Plans & Rates
Active members: Visit your health plan's website to learn how benefits, claims, and payment of claims are covered, as well as the service limitations and exclusions that may apply. You can also log in to myCalPERS to use the Search Health Plans tool to research the health plan coverage and benefits most important to you and your family.
Are you a retiree? View Retiree Plans & Rates customized just for you.
Rates & Employer Contributions
View How CalPERS Sets Health Rates to get details on the rates and plans process.
2019
2019 Combined Regional Rates (PDF)
View the 2019 health premium rates approved by the CalPERS Board of Administration:
State CoBen Allowances
| Bargaining Units | One-Party | Two-Party | Family |
|---|---|---|---|
| 2, 7, 16*, 17*, 18, and 19* | $630 | $1,245 | $1,623 |
| 8* | $667 | $1,281 | $1,660 |
| Excluded Employees | $668 | $1,293 | $1,673 |
* These bargaining units have health contribution language set in statute.
State Employer Health Benefit Contributions
Active CSU Members
- All Employees (Except Unit 6) - One-Party: $734; Two-Party: $1,398; Family: $1,788
- Unit 6 - One-Party: $739; Two-Party: $1,408; Family: $1,808
State CoBen Allowances
Consolidated Benefits (CoBen) is the employer-provided benefit allowance to offset the cost of health, dental, and vision benefits. For more information, visit CalHR. Check with your employer to determine your contribution amount.
COBRA Rates
If you have continued health coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA), contact your employer for your monthly premium rate. Refer to COBRA for information on continuing health coverage for yourself and your dependents if you involuntarily lose your health benefits.
COBRA rates are calculated at 102% of the Basic premiums, but some carriers may charge less than these maximum amounts.
State Rates for January 1, 2019 to December 31, 2019
| Plan Name | Single | 2-Party | Family |
|---|---|---|---|
| Anthem EPO Del Norte | $780.08 | $1,560.15 | $2,028.20 |
| Anthem Select HMO | $757.75 | $1,515.50 | $1,970.14 |
| Anthem Traditional HMO | $1,055.17 | $2,110.34 | $2,743.44 |
| Blue Shield Access+ | $815.01 | $1,630.02 | $2,119.03 |
| Blue Shield EPO | $815.01 | $1,630.02 | $2,119.03 |
| CAHP | $711.41 | $1,381.09 | $1,806.34 |
| CCPOA - North | $770.06 | $1,543.40 | $2,083.74 |
| CCPOA - South | $634.99 | $1,273.22 | $1,720.42 |
| Health Net Salud y Más | $384.43 | $768.86 | $999.51 |
| Health Net SmartCare | $743.27 | $1,486.55 | $1,932.51 |
| Kaiser (CA) | $722.56 | $1,445.12 | $1,878.65 |
| Kaiser (Out-of-State)1 | $983.97 | $1,967.95 | $2,558.33 |
| PERS Choice | $780.08 | $1,560.15 | $2,028.20 |
| PERS Select | $502.08 | $1,004.17 | $1,305.42 |
| PERSCare | $948.49 | $1,896.98 | $2,466.06 |
| PORAC | $789.48 | $1,655.46 | $2,117.52 |
| Sharp | $605.53 | $1,211.07 | $1,574.39 |
| UnitedHealthcare | $709.69 | $1,419.37 | $1,845.18 |
| Western Health Advantage | $720.93 | $1,441.85 | $1,874.40 |
1These premiums cover all Kaiser out-of-state areas.
View the 2019 COBRA rates by region (PDF).
Since health care costs vary throughout California, regional pricing adjusts premiums to reflect the actual cost of health care in your specific region. This ensures that your CalPERS premiums are appropriate and competitive for where you live.
To find your specific health plan premium rates, choose your region from the options below:
- Bay Area Rates (PDF) - View rates for Alameda, Amador, Contra Costa, Marin, Napa, Nevada, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma, Sutter, and Yuba.
