PPO Administrators for Basic Plan Members

Available by phone at 855-633-4436, online, or mobile app, Included Health is your go-to resource for personalized healthcare services, such as:

• Checking if your current doctor is in-network
• Finding new providers or urgent care centers
• Coordinating care, particularly if you have complex conditions
• When you want a second medical opinion
• Accessing virtual primary care and behavioral health services
• Receiving 24/7 clinical advice from a nurse
• Tracking your deductibles, copays, and coinsurance
• Understanding your medical bills

Download the Included Health app for easy access to your health plan information on the Apple Store or Google Play Store.

The 22 rural counties are:

• Alpine
• Amador
• Calaveras
• Del Norte
• Glenn
• Imperial
• Inyo
• Lassen
• Mariposa
• Mendocino
• Modoc
• Mono
• Plumas
• San Benito
• Shasta
• Sierra
• Siskiyou
• Sutter
• Tehama
• Trinity
• Tuolumne
• Yuba

Contact Included Health if you have questions.

You can change your PCP whenever you'd like. To update your PCP, you can log in to the Blue Shield Member Portal which is available through Included Health. Once logged in to your Included Health account, navigate to the "View More Services" tile on the homepage, which provides a link to the Blue Shield portal. From your member dashboard, navigate to the “change PCP” button. If you don't have an account, you'll need to register first. You’ll need your Social Security Number or Member ID to complete the registration process.

If you need assistance navigating the portal, you can contact the Included Health care team for support.

If your previous PCP is out-of-network (OON) for 2025 or does not meet Blue Shield’s PCP criteria, you may have been matched to a different PCP within the Blue Shield network. Blue Shield is continually adding new providers to its network and updating its PCP criteria. If you would like to change your PCP, please contact the Included Health care team or visit the Blue Shield member portal to search for available PCPs or to update your PCP.

For PPO plans, you can see any PCP without needing a referral even if they are not listed on your ID card. For Gold plan members, there is a copay incentive to see your designated PCP or a PCP at the same location. Platinum plan members do not have a copay difference between their designated PCP or another PCP of their choice.

Blue Shield requires that a provider be credentialed in one of the four primary care specialties: 1) internal medicine; 2) family medicine; 3) pediatrics; 4) or general medicine, and not have actively opted out of being an assignable PCP. However, even if you have one of the four primary care specialties, if your provider is hospital or facility based (hospitalist, emergency medicine, trauma) or part of an emergency medicine physician group they cannot be assigned as a PCP. OB/GYNs won’t automatically be available but can opt in to be assigned as a PCP. Your provider can contact Blue Shield of CA’s provider services line found on the back of your ID card.

If you're seeing a Nurse Practitioner (NP) or Physician Assistant (PA), please note that only MDs and DOs can be designated as your PCP on your ID card at this time.

Blue Shield has established an automatic override for CalPERS members that should allow you to change your PCP to your previous PCP even if the provider is marked as "not accepting new patients." If you have any challenges, please call Included Health to assist in updating your PCP. Please provide the provider's name and other details (e.g., address and phone number), via chat or phone call, and Included Health will update your PCP designation. You should receive your new ID card within 10 business days once updated.

You can only select MD/DOs (Doctors of Medicine/Doctors of Osteopathic Medicine) as your designated PCP. If you see an NP or PA, you may continue to see them, but your PCP must be the supervising MD/DO. If you're unsure about which PCP to choose, you can contact Included Health at includedhealth.com/calpers or call 855-633-4436 to find a high-quality provider in your area.

Once your PCP change is processed, you can expect to receive your updated ID card within 10 business days. You can continue using your old card until the new one arrives.

You can contact Included Health to update your PCP retroactively for that month. For members in the PERS Gold plan, the copay for seeing your designated PCP (or another PCP at the same location) is $10 and $35 for all other providers. In the Platinum plan, you can see the PCP of your choice at the same copay amount.

If you encounter any difficulties with updating your PCP or accessing the Included Health portal, their care team is available to assist you. You can chat or call the Included Health care team by going to includedhealth.com/calpers or calling 855-633-4436.

Blue Shield requires that a provider be credentialed in one of four primary care specialties: 1) internal medicine; 2) family medicine; 3) pediatrics; 4) or general practice. Providers with a primary care specialty can also choose to “opt-out” of being assignable as a PCP.

CalPERS members can select those OB/GYNs as their PCP. If you are seeing an OB/GYN for specialty care and you want them to now be your primary care physician, your provider must contact Blue Shield and request to be added as a primary care physician. The information for Blue Shield of CA’s provider services line is available on the back of your ID card. If your provider is of another specialty type, Blue Shield is continually evaluating the primary care provider criteria and will inform you if this changes in the future.

If Blue Shield uses our primary care assignment logic which matches you to a primary care provider that is:

• Within approximately 10 miles of the member’s address (but Blue Shield continues beyond 10-miles if a match can’t be found)
• Accepting new members (open panel)
• Accepting patients of the member’s age (every practitioner has age limitations, so member must be within the min/max age range as defined by practitioner)
• Accepting patients of the member’s gender (male, female or both)

No, the PCP listed on your ID card is your matched PCP but as part of the PERS Basic PPO you can see the in-network PCP of your choice. If you are a PERS Platinum member there are no cost sharing differences. If you are a PERS Gold member you pay a $10 copay for seeing your matched PCP (or another PCP at the same location) and a $35 copay for seeing any other PCP.

Blue Shield is your health plan provider, and your Member ID is the other information needed to share with your provider’s office.

Access this information on the Health and Wellness page which is updated with new information based on the services provided by Included Health.

Behavioral health benefits are provided by Blue Shield contracted mental health providers and Included Health provides supplemental virtual behavioral health services for Basic members.

Yes, if you're seeing a provider who'll continue to be in network with Blue Shield.

If your provider is no longer in network and you're in the PERS Platinum plan or are a PERS Gold member in one of the eligible counties or ZIP codes, you may be able to continue to see them at the in-network benefit. After the one year limited out-of-network exception, you might have to find a new provider or pay for out of network services.

Yes, members can see PCPs in-person. If you're seeing a provider who continues to be in network with Blue Shield, you'll be able to continue seeing that PCP in person. If your provider is no longer in network and you're in the PERS Platinum plan or are a PERS Gold member in one of the eligible counties or ZIP codes, you may be able to continue to see them at the in-network benefit. After the one year limited out-of-network exception, you might have to find a new provider or pay for out of network services.

Yes, Included Health employs licensed nurses and physicians who help guide care for members who participate in care management.

Included Health offers virtual primary care and behavioral health services which provide preventive care and chronic condition management, physical and behavioral health care, and seamless connections to local, in-network providers as needed. Virtual care can help to improve access and quality of care in rural areas where it can be difficult to get an appointment with a primary care or behavioral health care provider.

Yes, one of the benefits of a PPO is that you don’t need a referral for services. However, Included Health is available to recommend a provider for your specific condition if you would like assistance in locating one.

Virtual care is the same copay and coinsurance as in-person primary care. Please see your Evidence of Coverage (EOC) or Summary of Benefits (SBC) documents for specifics as they vary for Gold and Platinum Basic PPO plans.