Anthem Blue Cross

Is the Blue Shield Medicare PPO plan an HMO or a PPO plan?

The Anthem Medicare Preferred plan is a PPO plan; however, it has copays just like you would find in an HMO plan. Though, unlike an HMO plan, you can go to any provider that accepts Medicare.

I am enrolled in the Anthem Medicare Preferred PPO Plan and my dependent(s) is/are enrolled in the Anthem Blue Cross Traditional HMO plan, but when I log in to myCalPERS it shows that I am enrolled in an HMO plan. Why?

 You are enrolled in what CalPERS calls a “COMBO” plan, meaning, you are enrolled in a Medicare Plan and one or more of your dependents is enrolled in a Basic Plan. The Anthem Basic Plan in the COMBO is the Anthem Blue Cross Traditional HMO plan. The CalPERS system is currently set up with a limited number of display settings and it shows these COMBO plans as HMO’s.

I am enrolled in Anthem Medicare Preferred plan. Am I limited to only seeking services from providers that contract with Anthem?

Your Medicare Advantage plan through CalPERS has open access to all Medicare providers. This means that you can seek services from any provider that is currently contracted with Medicare regardless of whether they are contracted with your specific health plan.

Blue Shield of California

Is the Blue Shield Medicare PPO plan an HMO or a PPO plan?

The Blue Shield Medicare PPO plan is a PPO plan; however, it has copays just like you would find in an HMO plan. Though, unlike an HMO plan, you can go to any provider that accepts Medicare.

I am enrolled in the Blue Shield Medicare PPO Plan and my dependent(s) is/are enrolled in the BSC Basic HMO Plan, but when I log in to myCalPERS it shows that I am enrolled in an HMO plan. Why?

You are enrolled in what CalPERS calls a “COMBO” plan, meaning, you are enrolled in a Medicare Plan and one or more of your dependents is enrolled in a Basic Plan. The Blue Shield Basic Plans in the COMBO are Blue Shield Access+, Blue Shield EPO and Blue Shield Trio HMO plans. The CalPERS system is currently set up with a limited number of display settings and it shows these COMBO plans as HMOs.

Blue Shield of California will be the new Third Party Administrator for the PERS Gold Supplement and PERS Platinum Supplement to Original Medicare Plan. Will there be any changes to the benefit with this transition?

There are no changes to copays, coinsurance, or deductibles with this transition to BSC. Provider networks and care coordination by your doctor will not change. Most CalPERS PPO members will be able to continue seeing their existing doctor as an in-network provider since BSC has virtually all the same hospitals, facilities, and systems, and significant overlap of physicians and clinicians as the current plan.

I am enrolled in Blue Shield Medicare PPO plan. Am I limited to only seeking services from providers that contract with Blue Shield?

Your Medicare Advantage plan through CalPERS has open access to all Medicare providers. This means that you can seek services from any provider that is currently contracted with Medicare regardless of whether they are contracted with your specific health plan.

UnitedHealthcare

Is the UnitedHealthcare Group Medicare Advantage plan an HMO or a PPO plan?

The UnitedHealthcare Group Medicare Advantage plan is a PPO plan; however, it has copays just like you would find in an HMO plan. Though, unlike an HMO plan, you can go to any provider that accepts Medicare and the plan.

I am enrolled in the UnitedHealthcare Group Medicare Advantage PPO Plan and my dependent(s) is/are enrolled in the UHC Basic HMO Plan, but when I log in to myCalPERS it shows that I am enrolled in an HMO plan. Why?

You are enrolled in what CalPERS calls a “COMBO” plan, meaning, you are enrolled in a Medicare Plan and one or more of your dependents is enrolled in a Basic Plan. The UnitedHealthcare Basic Plan in the COMBO is the UnitedHealthcare SignatureValue Alliance or UnitedHealthcare SignatureValue Harmony HMO plan. The CalPERS system is currently set up with a limited number of display settings and it shows these COMBO plans as HMOs.