PERS Gold: Value-Based Insurance Design

Value-Based Insurance Design (VBID) aims to improve the quality — while lowering the cost — of health care by empowering choice. VBID programs mean high-value care such as wellness and prevention, fewer unwarranted medical procedures, and cost incentives for members.

PERS Gold offers the benefit of working with a personal doctor to guide and coordinate your health care. And the more preventive care you elect, the more you can lower your inpatient deductible and some forms of coinsurance.

Lower Your Deductible With Healthy Activities

You can earn up to $500 in credits toward your in-network, inpatient deductible by completing healthy activities. There is no extra cost.

Dependents of any age (other than a spouse or domestic partner) will automatically receive all five credits applied at the beginning of the year. Combined family deductible credits will not exceed $1,000.

Your Savings Can Add Up

If you qualify for all five credits, your remaining inpatient deductible will be: 

  • $500 for an individual
  • $1,000 for a family 

At least 5 of the 7 activities must be completed in order to receive the full $500 credit. A member may earn up to 4 credits from the Preventive Services under items 1 to 3. Each of the numbered activities from items 4 to 7 is worth a $100 credit. If you complete more than 5 activities, the maximum credit towards your deductible will be $500.

Check your progress with the Included Health deductible tracker. Log in to the Included Health website, or use the Included Health mobile app and navigate to the Activity menu to find your deductible.

Here are the preventive care activities that qualify to help reduce your inpatient deductible for 2025 and 2026:

Eligible ActivitiesMaximum Number of Credits Available
Preventive Screenings
  1. Cancer Screening (breast, cervical, colorectal, or lung)
  2. Metabolic Health Screening (hypertension, diabetes, lipid monitoring or screening during pregnancy)
  3. Preventive Adult Immunization (flu shot, COVID-19, DTaP, shingles, or pneumonia)
$400 credit
Mental Health ScreeningsDepression or anxiety screening (e.g., depression screening with the PHQ-2 or PHQ-9 or anxiety screening with the GAD-7)$100 credit
Diabetes Prevention ProgramFor eligible members, participation in Blue Shield of California Wellvolution program is required.$100 credit
Expert Medical Opinion-Second OpinionFor any elective surgery, members must get a second opinion prior to the surgery.$100 credit
Care and Case Management ParticipationFor eligible members, participation is required. $100 credit
ActivityCredit
Flu ShotGet a flu shot at an in-network pharmacy or at your doctor’s office. Then log in to includedhealth.com/calpers, go to View All Services, select Value-Based Inpatient Deductible Credits, and report your flu shot.1$100
Nonsmoking attestationLet us know that you don’t smoke by logging in to includedhealth.com/calpers. Then go to View All Services, select Value-Based Inpatient Deductible Credits, and report that you’re a nonsmoker.$100
Preventive screeningComplete a preventive screening (such as a lab test or cancer screening) at home, your doctor’s office, or a Quest Diagnostics or Labcorp facility.2$100
Virtual second opinionObtain a second opinion for a nonurgent or nonemergency surgery scheduled in 2025. Call Included Health or visit a doctor in the PERS Gold network.3$100
Condition care managementTake part in Included Health’s care management program if you have a chronic condition such as asthma, diabetes, chronic obstructive pulmonary disease (COPD), heart failure, or coronary artery or vascular disease.4$100

Endnotes

1 If you cannot have a flu shot due to health, personal, or religious reasons, you are eligible to receive the $100 deductible credit.

2 Check preventive screening test results from a Labcorp facility or a Quest Diagnostics facility.

3 If you do not need a nonurgent or nonemergency surgery in 2025, you are eligible to receive the $100 deductible credit.

4 If you do not require support from a care management program, you are eligible to receive the $100 deductible credit.

To support your wellness and preventive care, this program offers additional activities for you to complete. Because of this, automatic credits are not provided.

Refer to and read PERS Gold Basic Plan’s Evidence of Coverage for more complete descriptions of plan benefits and programs. For more information, visit Included Health or contact Included Health Member Services at (855) 633-4436.