- Los Angeles Area Rates (PDF) - View rates for Los Angeles, San Bernardino, and Ventura.
- Other Northern California Rates (PDF) - View rates for Alpine, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Plumas, San Benito, Shasta, Sierra, Siskiyou, Stanislaus, Tehama, Trinity, and Tuolumne.
- Other Southern California Rates (PDF) - View rates for Fresno, Imperial, Inyo, Kern, Kings, Madera, Orange, Riverside, San Diego, San Luis Obispo, Santa Barbara, and Tulare.
- Out-of-State Rates (PDF) - View rates for health plans available outside of California.
- Sacramento Area Rates (PDF) - View rates for El Dorado, Placer, Sacramento, and Yolo.
Employer Contribution Amounts
Contributions vary by employer. Contact your employer to find out how much they contribute toward your monthly premium rate.
State Active Contribution Rates for 2019
| Formula | Single (1) | 2 Party (2) | Family (3+) |
|---|---|---|---|
| 80-80 Formula | $583 | $1,170 | $1,518 |
| 85-80 Formula | $620 | $1,206 | $1,555 |
State Annuitant Contribution Rates for 2019
| Formula | Single (1) | 2 Party (2) | Family (3+) |
|---|---|---|---|
| Basic 80-80 Formula | $583 | $1,170 | $1,518 |
| Medicare 80-80 Formula | $278 | $554 | $833 |
| 100-90 Formula | $734 | $1,398 | $1,788 |
COBRA Rates
If you have continued health coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA), contact your employer for your monthly premium rate. Refer to COBRA for information on continuing health coverage for yourself and your dependents if you involuntarily lose your health benefits.
2020
View the 2020 health premium rates approved by the CalPERS Board of Administration:
Employer Contribution Amounts
Active State Members
Below are the contribution rates. Your cost is any amount above the employer contribution. Active subscribers are subject to the 80-80 or 85-80 formula. Active subscribers should contact their employer to inquire which formula applies to their bargaining unit.
CalPERS Health Program
State Employer Health Benefit Contributions
| Formula | Single (1) | 2 Party (2) | Family (3+) |
|---|---|---|---|
| 80-80 Formula | $609 | $1,223 | $1,585 |
| 85-80 Formula | $647 | $1,261 | $1,623 |
State CoBen Allowances
Consolidated Benefits (CoBen) is the employer-provided benefit allowance to offset the cost of health, dental, and vision benefits. For more information, visit CalHR. Check with your employer to determine your contribution amount.
State Employer Health Benefit Contributions
Active CSU Members
- All Employees (Except Unit 6) - One-Party: $767; Two-Party: $1,461; Family: $1,868
- Unit 6 - One-Party: $772; Two-Party: $1,471; Family: $1,888
COBRA Rates
If you have continued health coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA), contact your employer for your monthly premium rate. Refer to COBRA for information on continuing health coverage for yourself and your dependents if you involuntarily lose your health benefits.
COBRA rates are calculated at 102% of the Basic premiums, but some carriers may charge less than these maximum amounts.
