Medical GroupsHospitals
  • Hill Physicians Medical Group Sacramento

  • Sierra Nevada Medical Associates

  • UC Davis Health System   

  • Mercy General Hospital

  • Mercy Hospital of Folsom

  • Mercy San Juan Hospital

  • Methodist Hospital of Sacramento

  • UC Davis Medical Center

San Bernardino

IPA/Medical GroupsHospitals
  • Alliance Desert Physicians

  • Beaver Advantage Health Center

  • Beaver Medical Group

  • Choice Medical Group Apple Valley

  • Choice Medical Group Barstow

  • High Desert Primary Care Medical Group

  • High Desert Primary Care Premier

  • Inland Valley IPA

  • Pioneer Provider Network A Medical Group

  • San Bernardino Medical Group

  • Vantage IPA San Bernardino

  • Barstow Community Hospital

  • Bear Valley Community Hospital

  • Colorado River Medical Center

  • Hi Desert Medical Center

  • Loma Linda University Medical Center

  • Mountains Community Hospital

  • Redlands Community Hospital

  • San Antonio Community Hospital

  • St. Bernardine Medical Center

  • St. Mary Regional Medical Center

  • Victor Valley Community Hospital

San Diego

IPA/Medical GroupsHospitals
  • Arch Health Partners

  • Children's Physicians Medical Group

  • Encompass Medical Group

  • Greater Tri Cities IPA

  • Mercy Physicians Medical Group

  • Mid County Physicians Medical Group

  • Multicultural Primary Care Medical Group

  • Primary Care Association Cassidy

  • Primary Care Association Medical Group

  • Sharp Community Graybill

  • Sharp Community Inland North

  • Sharp Community Medical Group Chula Vista

  • Sharp Community Medical Group Graybill Temecula

  • Sharp Community Medical Group Grossmont

  • Sharp Community Medical Group San Diego

  • Sharp Rees-Stealy

  • Fallbrook Hospital District

  • Grossmont Hospital

  • Palomar Medical Center

  • Pomerado Hospital

  • Rady Children's Hospital of San Diego

  • Scripps Green Hospital

  • Scripps Memorial Hospital

  • Scripps Memorial Hospital Encinitas

  • Scripps Mercy Hospital

  • Scripps Mercy Hospital Chula Vista

  • Sharp Chula Vista Medical Center

  • Sharp Coronado Hospital and Healthcare Center

  • Sharp Mary Birch Hospital for Women and Newborns

  • Sharp Memorial Hospital

  • Tri City Medical Center

  • UCSD Medical Center

  • UCSD Medical Center La Jolla

  • Vibra Hospital San Diego

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San Francisco

IPA/Medical GroupsHospitals
  • Brown and Toland Medical Group

  • Chinese Community Healthcare Associates

  • Hill Physicians Medical Group San Francisco

  • Chinese Hospital

  • Medical Center at UCSF

  • St. Francis Memorial Hospital

  • St. Mary's Medical Center

  • UCSF/Mount Zion Medical Center

San Joaquin

IPA/Medical Groups
  • Hill Physicians Medical Group San Joaquin

  • Dameron Hospital

  • Doctors Hospital of Manteca

  • Lodi Memorial Hospital

  • St. Joseph's Behavioral Health Center

  • St. Joseph's Medical Center of Stockton

San Luis Obispo

IPA/Medical GroupsHospitals
  • Coastal Communities Provider Network
  • San Luis Obispo Select IPA
  • Arroyo Grande Community Hospital
  • French Hospital Medical Center
  • Sierra Vista Regional Medical Center

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San Mateo

IPA/Medical GroupsHospitals
  • Brown and Toland Medical Group
  • Hill Physicians Medical Group San Francisco
  • Sequoia Physicians Network
  • Menlo Park Surgical Hospital
  • Mills-Peninsula Health Center
  • Mills-Peninsula Medical Center
  • San Mateo Medical Center
  • Sequoia Hospital District
  • Seton Medical Center
  • Seton Medical Center Coastside

Santa Clara

IPA/Medical GroupsHospitals
  • Santa Clara County IPA
  • El Camino Hospital
  • El Camino Hospital Los Gatos
  • Good Samaritan Hospital
  • Mission Oaks Hospital
  • O'Connor Hospital
  • Regional Medical Center of San Jose
  • St. Louise Regional Hospital
  • Stanford Medical Center

Santa Cruz

IPA/Medical GroupsHospitals
  • Physicians Medical Group of Santa Cruz County
  • Dominican Santa Cruz Hospital
  • Sutter Maternity and Surgery of Santa Cruz
  • Watsonville Community Hospital

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Ventura

IPA/Medical GroupsHospitals
  • Facey Medical Foundation
  • Seaview IPA
  • Valley Care IPA
  • Valley Care Select IPA
  • Community Memorial Hospital of San Buenaventura
  • Ojai Valley Community Hospital
  • Santa Paula Hospital
  • Simi Valley Hospital and Health Care Services
  • Thousand Oaks Surgery Hospital
  • Ventura County Medical Center

Yolo

IPA/Medical GroupsHospitals
  • UC Davis Health System
  • Woodland Clinic
  • Woodland Memorial Hospital

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