Access+ HMO

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

  • Health and wellness programs, such as Condition Management and Wellvolution®

  • 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.

2016/2017 service area

Access+ HMO is available in the following counties. Click on a county to view a full listing of local providers.

AlamedaMarinSan Luis Obispo 
ButteMariposaSan Mateo
Contra CostaMercedSanta Barbara
El Dorado*Nevada*Santa Clara
FresnoOrange Santa Cruz
GlennPlacer*Solano
HumboldtRiversideSonoma
ImperialSacramentoStanislaus
KernSan Bernardino*Tulare
KingsSan Diego*Ventura
Los AngelesSan FranciscoYolo
MaderaSan Joaquin*

* Partial county – please check the applicable Evidence of Coverage for covered areas.

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How to select a doctor

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. 

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Covered services and copayments

You can find brief descriptions of the Blue Shield Access+ HMO plan benefits for CalPERS members in our 2016 brochure (PDF, 343KB).

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).

The CalPERS Health Benefits Committee and the Board of Administration made a number of updates to the Blue Shield Access+ HMO plan in 2016. Some of the highlights include:

  • New pharmacy benefit: You can get a 90-day supply of maintenance medications at select retail pharmacies for the same cost as the Blue Shield's mail service pharmacy. For a list of these 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 cash drawings throughout 2016 and 2017. 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: In line with 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 at (800) 334-5847.

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Pharmacy benefits

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 3 fills of maintenance drugsUp 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

$50 non-formulary

$100 non-formulary

 

Prescriptions through the mail-service pharmacy

Up to a 90-day supply of maintenance drugs
$10 generic
$40 brand-name

$100 non-formulary


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:

PrimeMail Pharmacy
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.

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

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