State Rates for January 1, 2020 to December 31, 2020
| Plan Name | Single | 2-Party | Family |
|---|---|---|---|
| Anthem EPO Del Norte | $802.74 | $1,605.48 | $2,087.12 |
| Anthem Select HMO | $803.55 | $1,607.09 | $2,089.22 |
| Anthem Traditional HMO | $1,138.07 | $2,276.13 | $2,958.97 |
| Blue Shield Access+ | $928.36 | $1,856.73 | $2,413.75 |
| Blue Shield EPO | $928.36 | $1,856.73 | $2,413.75 |
| Blue Shield Trio | $715.08 | $1,430.16 | $1,859.22 |
| CAHP | $732.75 | $1,422.52 | $1,860.53 |
| CCPOA - North | $820.53 | $1,644.76 | $2,220.64 |
| CCPOA - South | $676.58 | $1,356.79 | $1,833.43 |
| Health Net Salud y Más | $411.62 | $823.24 | $1,070.21 |
| Health Net SmartCare | $878.18 | $1,756.36 | $2,283.27 |
| Kaiser (CA) | $744.65 | $1,489.30 | $1,936.09 |
| Kaiser (Out-of-State)1 | $1,015.09 | $2,030.19 | $2,639.24 |
| PERS Choice | $802.74 | $1,605.48 | $2,087.12 |
| PERS Select | $502.08 | $1,004.17 | $1,305.42 |
| PERSCare | $1,009.68 | $2,019.36 | $2,625.16 |
| PORAC | $738.48 | $1,477.98 | $1,965.54 |
| Sharp | $618.14 | $1,236.28 | $1,607.16 |
| UnitedHealthcare | $741.49 | $1,482.98 | $1,927.87 |
| Western Health Advantage | $746.60 | $1,493.20 | $1,941.16 |
1These premiums cover all Kaiser out-of-state areas.
View the 2020 COBRA rates by region (PDF).
Since health care costs vary throughout California, regional pricing adjusts premiums to reflect the actual cost of health care in your specific region. This ensures that your CalPERS premiums are appropriate and competitive for where you live.
To find your specific health plan premium rates, choose your region from the options below:
- Region 1 Rates (PDF) - View rates for Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, and Yuba.
- Region 2 Rates (PDF) - View rates for Fresno, Imperial, Inyo, Kern, Kings, Madera, Orange, San Diego, San Luis Obispo, Santa Barbara, Tulare, and Ventura.
- Region 3 Rates (PDF) - View rates for Los Angeles, Riverside, and San Bernardino.
- Out-of-State Rates (PDF) - View rates for health plans available outside of California.
Employer Contribution Amounts
Contributions vary by employer. Contact your employer to find out how much they contribute toward your monthly premium rate.
Health Plans
2019
Administrator: Anthem Blue Cross
Offers Medicare?
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
- 2019 Anthem Blue Cross Select HMO Basic Evidence of Coverage (PDF)
- 2019 Anthem Blue Cross Select HMO Basic Summary of Benefits and Coverage with Uniform Glossary (PDF)
- 2019 Anthem Blue Cross Traditional HMO Basic Evidence of Coverage (PDF)
- 2019 Anthem Blue Cross Traditional HMO Basic Summary of Benefits and Coverage with Uniform Glossary (PDF)
- 2019 OptumRx Outpatient Prescription Drug Benefit Plan for Selected HMO Basic Plans Evidence of Coverage (PDF)
Anthem Blue Cross EPO is available only in Del Norte county.
Administrator: Anthem Blue Cross
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
Administrator: Blue Shield of California
Offers Medicare? No
Directory: Find a Doctor
Basic Publications
Blue Shield EPO is available only in Colusa, Mendocino, and Sierra counties.
Administrator: Blue Shield of California
Offers Medicare? No
Directory: Find a Doctor
Basic Publications
You must belong to the specific employee association and pay applicable dues to enroll in the California Association of Highway Patrolmen (CAHP). Note: The Prudent Buyer Network for CAHP's Basic and Combination Plan is available only in California and in limited areas of selected states outside of California. Contact us at 888 CalPERS (or 888-225-7377) for further assistance.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Directory: Find a Doctor
Basic Publications
- 2019 CAHP Basic Health Plan Evidence of Coverage (PDF, 3.16 MB)
- 2019 CAHP Summary of Benefits and Coverage with Uniform Glossary (PDF, 1.04 MB)
Medicare Publications
You must belong to the specific employee association and pay applicable dues to enroll in the California Correctional Peace Officers Association (CCPOA). The CCPOA plan is available only to dues-paying members of that organization and their families.
