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
- 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.
- 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
- 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.
- 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
- 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.