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. Depending on the organization and their plan, that means enhanced care, better wellness education programs, fewer unwarranted medical procedures, and accessible cost incentives.
The PERS Gold offers the benefit of working with a personal doctor to guide and coordinate your health care. And the more preventative care you elect, the lower your deductible and some forms of coinsurance.
For an even better PPO healthcare experience, CalPERS teamed up with Blue Shield of California and Included Health starting January 1, 2025. This partnership is designed to ensure you have access to the highest quality care for your unique needs.
Blue Shield is the administrator for your PPO plan, and Included Health will help you find personalized care using Blue Shield’s network of doctors and hospitals and Included Health’s network of virtual providers.
Lower your deductible with healthy activities
Every year that you’re enrolled in PERS Gold, 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 for subscriber, spouse, or domestic partner.
Your savings can add up
If you qualify for all five credits, your remaining 2025 inpatient deductible will be:
- $500 for an individual
- $1,000 for a family
Check your progress with the Included Health deductible tracker. Log in to includedhealth.com/calpers or the Included Health mobile app and navigate to the “Activity” menu to view your deductible.
Here is what you need to do:
| 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 the “View All Services” page, 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 the “View All Services” page, select Value Based Inpatient Deductible Credits, and report that you’re a nonsmoker. | $100 |
| Preventive screening | Complete a preventive screening (e.g., lab test, 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 |
Refer to and read all plan documents for more complete descriptions of plan benefits and programs. For more information, visit the Included Health website or contact Included Health Member Services at (855) 633-4436.
Footnote
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 View preventive screening test results from a Labcorp facility at labcorp.com/patients/results or a Quest Diagnostics facility at questdiagnostics.com/patients/test-results.
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.