Administrator: Blue Shield of California
Offers Medicare? Yes
Directory: Find a Doctor
Basic Publications
- 2019 CCPOA Access+ HMO Basic Evidence of Coverage (PDF)
- 2019 CCPOA Access+ Summary of Benefits and Coverage with Uniform Glossary (PDF)
Medicare Publications
Administrator: Health Net of California
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: ProviderSearch
Basic Publications
- 2019 Health Net of California: Salud y Más HMO Evidence of Coverage (PDF)
- 2019 Health Net of California: Salud y Más HMO Summary of Benefits and Coverage with Uniform Glossary (PDF)
- 2019 Health Net of California: SmartCare HMO Evidence of Coverage (PDF)
- 2019 Health Net of California: SmartCare HMO Summary of Benefits and Coverage with Uniform Glossary (PDF)
- 2019 OptumRx Outpatient Prescription Drug Benefit Plan for Selected HMO Basic Plans Evidence of Coverage (PDF)
This plan is available in some states. Refer to the Evidence of Coverage for service area information.
Administrator: Kaiser Permanente
Offers Medicare? Yes
Directory: Doctors & Locations
Basic Publications
- 2019 Kaiser Health Plan Evidence of Coverage (PDF)
- 2019 Kaiser Summary of Benefits and Coverage with Uniform Glossary (PDF)
Medicare Publications
- 2019 Kaiser Health Plan Senior Advantage Medicare Evidence of Coverage (PDF)
- 2019 Kaiser Health Plan Senior Advantage When Medicare Is Secondary Evidence of Coverage (PDF)
Kaiser Out-of-State: Early Retirees Basic Publications
- 2019 Kaiser Basic – Colorado Evidence of Coverage (PDF)
- 2019 Kaiser Basic – Georgia Evidence of Coverage (PDF)
- 2019 Kaiser Basic – Hawaii Evidence of Coverage (PDF)
- 2019 Kaiser Basic – Mid-Atlantic Evidence of Coverage (PDF)
- 2019 Kaiser Basic – Northwest Evidence of Coverage (PDF)
- 2019 Kaiser Basic – Washington Evidence of Coverage (PDF)
Kaiser Out-of-State: Medicare Publications
- 2019 Kaiser Medicare – Colorado Evidence of Coverage (PDF)
- 2019 Kaiser Medicare – Georgia Evidence of Coverage (PDF)
- 2019 Kaiser Medicare – Hawaii Evidence of Coverage (PDF)
- 2019 Kaiser Medicare – Mid-Atlantic Evidence of Coverage (PDF)
- 2019 Kaiser Medicare – Northwest Evidence of Coverage (PDF)
- 2019 Kaiser Medicare – Washington Evidence of Coverage (PDF)
You must belong to the specific employee association and pay applicable dues to enroll in the Peace Officers Research Association of California (PORAC). This plan is available outside of California. Refer to the plan's Evidence of Coverage for service area information.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Directory: Find a Doctor
Basic Publications
- 2019 PORAC Prudent Buyer Plan Evidence of Coverage (PDF)
- 2019 PORAC Prudent Buyer Plan Summary of Benefits and Coverage with Uniform Glossary
- 2019 PORAC Out-of-State Resident Basic Health Plan Evidence of Coverage
- 2019 PORAC Out-of-State Resident Summary of Benefits and Coverage with Uniform Glossary
Medicare Publications
This plan has no geographical restrictions. It provides coverage anywhere in the world.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
- 2019 PERSCare Basic Plan Evidence of Coverage (PDF)
- 2019 PERSCare Basic Plan Summary of Benefits and Coverage with Uniform Glossary (PDF)
Medicare Publications
This plan has no geographical restrictions. It provides coverage anywhere in the world.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
- 2019 PERS Choice Basic Plan Evidence of Coverage (PDF)
- 2019 PERS Choice Basic Plan Summary of Benefits and Coverage with Uniform Glossary (PDF)
Medicare Publications
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
New: Value-Based Insurance Design
Basic Publications
- 2019 PERS Select Basic Plan Evidence of Coverage (PDF)
- 2019 PERS Select Basic Plan Summary of Benefits and Coverage with Uniform Glossary (PDF)
Medicare Publications
Administrator: Sharp Health Plan
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find a Doctor
Basic Publications
Administrator: UnitedHealthcare
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find a Doctor
Basic Publications
- 2019 UnitedHealthcare SignatureValue Alliance Evidence of Coverage (PDF, 1.84 MB)
- 2019 UnitedHealthcare SignatureValue Alliance Summary of Benefits and Coverage with Uniform Glossary (PDF, 1.21 MB)
- 2019 OptumRx Outpatient Prescription Drug Benefit Plan for Selected HMO Basic Plans Evidence of Coverage (PDF)
Administrator: UnitedHealthcare
Offers Medicare? Yes
Directory: Find a Doctor
Medicare Publications
Administrator: Western Health Advantage
Offers Medicare? No
Basic Publications
2020
Administrator: Anthem Blue Cross
Offers Medicare?
