Blue Shield Non-Medicare Plans
Blue Shield offers three health plans to CalPERS members: Access+ HMO, Trio HMO and the Blue Shield EPO plans.
Reasons to choose the Trio HMO plan for 2023:
In addition to the same features as the Access+ HMO plan, you get:
- Lower cost
- Access to virtual care for $0 copayments
- Discounts on fruits, vegetables and other eligible healthy foods
Find the right health plan for you in 5 minutes or less
Our interactive video will help you to:
- Compare plans quickly
- Find network doctors
- Explore wellness programs and more
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Access+ HMO Plan
Same broad network with lower rates for 2023.
Access+ HMO highlights:
- Lowest cost broad-network HMO plan available to CalPERS members
- No deductible
- $0 copayments for 24/7 virtual care and many covered services
- Self-refer to specialists*
- An extensive pharmacy network, including Safeway/Vons, Costco, and CVS
- 2023 Plan documents
- Evidence of Coverage
- Summary of Benefits & Coverage
- Plan presentations
- Learn about 2023 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 care 24/7Through Teladoc, talk to a medical doctor by phone or video for a $0 copay.
2023 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
To enroll, you must have a primary residence or workplace within the Trio service area.
Available in these counties for 2023:
• Butte • El Dorado • Kern • Kings • Los Angeles • Monterey • Nevada • Orange • Placer • Riverside • Sacramento • San Bernardino • San Luis Obispo • Santa Barbara • Santa Cruz • Stanislaus • Tulare • Ventura • Yolo
Available in these counties for 2023:
• Butte • El Dorado • Kern • Kings • Los Angeles • Monterey • Nevada • Orange • Placer • Riverside • Sacramento • San Bernardino • San Luis Obispo • Santa Barbara • Santa Cruz • Stanislaus • Tulare • Ventura • Yolo
Trio HMO highlights:
- Same benefits and lower contribution rates than Access+ HMO
- No deductible
- $0 copayments for 24/7 virtual care and many covered services
- Self-refer to specialists**
- An extensive pharmacy network, including Safeway/Vons, Costco, and CVS
- 2023 Plan documents
- Evidence of Coverage
- Summary of Benefits & Coverage
- Plan presentations
- Learn about 2023 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.
2023 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
Available in these counties for 2023:
• Alpine • Calaveras • Colusa • Inyo • Lake • Lassen • Mendocino • Modoc • Mono • Plumas • Shasta • Sierra • Siskiyou • Tehama • Trinity • Tuolumne
• Alpine • Calaveras • Colusa • Inyo • Lake • Lassen • Mendocino • Modoc • Mono • Plumas • Shasta • Sierra • Siskiyou • Tehama • Trinity • Tuolumne
Blue Shield EPO highlights:
- Access to providers in the broad Blue Shield Preferred Provider network
- Same benefits as those in the Access+ HMO plan
- Self-referral to specialists without a referral from a primary care physician
- $0 copayments for 24/7 virtual care and many covered services
- An extensive pharmacy network, including Safeway, Costco, and CVS
- 2023 Plan documents
- Evidence of Coverage
- Summary of Benefits & Coverage
- Plan presentations
- Learn about 2023 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 or video for a $0 copay.
2023 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.
** 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.