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
The PERS Gold plan has two separate in-network deductibles: one for inpatient care ($500 for an individual and $1,000 for a family) and one for outpatient care ($500 for an individual and $1,000 for a family). Each deductible must be met separately. 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 towards your inpatient deductible, your remaining deductible will be:
- $500 outpatient deductible for an individual
- $1,000 outpatient deductible for a family
In 2026 and 2027, 5 activities must be completed to receive the full $500 credit. A member may earn up to 4 credits from Preventive Services. Additional activities include Mental Health Screening, Diabetes Prevention Program, Expert Medical Opinion, and Care and Case Management. Each of these activities 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. Some activities can be self-reported in the 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.
Preventative Care Activities By Year That Reduce Impatient Deductibles
Here are the preventive care activities that qualify to help reduce your inpatient deductible for 2025 and 2026–2027 (same criteria for 2026 and 2027):
| Eligible Activities | Maximum Number of Credits Available | |
|---|---|---|
| Preventive Screenings (any combination of the 3 listed activities, i.e., 3 immunizations and a Diabetes Screening) | Cancer Screening (breast, cervical, colorectal, or lung) Metabolic Health Screening (hypertension or diabetes) Preventive Adult Immunization (flu shot, COVID-19, DTaP, shingles, or pneumonia) | Up to $400 credit |
| Mental Health Screenings | Depression 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 Program | For eligible members, participation in Blue Shield of California’s Diabetes Prevention Program is required. | $100 credit |
| Expert Medical Opinion-Second Opinion | For any elective surgery, members must get a second opinion prior to the surgery. | $100 credit |
| Care and Case Management Participation | For eligible members, participation in Included Health’s Care Management Program is required. Eligible members include members with chronic conditions such as asthma, diabetes, chronic obstructive pulmonary disease (COPD), heart failure, or coronary artery or vascular disease. | $100 credit |
| Activity | Credit | |
|---|---|---|
| Flu Shot | Get 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 attestation | Let 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 screening | Complete 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 opinion | Obtain 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 management | Take 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.