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
- 2020 Anthem Blue Cross Select HMO Basic Evidence of Coverage (PDF)
- 2020 Anthem Blue Cross Select HMO Basic Summary of Benefits and Coverage (PDF)
- 2020 Anthem Blue Cross Traditional HMO Basic Evidence of Coverage (PDF)
- 2020 Anthem Blue Cross Traditional HMO Basic Summary of Benefits and Coverage (PDF)
- 2020 OptumRx Outpatient Prescription Drug Benefit Plan for Selected HMO Basic Plans Evidence of Coverage (PDF)
Anthem Blue Cross EPO is available only in Del Norte county.
Administrator: Anthem Blue Cross
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Medicare Publications
Administrator: Blue Shield of California
Offers Medicare? No
Directory: Find a Doctor
Basic Publications
Blue Shield EPO is available only in Colusa, Mendocino, and Sierra counties.
Administrator: Blue Shield of California
Offers Medicare? No
Directory: Find a Doctor
Basic Publications
You must belong to the specific employee association and pay applicable dues to enroll in the California Association of Highway Patrolmen (CAHP). Note: The Prudent Buyer Network for CAHP's Basic and Combination Plan is available only in California and in limited areas of selected states outside of California. Contact us at 888 CalPERS (or 888-225-7377) for further assistance.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Directory: Find a Doctor
Basic Publications
- 2020 CAHP Basic Health Plan Evidence of Coverage (PDF)
- 2020 CAHP Summary of Benefits and Coverage (PDF)
Medicare Publications
You must belong to the specific employee association and pay applicable dues to enroll in the California Correctional Peace Officers Association (CCPOA). The CCPOA plan is available only to dues-paying members of that organization and their families.
Administrator: Blue Shield of California
Offers Medicare? Yes
Directory: Find a Doctor
Basic Publications
- 2020 CCPOA Access+ HMO Basic Evidence of Coverage (PDF)
- 2020 CCPOA Access+ Summary of Benefits and Coverage(PDF)
Medicare Publications
- 2020 CCPOA Access+ HMO Supplement to Medicare Evidence of Coverage (PDF)
- 2020 CCPOA Medicare Part D Prescription Drug Plan Evidence of Coverage (PDF)
Document coming soon
Administrator: Health Net of California
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: ProviderSearch
Basic Publications
- 2020 Health Net of California: Salud y Más HMO Evidence of Coverage (PDF)
- 2020 Health Net of California: Salud y Más HMO Summary of Benefits and Coverage (PDF)
- 2020 Health Net of California: SmartCare HMO Evidence of Coverage (PDF)
- 2020 Health Net of California: SmartCare HMO Summary of Benefits and Coverage (PDF)
- 2020 OptumRx Outpatient Prescription Drug Benefit Plan for Selected HMO Basic Plans Evidence of Coverage (PDF)
This plan is available in some states. Refer to the Evidence of Coverage for service area information.
