CalPERS

FAQs - 2014 Health Plans

Why is CalPERS adding new health plans?

CalPERS wants to provide broad access to high quality health plans for you, our members and employers.

When will new HMO health plan choices be available?

New health plan choices will be effective January 1, 2014. CalPERS posted information about the new plans in June in the 2014 Health Plan Rates area. We encourage you to closely examine the Open Enrollment materials that are available online and were mailed to you in August.

When will I be able to change my plan?

The next Open Enrollment period will be in the fall of 2014.

What if I don't want to change my plan? Are you going to force me to change my plan?

If the ZIP Code where you work or live is still in your current plan’s coverage area in the upcoming calendar year, you will not be forced to change plans. CalPERS has many resources available online and in the Open Enrollment materials mailed to you, including the Health Plan Search by ZIP Code tool and the 2014 Health Benefit Summary (PDF, 494 KB).

How can I check to see if my doctor is available through another plan being offered?

Provider directories are available online or you can contact the plan directly at the toll-free number listed in the provider directory.

I'm seeing a specialist with my current plan. If I switch plans, will I still be able to see my specialist?

Health plans posted their provider directories online, which includes a list of primary care physicians and specialists. Refer to the health plan's provider directory to see if your current physician or specialist will be part of that health plan. You can also call the health plan directly to check the availability of your current physician or specialist.

How will I know what health plan choices will be available in my area?

This information is available online and in the Open Enrollment materials mailed to you. You can use the Health Plan Search by ZIP Code tool or refer to the 2014 Health Benefit Summary (PDF, 494 KB). These materials show available plans based on ZIP Code and/or county. The Health Plan Chooser is another easy-to-use online tool that may be helpful in selecting a plan.

If I don't like my new plan, can I switch back?

When you select a plan, the selection is valid for a year. Under certain limited instances, plan changes can be made outside the annual Open Enrollment period. Please refer to the Health Program Guide for 2014 (PDF, 289 KB) for a description of qualifying events.

Is Kaiser Permanente still going to be available?

Yes.

Are there any changes to my Medicare Supplement or Medicare Advantage Plan?

There may be changes depending on your service area or ZIP Code and the health plan you choose to enroll in. This information is available online and in the Open Enrollment materials mailed to you.

When will the health plan premiums for 2014 be available?

Health plan premiums for 2014 were announced in June and are available online in our 2014 Health Plan Rates area. Rates are listed in the Open Enrollment materials mailed to you.

Will my premium change in 2014?

Refer to the 2014 Health Plan Rates to see if your premium will change in 2014. You can also compare your current health plan premium to other plans available in your area.

I am currently enrolled in a PPO health plan. Will these plans be available in 2014?

Anthem Blue Cross will continue to administer PERSCare, PERS Select and PERS Choice. CVS Caremark will continue as the pharmacy benefit manager.

Will I be able to get my prescriptions filled at the same pharmacy if I change plans?

It depends. Each health plan has a contracted pharmacy network. For example, a change from any plan to Kaiser Permanente will require that prescriptions be filled by Kaiser. We encourage you to closely examine the 2014 Health Benefit Summary (PDF, 494 KB) and the Health Plan Evidence of Coverage (EOC) publications.

Are all the benefits and/or drug formularies the same across all the plans?

No. In order to provide choices to members with different health plan needs, each health plan offers different co-pays, deductibles, benefit limits and drug formularies. You are encouraged to closely examine the Open Enrollment materials, so you can make informed choices.

I am currently receiving an ongoing course of medical treatment through my current health plan, or, I have a procedure scheduled right after the New Year. What will happen if I choose a new health plan effective January 1, 2014?

Before changing health plans, you should verify that the procedure or treatment you are receiving from your current health plan will continue to be a covered service through the health plan you are considering changing to. If the new health plan covers the service and your provider does not change, there should not be an impact. If your provider will change, you may want to follow up with both your current health plan and the new health plan to determine what steps you'll need to take to ensure the procedure or treatment you are receiving will be covered. In either instance, you should contact the new health plan prior to changing plans during Open Enrollment to be certain.

What is Health Net Salud y Mas? Is it a separate health plan from Health Net SmartCare?

Salud y Mas and SmartCare are two separate HMO plans offered by Health Net to CalPERS members and dependents working or residing in California, within Health Net's service areas. Members of either HMO plan can visit a select network of providers and physician groups in the SmartCare or Salud y Mas service areas.

Further, members of the Salud y Mas HMO plan have the option of accessing medical care in Mexico (Tijuana, Mexicali, Rosarito and Tecate) through participating providers in their SIMNSA network. However, members must use the ZIP codes listed for Health Net's service area (California) for enrollment purposes. This network is regulated by the California Department of Managed Health Care.

Who is eligible to enroll in Health Net Salud y Mas? Can dependents residing in Mexico enroll in the plan and access coverage?

As with all CalPERS health plans, eligibility for enrollment in any health plan is based on the California ZIP code in which you work or reside. If you use your residential ZIP code for eligibility, all your dependents must also reside within the health plan's service area. When you use your work ZIP code, all of your enrolled dependents must receive all covered services (except emergency and urgent care) within the health plan's service area, even if they do not reside in that service area.


Additional Resources

FAQs - Health Benefits
FAQs - Open Enrollment

Dated: 10-11-2013