Blue Shield Non-Medicare Plans
Blue Shield offers three health plans to CalPERS members: Access+ HMO, Trio HMO and the Blue Shield EPO plans.
Away From Home Care Program
New to Access+ HMO, Trio HMO and Blue Shield EPO for 2024
The Away From Home Care program provides convenient healthcare coverage while you are temporarily residing in the service area of a
participating (host) for at least 90 consecutive days. The program addresses your healthcare needs if you have one of the following situations:
Note: Program eligibility is contingent upon the subscriber maintaining a permanent address in California.
Important: Always carry your current member ID card.
- A child attending school outside of California.
- Family members living in different service areas outside of California.
- A long-term work assignment outside of California or are a retiree with a dual residence.
Note: Program eligibility is contingent upon the subscriber maintaining a permanent address in California.
Important: Always carry your current member ID card.
Watch our interactive video to help you:
Our interactive video will help you to:
Blue Shield EPO interactive video
- Compare plans quickly
- Find network doctors
- Explore wellness programs and more
Blue Shield EPO interactive video
Compare your Blue Shield plan options
Access+ HMO plan
Predictable out-of-pocket costs for 2024.
Plan highlights:
- Lowest cost broad-network HMO plan available to CalPERS members.
- Self-referral to specialists* may be possible within your medical group - no need to see your primary care physician first.
- No deductible; only fixed copayments for most covered services like doctor visits, urgent care and emergency care.
- Mental health benefits for help with depression, mental illness, and alcohol or substance use disorder.
- Convenient access to an extensive pharmacy network, including Safeway/Vons, Costco, and CVS (including CVS Pharmacy® in Target stores).
- 2024 Plan documents
- Summary of Benefits & Coverage
- Evidence of Coverage
- 2023 Plan documents
- Summary of Benefits & Coverage
- Evidence of Coverage
- Plan presentations
- Learn about 2024 plan benefits.
Plan features
- Chiropractic and acupuncture servicesVisit any chiropractor or acupuncturist in the ASH network.
- Emergency and urgent care around the worldYou’re covered for emergency and urgent care around the world regardless of whether the provider is in your plan’s HMO network.
- Mental health and substance use disorder careYou have access to inpatient and outpatient care for issues such as depression, alcohol/substance use disorder and mental illness. You can access these services through Blue Shield’s mental health service administrator (MHSA) provider network and non-network providers.
- NurseHelp 24/7TMRegistered nurses are available to answer your health questions at any time, every day.
- Preventive careLearn how your preventive care benefits can help keep you healthy.
- Shield ConciergeGet support managing your health needs for a wide range of conditions from a team specially trained on the specific health benefits and programs available to you. You’ll also receive personalized service for everything from finding a doctor to understanding benefits and claims. The Concierge team can be reached at (800) 334-5847 (TTY 711) and is available 7 a.m. - 8 p.m., seven days a week.
- Specialty care*Access+ SpecialistSM makes it easy to self-refer to a specialist within your medical group or IPA for a consultation.
- Urgent careFor non-emergencies, you can receive care at an urgent care center that’s affiliated with your doctor’s medical group or IPA. Your cost will usually be lower than the cost for a hospital emergency room visit.
- Virtual careThrough Teladoc, talk to a medical doctor by phone for a $0 copay.