Administrator: Kaiser Permanente
Offers Medicare? Yes
Directory: Doctors & Locations
Basic Publications
- 2020 Kaiser Health Plan Evidence of Coverage (PDF)
- 2020 Kaiser Summary of Benefits and Coverage (PDF)
Medicare Publications
You must belong to the specific employee association and pay applicable dues to enroll in the Peace Officers Research Association of California (PORAC). This plan is available outside of California. Refer to the plan's Evidence of Coverage for service area information.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Directory: Find a Doctor
Basic Publications
- 2020 PORAC Prudent Buyer Plan Evidence of Coverage (PDF)
- 2020 PORAC Prudent Buyer Plan Summary of Benefits and Coverage (PDF)
- 2020 PORAC Out-of-State Resident Basic Health Plan Evidence of Coverage (PDF)
- 2020 PORAC Out-of-State Resident Summary of Benefits and Coverage (PDF)
Medicare Publications
This plan has no geographical restrictions. It provides coverage anywhere in the world.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
- 2020 PERSCare Basic Plan Evidence of Coverage (PDF)
- 2020 PERSCare Basic Plan Summary of Benefits and Coverage (PDF)
Medicare Publications
- 2020 PERSCare Supplement to Original Medicare Plan Evidence of Coverage (PDF)
- 2020 PERSCare Medicare Part D Prescription Drug Plan Evidence of Coverage (PDF)
Document coming soon.
This plan has no geographical restrictions. It provides coverage anywhere in the world.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
Basic Publications
- 2020 PERS Choice Basic Plan Evidence of Coverage (PDF)
- 2020 PERS Choice Basic Plan Summary of Benefits and Coverage (PDF)
Medicare Publications
- 2020 PERS Choice Supplement to Original Medicare Plan Evidence of Coverage (PDF)
- 2020 PERS Choice Medicare Part D Prescription Drug Plan Evidence of Coverage (PDF)
Document coming soon.
Administrator: Anthem Blue Cross
Offers Medicare? Yes
Prescription Drug Services: OptumRx
Directory: Find A Doctor, Pharmacy, Hospital or Urgent Care Center
New: Value-Based Insurance Design
Basic Publications
- 2020 PERS Select Basic Plan Evidence of Coverage (PDF)
- 2020 PERS Select Basic Plan Summary of Benefits and Coverage (PDF)
Medicare Publications
- 2020 PERS Select Supplement to Original Medicare Plan Evidence of Coverage (PDF)
- 2020 PERS Select Medicare Part D Prescription Drug Plan Evidence of Coverage (PDF)
Document coming soon.
Administrator: Sharp Health Plan
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find a Doctor
Basic Publications
Administrator: UnitedHealthcare
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find a Doctor
Basic Publications
Administrator: UnitedHealthcare
Offers Medicare? Yes
Directory: Find a Doctor
Medicare Publications
Administrator: Western Health Advantage
Offers Medicare? No
Prescription Drug Services: OptumRx
Directory: Find a Doctor
Basic Publications
About Our Plans
- HMO - A Health Maintenance Organization (HMO) plan provides health care from specific doctors and hospitals under contract with the plan. You pay co-payments for some services, but you have no deductible, no claim forms, and a geographically restricted service area.
- PPO - A Preferred Provider Organization (PPO) is similar to a traditional "fee-for-service" plan, but you must use doctors in the PPO provider network or pay higher co-insurance (percentage of charges). You must usually meet an annual deductible before some benefits apply. You're responsible for a certain co-insurance amount and the plan pays the balance up to the allowable amount.
- EPO - The Exclusive Provider Organization (EPO) plan offers the same covered services as an HMO plan, but you must seek services from the plans' PPO network of preferred providers. You're not required to select a primary care physician.
- Combination Plans - 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 health plan through the same health carrier. CalPERS requires all family members to have the same health carrier.
Additional Resources
- CA Wildfire Health Information & FAQ
- Health Plan Events & Resources
- Non-Discrimination Notice (PDF)
- Provider Disruption (PDF)
