CalPERS open enrollment runs Sept. 15 to Oct. 10

CalPERS health plan members will notice many new options available to them in the open enrollment package recently mailed by CalPERS.

Six Health Maintenance Organization (HMO) options are available for 2015, including Anthem Blue Cross, Blue Shield of California, Health Net, Kaiser Permanente, Sharp Health and United Healthcare.

Anthem, Blue Shield, Kaiser and United provide plan coverage throughout most of California. Health Net covers seven counties in Southern California and Sharp’s coverage centers on San Diego County. 

Anthem provides Exclusive Provider Organization (EPO) coverage in Monterey County. In addition, Anthem continues to serve as the Third Party Administrator for CalPERS self-funded Preferred Provider Organization (PPO) health plans, PERS Care, PERS Choice and PERS Select.

In a plan change for 2015, Blue Shield is dropping its NetValue coverage in Humboldt County and removing Sharp from its network. Also, United Healthcare is expanding its coverage into Solano and San Joaquin counties.

There are also a few benefit changes in 2015. Blue Shield is not only dropping the requirement that its members use only certain facilities for knee and hip replacement surgeries, it is also eliminating the $250 outpatient hospital copay for certain procedures like endoscopies and colonoscopies.

In addition, any HMO plan that does not currently offer acupuncture and chiropractic benefits will provide 20 annual combined visits for those services. HMOs will also increase their maximum out-of-pocket limits to comply with the Affordable Care Act.

CalPERS will also adopt a High Performance Generic Step Therapy (HPGST) program in 2015 in an effort to provide clinically appropriate prescription drugs at the lowest cost. The HPGST will encourage members to use more cost-effective, first-line generic drugs where appropriate.

For more information, refer to the Evidence of Coverage (EOC) booklet available on your health plan’s website or at www.calpers.ca.gov 

During open enrollment – Sept. 15 to Oct. 10 – CalPERS members may decide whether they want to remain in their current health plan or choose another option. They may also add eligible family members and remove those who are ineligible.

CalPERS members who don’t plan to change anything are still encouraged to read the open enrollment materials, which include a personalized health plan statement; a 2015 health plan premium rate sheet and postcard listing the monthly premiums for the available health plans; and the Open Enrollment Newsletter, which provides more information on health benefit changes for 2015.

HEALTH PREMIUM RATES

The 2015 health premium rates were set in June by the CalPERS Board of Administration and listed in the July issue of the California State Retiree.

In general, more than 570,000 CalPERS health plan subscribers will see premium rate reductions of about 3 percent in 2015. About 175,000 members will experience increases of less than 3 percent if they stay with their current health plan.

CalPERS subscribers to Blue Shield of California health plans, however, will see a larger-than-average premium rate increase than those who belong to other health plans. Blue Shield’s overall premium increases average just under 15 percent for 2015.

More information and charts listing the scheduled rate increases and estimated premium payments for each health plan may be found at www.calpers.ca.gov in the Health Benefits section.