2024 Medical benefits at-a-glance
| Benefits | You pay |
|---|---|
| Calendar-year deductible | |
| Member/family | None |
| Physician services | |
| Preventive health exam | No Charge |
| Pregnancy and maternity care: prenatal/postnatal office visits | No Charge |
| Well-baby care | No Charge |
| Immunization/inoculation | No Charge |
| Allergy testing/treatment | No Charge |
| Primary care office visits | $15/visit |
| Teladoc medical doctor or phone consultation | $0/call |
| Urgent care | $15/visit |
| Infertility testing and treatment | 50% of allowable amount |
| Physician inpatient hospital visits | No Charge |
| Surgery/anesthesia | No Charge |
| Chiropractic and acupuncture services | |
| Combined maximum of 20 visits per year | $15/visit |
| Access+ Specialist | |
| Access+ Specialists care office visit (self-referral)* | $30/visit |
| Other specialist care office visit (referred by PCP) | $15/visit |
| Hospital services | |
| Inpatient | No Charge |
| Outpatient | No Charge |
| Ambulatory surgery centers | No Charge |
| Transgender surgical centers | No Charge |
| Ambulance services | No Charge |
| Emergency care - no copayment if hospitalized or kept for observation | $50/visit |
| Diagnostic X-ray/lab | |
| Inpatient | No Charge |
| Skilled nursing facility | |
| Inpatient | No Charge |
| Hospice | |
| Hospice | No Charge |
| Mental health/substance use disorder | |
| Inpatient | No Charge |
| Outpatient | $15/visit |
| Office visits | $15/visit |
| Flu vaccine | |
| From participating retail pharmacies | No Charge |
| Vision care | |
| Eye refraction to determine need for corrective lenses | No Charge |
| Eyeglasses - not covered, except for those that are necessary after cataract surgery | 20% discount available |
| Hearing aid services | |
| Evaluation | No Charge |
| Hearing aid - up to a maximum of $1,000 per member, every 36 months for both ears for the hearing aid instrument and ancillary equipment | Charges in excess of $1,000 |
| Durable medical equipment | |
| Including orthoses and prostheses | No Charge |
| Physical/occupational/speech therapy | |
| Inpatient visits at a hospital or skilled nursing facility | No Charge |
| Outpatient and home visits | $15/visit |
| Medical benefit calendar-year out-of-pocket maximum | |
| Member: $1,500 | Family: $3,000 |
Trio HMO plan
Plan highlights:
- Same benefits and lower contribution rates than Access+ HMO.
- Designed to be affordable with $0 copayments.
- Self-referral to specialists** within your medical group - no need to see your primary care physician first.
- Mental health benefits for help with depression, mental illness, and alcohol or substance use disorder. Some services are available virtually.
- Discounts on fruits, vegetables and other eligible healthy foods.
- Convenient access to an extensive pharmacy network, including Safeway/Vons, Costco, and CVS (including CVS Pharmacy® inside Target stores).
- 2024 Plan documents
- Summary of Benefits & Coverage
- Evidence of Coverage
- 2023 Plan documents
- Summary of Benefits & Coverage
- Evidence of Coverage
- Plan presentations
- Learn about 2024 plan benefits.
Plan features
- Chiropractic and acupuncture servicesVisit any chiropractor or acupuncturist in the ASH network.
- Emergency and urgent care around the worldYou’re covered for emergency and urgent care around the world regardless of whether the provider is in your plan’s HMO network.
- Hearing aid and ancillary equipment benefitCoverage includes a $0 copayment for routine hearing exams and $1,000 allowance every three years for the purchase of hearing aid and ancillary equipment, along with visits for fitting, counseling and adjustments.
- Healthy Savings® programGet discounts on fruits, vegetables and other eligible healthy foods with this program designed to help you eat healthier. Just scan your Healthy Savings card or app at the checkout counter of any participating grocery store for instant savings.
- Meal delivery and non-emergency transportationQualified members recovering from serious illnesses can get meals delivered for $0 copayments and transportation for medical appointment non-emergencies.
- Mental health and substance use disorder careYou have access to inpatient and outpatient care for issues such as depression, alcohol/substance use disorder and mental illness. You can access these services through Blue Shield’s mental health service administrator (MHSA) provider network and non-network providers.
- NurseHelp 24/7TMRegistered nurses are available to answer your health questions at any time, every day.
- Preventive careLearn how your preventive care benefits can help keep you healthy.
- Shield ConciergeGet support managing your health needs for a wide range of conditions from a team specially trained on the specific health benefits and programs available to you. You’ll also receive personalized service for everything from finding a doctor to understanding benefits and claims. The Concierge team can be reached at (800) 334-5847 (TTY 711) and is available 7 a.m. - 8 p.m., seven days a week.
- Specialty care**Trio SpecialistSM makes it easy to self-refer to a specialist within your medical group or IPA for a consultation.
