For an even better PPO health care experience, CalPERS is partnering with Blue Shield and Included Health to ensure members in a Basic PPO plan receive the highest quality care for their unique needs.
Medicare members will not see any changes to the provider networks and care coordination that is currently provided by their doctors, and will work with Blue Shield directly for health care services .
What’s Changing for Members in a Basic PPO Plan?
Included Health will help Basic PPO plan members find the personalized care they need, using Blue Shield’s network of doctors and hospitals and Included Health’s network of virtual providers.
Most members will be able to keep their primary care and specialist providers. If your doctor is not in the network, CalPERS and Blue Shield have plans in place to minimize the disruption to you and ensure you have access to high-quality providers. This is where Included Health will help.
Included Health is available by phone, online, or app to help you navigate your health care and PPO health benefits. Whether you need to find out if your doctor is in-network, get a new primary care doctor, have questions about a medical bill, or want an easy way to keep track of your insurance information, Included Health is your first stop for comprehensive, personalized health care.
What’s Changing for Members in a Medicare Supplement Plan?
If you have questions about your Medicare plan and health care services, you will contact Blue Shield.
What’s Not Changing for Both Basic and Medicare PPO Plans
- Copays, deductibles, and coinsurance will all stay the same in 2025.
- For PERS Gold members — your ability to lower the deductible through various activities.
- Service areas — PERS Gold will continue to be available everywhere in California, and PERS Platinum will continue to be available across the country and around the world.
- Pharmacy benefits will continue to be administered through OptumRx.
Basic PPO Plan Members
Find out if your doctor is in the PPO network
While most members will be able to have the same primary care and specialist providers, there are resources for you to confirm your doctors are in-network:
- Call Included Health’s dedicated line for CalPERS PPO Basic members at (855) 633-4436
- Visit the CalPERS Included Health website
- Download the Included Health app and log in
- Search for your doctor using the Health Plan Search by ZIP Code on the CalPERS website or through your myCalPERS account (learn more about Using myCalPERS)
Included Health is your first stop for personalized health care services, such as:
- Assistance with finding out if your doctor is in-network
- Assistance with finding a doctor or urgent care
- Care coordination, particularly if you have complex conditions
- When you want a second medical opinion
- Virtual primary care and behavioral health providers
- Live clinical advice with a nurse over the phone 24/7
- Tracking your deductibles, copay, and coinsurance
- Understanding your medical bills
Want to Know More?
Visit our PPO webpage to learn more about the new PPO administrators and what it means for you. You’ll find a recording of the PPO webinar, which provides detailed information on the new partnership, and a comprehensive list of Frequently Asked Questions.