Medical Insurance coverage for eligible Cal Poly employees is administered by the California Public Employee's Retirement System (CalPERS). CalPERS offers a variety of plan choices.
There are two types of plans to choose between - Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).
An HMO offers members a range of health benefits, including preventive care, for a monthly fee, with no deductibles or maximums, and minimal co-payments. You will need to choose a primary care physician (PCP) within a network of contracting doctors. The PCP coordinates all your care, including referrals to specialists, when necessary. If you go outside of the HMO without a referral from the plan, you'll be responsible for the total cost of services, except for emergencies or urgent care services. HMOs are available only in designated California services areas.
A PPO is a form of managed care, but it is more similar to a traditional "fee-for-service" type plan. PPOs contract with doctors, hospitals, and other providers to provide services for an agreed-upon charge. You may choose to use a doctor outside their network, but you will pay a higher co-payment. These plans are available statewide and outside of California.
Unlike an HMO, where a primary care physician directs all your care, a PPO allows you to select a provider and a specialist without referral. There are annual deductibles to meet before the plan will pay benefits and you are responsible for a certain percentage of the charges (co-payments). The plan pays the balance up to the agreed-upon amount. The covered benefits vary by plan.
Please refer to each plan’s Evidence of Coverage (EOC) booklet for the exact terms and conditions of coverage. In case of a conflict between this summary and your plan’s EOC, the EOC booklet determines the benefits that will be provided.
Comparisons, Rates and Providers
- 2017 Monthly Premium Rates for Health Plans and Summary of Covered Services
- PERS Anthem PPO Online Provider Directory
- Blue Shield HMO Online Provider Directory
- UnitedHealthcare Online Provider Directory
- Anthem Blue Cross Traditional HMO Online Provider Directory
2017 Plan Details
- CalPERS Health Plan Chooser (Compare health plans available to you)
- 2017 Evidence of Coverage - Details regarding coverage, restrictions and authorizations. To view a complete list of plans and rates visit CalPERS Plans and Rates page.
- 2017 Blue Shield Access+ HMO Plan Evidence of Coverage
- 2017 UnitedHealthcare HMO Plan Evidence of Coverage
- 2017 Anthem Traditional HMO Plan Evidence of Coverage
- 2017 PERS Choice PPO Plan Evidence of Coverage
- 2017 PERS Select PPO Plan Evidence of Coverage
- 2017 PERS Care PPO Plan Evidence of Coverage
- 2017 PORAC Prudent Buyer Plan Evidence of Coverage
This service is for PPO Health Plan Enrollees. This site provides one-stop-shopping for all your health information needs. CalPERS | Compare will track your medical spending and shop for medical services, prescriptions, and doctors in your network. Vist the site today to create an account and start tracking!
Tax Treatment of Health Plan Premiums
Health premiums are deducted from your paycheck on a pre-tax basis; this will reduce your federal, state and FICA taxes. This special tax treatment is permitted through the CSU Tax Advantage Premium Plan (TAPP). All employees who are enrolled in a health plan are enrolled automatically into TAPP. If you prefer to pay your premiums on an after-tax basis, please contact Human Resources at 805-756-5436.
- CVS Caremark - pharmacy manager for Blue Shield Access+ www.caremark.com (866) 346-7200
- OptumRx - pharmacy manager for all other plans (PERS Select, Choice, Care, United Healthcare HMO, and Anthem Tradtional HMO) www.chp.optumrx.com 855-505-8110
Enrolling Family Members/Domestic Partners
You can cover only yourself or include your family members in the CalPERS Health Program. If you decide to cover your family members, you must cover all eligible family members as a single group. Rules and regulations regarding Domestic Partnerships can vary state to state.
- Guidelines for enrolling family members
- Imputed Taxes Charged for Domestic Partner Benefits: 2017 Rates
- State of California - Domestic Partners Registry
Premium Assistance Available Under Medicaid and CHIP
Potential opportunities for premium assistance under Medicaid and CHIP for your family's health coverage (whether or not you are enrolled in a health plan) are described on this Medicaid and the State Children’s Health Insurance Program Notice.
A Few Words About Medicare
Medicare eligible active employees and/or their spouses/domestic partners who are currently enrolled in one of the CSU group health plans do not need to enroll in Medicare before retirement. There will be no penalties assessed to these employees and/or their dependent spouses/domestic partners when they elect to enroll later. We do suggest that you enroll in Medicare Part A (Hospital), it is free and can be beneficial. (See "Special Enrollment Period" on the Social Security website by viewing the Medicare Enrollment Flyer.)
If retired, at age 65, by law, you must enroll in both Part A (hospital) and Part B (medical) of Medicare in order to maintain your eligibility for health benefits under CalPERS. Enrollment is not automatic, and the retiree must contact Social Security directly for enrollment information.
IMPORTANT CHANGE EFFECTIVE JANUARY 1, 2013: CalPERS is converting its Blue Shield HMO Plans and its PERS Select/Choice/Care PPO Supplement to Medicare Plans from a Retiree Drug Subsidy to an Employer Group Waiver Plan (EGWP). Retirees will have a choice to opt-out of EGWP without otherwise affecting their health coverage, but they will be financially responsible for all prescription drug costs if they do so. However, if they then choose to enroll in a non-CalPERS Medicare Part D plan, then the CalPERS health plan will be cancelled. A list of Frequently Asked Questions on EGWP is available at CalPERS.
Note: FERPs are retired, and therefore must enroll themselves and/or their 65-year-old spouses/domestic partners in Medicare.
Retirees must notify CalPERS once they are enrolled in Medicare. Upon receipt of enrollment confirmation, the CalPERS health plan converts to a Medicare Supplement plan.
The Evidence of Coverage Publications for the Medicare Health Plan Supplements can be found on CalPERS Plans and Rates.