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Plan overview
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
CalPERS hmo trio CalPERS EPO
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

Plan features

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
Please see your Evidence of Coverage and Disclosure (EOC&D) for a detailed description of coverage benefits and limitations.
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
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

Plan features

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
Please see your Evidence of Coverage and Disclosure (EOC&D) for a detailed description of coverage benefits and limitations.
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
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

Plan features

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
Please see your Evidence of Coverage and Disclosure (EOC&D) for a detailed description of coverage benefits and limitations.
* 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.