Health plan documents for CalPERS retirees
Blue Shield Medicare (PPO) plan
Blue Shield Medicare (PPO) plan: January 1, 2026 - December 31, 2026
- Summary of Benefits (coming soon)
- Evidence of Coverage
- Formulary (coming soon)
- Pharmacy Directory (coming soon)
- Provider Directory (coming soon)
- Travel Reimbursement Form
Blue Shield Medicare (PPO) plan: January 1, 2025 - December 31, 2025
Blue Shield Medicare (PPO) with Dental and Vision plan
Blue Shield Medicare (PPO) with Dental and Vision plan: January 1, 2026 - December 31, 2026
- Summary of Benefits (coming soon)
- Evidence of Coverage
- Formulary (coming soon)
- Pharmacy Directory (coming soon)
- Provider Directory (coming soon)
- Travel Reimbursement Form
Blue Shield Medicare (PPO) with Dental and Vision plan: January 1, 2025 - December 31, 2025
PERS Gold Supplement to Original Medicare plan
PERS Gold Supplement to Original Medicare plan: January 1, 2026 - December 31, 2026
PERS Gold Supplement to Original Medicare plan: January 1, 2025 - December 31, 2025
PERS Platinum Supplement to Original Medicare plan
PERS Platinum Supplement to Original Medicare plan: January 1, 2026 - December 31, 2026
PERS Platinum Supplement to Original Medicare plan: January 1, 2025 - December 31, 2025
Blue Shield of California is a PPO plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal.
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Customer Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
H4937_25_487A_M 09112025
Page Last Updated 09/15/2025