Active members and retirees: 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. Here are some tips to help you choose a health plan:

  • Access our Health Plan Chooser to find doctor directories, estimate costs, and view satisfaction ratings.
  • Review each plan’s Evidence of Coverage, and Summary of Benefits and Coverage with Glossary, in the sections below.
  • Use our Health Plan Search by ZIP Code tool to see which plans are available in your area.
  • View the 2016 Health Benefit Summary (PDF) to compare features of the different health plans.

2016 Rates

View this year's health premium rates approved by the CalPERS Board of Administration:

Employer Contribution Amounts

Active State Members

Your cost is any amount above the employer contribution. The 2016 estimated contribution amounts are:

  • 85/80 - One-Party: $597; Two-Party: $1,163; Family: $1,504
  • 80/80 - One-Party: $562; Two-Party: $1,128; Family: $1,469

Please check with your employer to determine your contribution amount.

Active CSU Members

Contact your personnel office for your employer contribution amount.

Retired State and CSU Members

Your cost is any amount above the employer contribution. The 2016 estimated contribution amounts are: One-Party: $705; Two-Party: $1,343; Family: $1,727. Learn about vesting requirements that determine how much of the state's contribution you'll receive toward your health premium after retirement.

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 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.

HMO Health Plans

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.

You must belong to the specific employee association and pay applicable dues to enroll this Association Plan. The CCPOA plan is available only to dues-paying members of that organization and their families.

Administrator: Blue Shield of California

2016

Medicare

PPO Health Plans

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.

This plan has no geographical restrictions. It provides coverage anywhere in the world. Visit CalPERS | Compare to shop for doctors, hospitals, medical services, and prescriptions.

Administrator: Anthem Blue Cross
Prescription Drug Services: CVS/caremark

2016

Medicare

This plan has no geographical restrictions. It provides coverage anywhere in the world. Visit CalPERS | Compare to shop for doctors, hospitals, medical services, and prescriptions.

Administrator: Anthem Blue Cross
Prescription Drug Services: CVS/caremark

2016

Medicare

This plan has no geographical restrictions. It provides coverage anywhere in the world. Visit CalPERS | Compare to shop for doctors, hospitals, medical services, and prescriptions.

Administrator: Anthem Blue Cross
Prescription Drug Services: CVS/caremark

2016

Medicare

You must belong to the specific employee association and pay applicable dues to enroll in this Association Plan.

Administrator: Anthem Blue Cross

2016

Medicare

You must belong to the specific employee association and pay applicable dues to enroll in this Association Plan. This plan is available outside of California. Refer to the plan's Evidence of Coverage for service area information.

Administrator: Anthem Blue Cross

2016

Medicare

Administrator: UnitedHealthcare

2016 Medicare

The UnitedHealthcare Group Medicare Advantage PPO Plan is new in 2016. Review Medicare Plan Changes for more information.

EPO Health Plans

The Exclusive Provider Organization (EPO) plan offers the same covered services as an HMO plan, but you must seek services from the plan's PPO network of preferred providers. You're not required to select a primary care physician.

CVS/caremark

CVS/caremark administers the prescription benefit for the following HMO health plans:

  • Anthem Blue Cross Select and Traditional
  • Health Net SmartCare and Salud y Mas
  • Sharp Performance Plus
  • UnitedHealthcare SignatureValue Alliance

Administrator: CVS/caremark

2016

In addition, CVS/caremark administers the prescription benefit for the following EPO and PPO health plans (medical benefits administered by Anthem Blue Cross):

  • Del Norte County EPO
  • Monterey County EPO
  • PERSCare
  • PERS Choice
  • PERS Select

For applicable Outpatient Prescription Drug Plan information, refer to the EPO and PPO sections above.



Resources

Forms & Publications

Frequently Asked Questions