Access one of the largest networks of doctors and hospitals in California with Blue Shield's Access+ HMO plan
The Blue Shield Access+ HMO® plan is designed to provide you and your family with comprehensive benefits and access to one of the largest healthcare provider networks in the state. The Access+ provider network includes more than 11,000 Personal Physicians, 300 hospitals and 21,000 specialists.
With Access+ HMO, you'll pay no or low copayments each time you see a physician. Your eligible dependents can also enroll in in the plan.
Access+ delivers value, quality and many care choices. Highlights of the plan include:
No deductible and zero copayments for hospitalization and preventive care
Coverage for urgent and emergency care anywhere in the world
Ability to select a different Personal Physician for each member of your family, and change that physician anytime
Self-referral to specialists, using the Access+ Specialist℠ self-referral feature1
Ability to get a second opinion on your diagnosis or treatment from any contracted Blue Shield physician in the state
24/7 access to board-certified California doctors online or by phone through Teladoc when your doctor is not available
Chiropractic and acupuncture services covered for a $15 copay, up to a maximum of 20 combined visits, when using American Specialty Health (ASH) network providers
Flu vaccines available at participating retail pharmacies (PDF, 46KB) in addition to your doctor's office for a $0 copay
One-on-one support from Shield Concierge, a CalPERS-dedicated Member Services team
1With Access+ Specialist, you can self-refer to a participating specialist in the same medical group or Independent Practice Association (IPA) as your Personal Physician for a fixed office visit copayment of $30. Not all medical groups or IPAs participate in this program.
Access+ HMO is available in the following counties. Click on a county to view a full listing of local providers.
* Partial county – please check the applicable Evidence of Coverage for covered areas.
As a member of the Blue Shield Access+ HMO plan, you and your dependents have the option to choose from a variety Personal Physicians and medical groups. You can change your Personal Physician at any time for any reason, and your new doctor will be effective on the first day of the following month.
To find out if your current doctor is in our network or to choose a new doctor, go to blueshieldca.com/findaprovider. Choose Find a Doctor, under Choose a Plan, select CalPERS-2016 or CalPERS-2017 (depending on the plan year you want), and then choose CalPERS Access+ HMO.
Need help? Call your dedicated Shield Concierge team at (800) 334-5847 for personal assistance.
For the exact terms and conditions of coverage, including plan limitations and exclusions, please see the 2016 Access+ HMO Basic Plan Evidence of Coverage (PDF, 628KB) or 2017 Access+ HMO Basic Plan Evidence of Coverage (PDF, 1MB).
The CalPERS Health Benefits Committee and the Board of Administration approved the following changes to the Blue Shield Access+ HMO plan for 2017:
The NetValue HMO plan will be discontinued: If you are a NetValue member, you will be automatically enrolled in our Access+ HMO plan if you do not choose another plan during open enrollment. By switching to Access+ HMO, NetValue members will be able to keep their same doctors and benefits, while gaining access to an even larger network of doctors, specialists and hospitals. Please contact your Health Benefits Officer to find out how the plan change will impact your monthly payments.
Teladoc copay will change: The Teladoc copay will decrease from $15 to $5 per call.
A new Diabetes Prevention Program will be introduced: CalPERS members who are at risk for developing type 2 diabetes will now have access to a Diabetes Prevention Program. Members eligible to participate will be offered a range of support, based on individual needs, for a pre-defined period of time. The goal is to modify lifestyle habits that put members at risk for developing diabetes at no additional cost to members.
New out-of-pocket maximums will take effect: Per federal healthcare reform requirements, the out-of-pocket maximum for both pharmacy and medical expenses will not exceed $7,150 per individual and $14,300 per family. There is still a $1,500 per individual and $3,000 per family out-of pocket maximum for medical expenses. However, there will now be a $5,650 per individual and $11,300 per family out-of-pocket maximum for pharmacy expenses.If you have questions about any of these benefit changes, please contact Shield Concierge at (800) 334-5847.
In addition to offering a large pharmacy network that includes chains such as Walgreens, CVS and Rite Aid, we have a convenient mail-order prescription service through PrimeMail®.
If you take medication for a chronic condition such as diabetes or high blood pressure, you can get up to a 90-day supply of your prescriptions by mail or from one of our select retail pharmacies. For a list of select pharmacies, please visit the Pharmacy Resources page.
Prescriptions at retail pharmacies
|Up to a 30-day supply of non-maintenance drugs or the first three fills of maintenance drugs||Up to a 30-day supply of maintenance drugs after the first three fills or up to a 90-day supply of maintenance drugs from select retail pharmacies|
|$5 generic||$10 generic|
|$20 brand-name||$40 brand-name|
Prescriptions through mail service prescriptions
|Up to a 90-day supply of maintenance drugs|
To receive medications from PrimeMail, download and complete a New Prescription Order Form (PDF, 193KB) and send it with your original prescription(s), and if applicable, the mail service copayment for each drug to:
P.O. Box 27836
Albuquerque, NM 87125-7836
PrimeMail will fill your prescriptions for covered maintenance drugs, according to your physician's directions, up to the amount covered by your pharmacy benefit. Maintenance drugs are medications used on an ongoing basis for treatment of long-term conditions, such as high blood pressure.
Please allow up to 10 days for delivery from the time you mail your prescription.
You may check the status of your order or order prescription refills by visiting www.myprimemail.com or by calling (866) 346-7200. If you rely on TTY equipment, please call (866) 346-7197.
2017 Pharmacy Network Changes—Mail Service and Specialty Pharmacy
Please note pharmacy network changes to the Blue Shield of California’s Access+ HMO plan effective January 1, 2017.*
Mail Service Pharmacy
CVS Caremark Mail Service Pharmacy will replace PrimeMail as Blue Shield’s contracted network mail service pharmacy.
CVS Caremark Specialty Pharmacy will replace Walgreens Specialty Pharmacy as Blue Shield’s contracted network specialty pharmacy.
Blue Shield is working to ensure a smooth transition for members who are currently utilizing PrimeMail and Walgreens Specialty Pharmacy. Members affected by these changes will receive a letter by mail with more information before the end of the year.
In the meantime, please contact Shield Concierge, our dedicated customer service team for CalPERS members, at (800) 334-5847, 7 a.m. to 8 p.m., seven days a week.
*Pending Department of Managed Health Care approval
To find out more about your personal pharmacy copayments and benefits:
Check your Evidence of Coverage (EOC) booklet
Call Shield Concierge at (800) 334-5847
Log in to blueshieldca.com and select My Health Plan