Your healthcare costs don’t have to be
The Blue Shield Access+ HMO plan is designed to provide you and your family with comprehensive benefits and access to one of the largest 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 can count on comprehensive coverage. You'll pay only an affordable copayment each time you see a physician. Your eligible dependents can also enroll in Access+ HMO.
Access+ delivers value, quality, and many care choices:
No deductible; zero copayments for hospitalization and preventive care; covered 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
24/7/365 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 in addition to your doctor's office for a $0 copay
A CalPERS-dedicated Member Services team called Shield Concierge
1With Access+ Specialist, you can self-refer to a participating specialist in the same medical group or IPA as your Personal Physician for a fixed office visit copayment of $30. Not all medical groups or IPAs participate in this program.
If you are a Medicare-eligible member, learn about the Access+ HMO Supplement to Original Medicare Plan.
Access+ HMO is available in the following counties. Click on a county to view a full listing of providers within the county.
* partial county – please check the applicable Evidence of Coverage for covered areas.
As a member of the Blue Shield Access+ HMO plan, you’ll choose your Personal Physician from one of the largest provider networks in the state. You and your dependents have the option to choose different 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 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, and then choose CalPERS Access+ HMO. Need help? Call your dedicated Shield Concierge team at (800) 334-5847 for personal assistance.
Please see the 2015 Access+ HMO Basic Plan Evidence of Coverage (PDF, 1.1MB) or the 2016 Access+ HMO Basic Plan Evidence of Coverage (PDF, 628KB) for the exact terms and conditions of coverage, including plan limitations and exclusions.
Following are some of the changes the CalPERS Health Benefits Committee and the Board of Administration have made to the Blue Shield Access+ HMO plan for 2016:
New pharmacy benefit: You can now get a 90-day supply of maintenance medications at select retail pharmacies for the same cost as the mailservice pharmacy. For a list of select pharmacies, please visit the Pharmacy Resources page.
Two new wellness programs: Walkadoo™ is a fun, easy-to-use walking program which uses a wireless pedometer to track your steps. Earn points to be eligible for weekly cash drawings in 2016! QuitNet is a smoking cessation program in which participants can choose from different methods, including online and mobile support from experts and peers, personalized email, and SMS text support.
New health resource: Welvie is an online program that helps you decide on, prepare for, and recover from surgery. The program guides you through the surgery decision process, including understanding surgical and non-surgical treatment options. If surgery is the decision, Welvie can help you prepare to have better results. Plus, you’ll earn a $25 gift card for completing the program.
New out-of-pocket maximums: Per federal healthcare reform requirements, the out-of-pocket maximum for both pharmacy and medical expenses will not exceed $6,850 per individual and $13,700 per family. There is still a $1,500 per individual and $3,000 per family out-of pocket maximum for medical expenses. There will now be a $5,350 per individual and $10,700 per family out-of-pocket maximum for pharmacy expenses.
If you have questions about any of these benefit changes, please contact Shield Concierge, our CalPERS-dedicated Member Services team at (800) 334-5847, 7 a.m. to 8 p.m., seven days a week.
In addition to offering a large pharmacy network that includes chains such as Walgreens, CVS and Rite Aid, we feature a convenient mail-order prescription service. 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 3 fills of maintenance drugs||Up to a 30-day supply of maintenance drugs after the first 3 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 the Mail-Service Pharmacy
|Up to a 90-day supply of maintenance drugs|
To receive medications from PrimeMail, download and complete a New Prescription Order Form 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 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.
To find out more about your personal Pharmacy copayments and benefits:
Check your Evidence of Coverage (EOC) booklet.
Call Member Services at (800) 334-5847.
Log in to blueshieldca.com, and select My Health Plan to view your plan summary, benefits and more.