- Urgent careFor non-emergencies, you can receive care at an urgent care center that’s affiliated with your doctor’s medical group or IPA. Your cost will usually be lower than the cost for a hospital emergency room visit.
- Virtual careThrough Teladoc, talk to a medical doctor or mental health professional by phone or video for a $0 copay.
2024 Medical benefits at-a-glance
| Benefits | You pay |
|---|---|
| Calendar-year deductible | |
| Member/family | None |
| Physician services | |
| Preventive health exam | No Charge |
| Pregnancy and maternity care: prenatal/postnatal office visits | No Charge |
| Well-baby care | No Charge |
| Immunization/inoculation | No Charge |
| Allergy testing/treatment | No Charge |
| Primary care office visits | $15/visit |
| Teladoc medical doctor or mental health professional video or phone consultation | $0/call |
| Urgent care | $15/visit |
| Infertility testing and treatment | 50% of allowable amount |
| Physician inpatient hospital visits | No Charge |
| Surgery/anesthesia | No Charge |
| Chiropractic and acupuncture services | |
| Combined maximum of 20 visits per year | $15/visit |
| Trio+ Specialist | |
| Trio+ Specialists care office visit (self-referral)** | $30/visit |
| Other specialist care office visit (referred by PCP) | $15/visit |
| Hospital services | |
| Inpatient | No Charge |
| Outpatient | No Charge |
| Ambulatory surgery centers | No Charge |
| Transgender surgical centers | No Charge |
| Ambulance services | No Charge |
| Emergency care - no copayment if hospitalized or kept for observation | $50/visit |
| Diagnostic X-ray/lab | |
| Inpatient | No Charge |
| Skilled nursing facility | |
| Inpatient | No Charge |
| Hospice | |
| Hospice | No Charge |
| Mental health/substance use disorder | |
| Inpatient | No Charge |
| Outpatient | $15/visit |
| Office visits | $15/visit |
| Flu vaccine | |
| From participating retail pharmacies | No Charge |
| Vision care | |
| Eye refraction to determine need for corrective lenses | No Charge |
| Eyeglasses - not covered, except for those that are necessary after cataract surgery | 20% discount available |
| Hearing aid services | |
| Evaluation | No Charge |
| Hearing aid - up to a maximum of $1,000 per member, every 36 months for both ears for the hearing aid instrument and ancillary equipment | Charges in excess of $1,000 |
| Durable medical equipment | |
| Including orthoses and prostheses | No Charge |
| Physical/occupational/speech therapy | |
| Inpatient visits at a hospital or skilled nursing facility | No Charge |
| Outpatient and home visits | $15/visit |
| Medical benefit calendar-year out-of-pocket maximum | |
| Member: $1,500 | Family: $3,000 |
Blue Shield EPO plan
Freedom and flexibility
2024 service area expansion into rural counties:
2024 service area expansion into rural counties:
- Del Norte in Northern California
- San Benito in Central California
Plan highlights:
- Same benefits as those in the Access+ HMO plan.
- Access to doctors and specialists within the Blue Shield's PPO network.
- Low, fixed copayments with no coinsurance or deductible.
- No need to see your primary care physician first - you can go to any specialist within the Blue Shield’s PPO network.
- Mental health benefits for help with depression, mental illness, and alcohol or substance use disorder.
- Convenient access to an extensive pharmacy network, including Safeway/Vons, Costco, and CVS (including CVS Pharmacy® in Target stores).
- To learn more about the Blue Shield EPO plan visit here.
- 2024 Plan documents
- Summary of Benefits & Coverage
- Evidence of Coverage
- 2023 Plan documents
- Summary of Benefits & Coverage
- Evidence of Coverage
- Plan presentations
- Learn about 2024 plan benefits.
Plan features
- Chiropractic and acupuncture servicesVisit any chiropractor or acupuncturist in the ASH network.
- Emergency and urgent care around the worldYou’re covered for emergency and urgent care around the world regardless of whether the provider is in your plan’s PPO network.
- Mental health and substance use disorder careYou have access to inpatient and outpatient care for issues such as depression, alcohol/substance use disorder and mental illness. You can access these services through Blue Shield’s mental health service administrator (MHSA) provider network and non-network providers.
