Open Enrollment for Active Members

Where do I find information about the removal of UnitedHealthcare SignatureValue Alliance and Harmony basic plans?

To find the administrative transfer plans, visit the UnitedHealthcare - Basic Health Plans Removal for 2027 webpage for frequently asked questions (FAQs).

Will prior authorizations transfer for Monterey County for those that are administratively transferring into Blue Shield Access+? When will members get new cards?

Yes. CalPERS is working with Anthem to transfer information to the default plan and members will get new ID cards in early December. If you haven’t received your ID card by December 15, contact your new health plan.

I’m with UHC Alliance and Sutter Medical group, and currently in active treatment. I used the CalPERS search tool to look up my doctor, and it says he isn’t covered under the Sutter Health Plan. What do I do?

You’ll want to contact Sutter Health Plan to confirm if your doctor is in network If they aren’t, talk to your current health plan about continuity of care options. Depending on the situation you may be able to keep your current provider while you transition to an in-network doctor.

I live in Monterey County and am enrolled in the Anthem Medicare plan; can I still go to Aspire?

Anthem and Aspire aren’t continuing their agreement into 2027 on the basic plan, but they still have a plan in place for Medicare. Anthem Medicare members in Monterey County aren’t impacted by the Anthem/Aspire contract negotiations for the basic plan.

If moving from UHC to Sutter Health Plan, do we need to change from Walgreens to CVS for medications?

No. Sutter Health Plan is using CVS as its Pharmacy Benefits Manager (PBM), which means your current pharmacy benefits will remain.

If I’m transferring from UHC to Blue Shield, how are prescriptions transferred as CVS is not the PBM for BlueShield?

Blue Shield and UHC/CVS are working on a transition plan, and Blue Shield will accept prior authorization from UHC/CVS. However, there are differences between the CVS and Blue Shield formularies, which means you should review formulary coverage.

Is there a benefit to me if I use my work ZIP code for health eligibility instead of my home ZIP code?

It depends on your individual situation on where you want to seek services. If you want to seek services closer to your employer’s place of business, you’ll use their ZIP code. If you prefer services near your home, you’ll use your residential ZIP code. This could also be a cost-comparison decision. You’ll want to make sure that you use services in the ZIP code you choose, or it’ll be considered out-of-network. Use the Health Plan Search by ZIP Code tool or log in to your myCalPERS account to check plan availability.

I’m in a PPO Basic plan; how can we access our claims and current deductible used to determine any changes we may want to make for the following year?

If you have questions about your claims or current deductibles, contact Included Health at the number on the back of your ID card, (855)633-4436 or log in to your Included Health account. They’ll help you understand the status of your deductibles and co-insurance.

Are there any changes for out-of-state members?

Kaiser is expanding into northwestern Nevada. Details may be found on the Plans & Rates webpage.

Will HMO and PPO plans all have the same Family Building benefits and providers?

Beginning July 1, 2027, all basic health plans will offer coverage for the diagnosis and treatment of infertility. Progyny will administer benefits for basic health plans, except Kaiser, and members will have access to Progyny’s comprehensive provider network. Kaiser will administer these benefits for Kaiser members and members will have access to Kaiser’s providers.

Is there a resource available that goes over the new fertility coverage for the basic plans?

Yes. This information may be found in the basic health plans’ Evidence of Coverage publications for 2027.

Can you confirm that the Delta Dental PPO plans will change in name only? There’s nothing I need to do to continue with my current Delta Dental PPO coverage?

The Delta Dental PPO plans will change in name only, and no action is required to continue your current coverage. For more information visit the CalHR state employee and CalHR retiree dental webpages.

Does PERS Platinum include vision coverage?

PERS Platinum Medicare Supplement includes vision benefits. You’ll want to refer to the PERS Platinum Supplement to Medicare Evidence of Coverage to confirm coverage details.

I’ll turn 65 in August 2027; my spouse will turn 65 in January 2028. We’re currently on the same plan. If I switch to Medicare before him, what will happen to his coverage?

This is referred to as a combination plan. A combination plan means at least one family member is enrolled in a Medicare health plan and at least one family member is enrolled in a basic (non-Medicare) health plan through the same health carrier. If your current plan doesn’t offer a combination plan, you’ll need to choose a new health plan, or we’ll automatically enroll you into a combination plan.

Does Sutter Health Plan offer a Medicare plan?

No. Sutter Health Plan doesn’t offer a Medicare plan for CalPERS members. Visit our Plans & Rates webpage for a full list of health plans.

Your Health Plan Statement will be available in myCalPERS on September 8. When you review it, ensure the health enrollment information is accurate. Use A Guide to Understanding Your Health Plan Statement if you have questions about the information on your Health Plan Statement.

Will your plan still be available next year, or is there a better option for you? If you change plans, will you still have access to your preferred doctors and/or specialists? Use How to Choose a Health Plan (PDF) as a checklist of factors to consider and resources to guide you as you explore your options.

• myCalPERS: Log in and use the Search Health Plans tool to find the best health plan for you and your family.
  • Beginning on September 8, you can compare 2027 monthly premiums; find plans your doctors, specialists, or medical groups participate in; compare benefits and costs; and access member satisfaction ratings for each plan.
• Active Member Plans & Rates: Access a full listing of 2027 health plans, premiums, and health plan websites and phone numbers. Access Evidence of Coverage and Summary of Benefits publications (available by September 14).
• Eligibility & Enrollment: Learn about the CalPERS Health Program, including eligibility requirements and general enrollment information.
• Online Health Enrollments: With your employer’s approval, make health enrollment changes through your myCalPERS account.
• 2027 Open Enrollment Newsletter: Review 2027 health program highlights, notable health plan changes, and important health reminders.
  • Open Enrollment Newsletter (English) (PDF)
  • Open Enrollment Newsletter (Español) (PDF)
• 2027 Health Benefit Summary (PDF): Compare covered services, co-payments, and benefits for each CalPERS health plan.
• Medical Board of California: Learn how the state is protecting health care consumers and access to quality medical care.