- NurseHelp 24/7TMRegistered nurses are available to answer your health questions at any time, every day.
- Preventive careLearn how your preventive care benefits can help keep you healthy.
- Shield ConciergeGet support managing your health needs for a wide range of conditions from a team specially trained on the specific health benefits and programs available to you. You’ll also receive personalized service for everything from finding a doctor to understanding benefits and claims. The Concierge team can be reached at (800) 334-5847 (TTY 711) and is available 7 a.m. - 8 p.m., seven days a week.
- Specialty careYou can see any specialist in the PPO network when needed without prior authorization from your primary care physician. However, some services may require prior authorization.
- Urgent careFor non-emergencies, you can receive care at an urgent care center. Your cost will usually be lower than the cost for a hospital emergency room visit.
- Virtual careThrough Teladoc, talk to a medical doctor by phone for a $0 copay.
2024 Medical benefits at-a-glance
| Benefits | You pay |
|---|---|
| Calendar-year deductible | |
| Member/family | None |
| Physician services | |
| Preventive health exam | No Charge |
| Gynecological/well-woman exam | No Charge |
| Pregnancy and maternity care: prenatal/postnatal office visits | No Charge |
| Well-baby care | No Charge |
| Immunization/inoculation | No Charge |
| Allergy testing/treatment | No Charge |
| Primary care office visits | $15/visit |
| Teladoc medical doctor or phone consultation | $0/call |
| Urgent care | $15/visit |
| Infertility testing and treatment | 50% of allowable amount |
| Physician inpatient hospital visits | No Charge |
| Surgery/anesthesia | No Charge |
| Chiropractic and acupuncture services | |
| Combined maximum of 20 visits per year | $15/visit |
| Specialist | |
| Specialist care office visit | $15/visit |
| Hospital services | |
| Inpatient | No Charge |
| Outpatient | No Charge |
| Ambulatory surgery centers | No Charge |
| Transgender surgical centers | No Charge |
| Ambulance services | No Charge |
| Emergency care - no copayment if hospitalized or kept for observation | $50/visit |
| Diagnostic X-ray/lab | |
| Inpatient | No Charge |
| Skilled nursing facility | |
| Inpatient | No Charge |
| Hospice | |
| Hospice | No Charge |
| Mental health/substance use disorder | |
| Inpatient | No Charge |
| Outpatient | $15/visit |
| Office visits | $15/visit |
| Flu vaccine | |
| From participating retail pharmacies | No Charge |
| Vision care | |
| Eye refraction to determine need for corrective lenses | No Charge |
| Eyeglasses - not covered, except for those that are necessary after cataract surgery | 20% discount available |
| Hearing aid services | |
| Evaluation | No Charge |
| Hearing aid - up to a maximum of $1,000 per member, every 36 months for both ears for the hearing aid instrument and ancillary equipment | Charges in excess of $1,000 |
| Durable medical equipment | |
| Including orthoses and prostheses | No Charge |
| Physical/occupational/speech therapy | |
| Inpatient visits at a hospital or skilled nursing facility | No Charge |
| Outpatient and home visits | $15/visit |
| Medical benefit calendar-year out-of-pocket maximum | |
| Member: $1,500 | Family: $3,000 |
* To use this option, members must select a PCP who is affiliated with a medical group or IPA that is an Access+ provider group, which offers the Access+ Specialist feature. Members should then select a specialist within that medical group or IPA. This benefit is for a first specialist visit only; subsequent visits will require a referral. Access+ Specialist visits for mental health services must be provided by a participating mental health service administrator (MHSA) network provider. Access+ HMO is a registered trademark of Blue Shield of California.
** To use this option, members must select a PCP who is affiliated with a medical group or IPA that is a Trio+ provider group, which offers the Trio+ Specialist feature. Members should then select a specialist within that medical group or IPA. This benefit is for a first specialist visit only; subsequent visits will require a referral. Trio+ Specialist visits for mental health services must be provided by a participating mental health service administrator (MHSA) network provider.