1. Confirm Your Health Plan Details
Make sure you’ve received your new health plan ID card. This card has all the essential information you’ll need, like your member ID number, health plan contact number, and the name of your primary care physician (PCP) as applicable:
- If you chose a PCP during Open Enrollment, confirm the name listed matches your choice, or contact your health plan to confirm.
- If you did not choose a PCP, your health plan will match you to one. Contact your plan if you’d like to switch.
Why is this important? Knowing who your PCP is ensures you can schedule care without delays.
If your physical ID card hasn’t arrived yet:
- Check for a digital version through your health plan’s website or app.
- Call your health plan – they’ll work to ensure you receive a physical card.
2. Understand Your Plan’s Details
Review these key documents to get a clear understanding of your benefits:
- Summary of Benefits and Coverage (SBC): Outlines what your health plan covers, including costs, premiums, and exclusions.
- Evidence of Coverage (EOC): Details terms and conditions of your health plan, including benefits, coverage, exclusions, cost-sharing requirements such as copayments and deductibles, and other important information.
Why is this important? These key documents can help you better understand your benefits, plan for health care costs — or how to avoid unexpected costs — and help you make informed decisions about your health care needs.
3. Set Up Your Digital Tools
Having an online account makes managing your health benefits easier and more convenient. Here’s what you can do:
- Create an online account with your health plan to track claims, access your digital ID card, and review health benefits details all in one place.
- Sign up with your medical group (if applicable). Many medical groups offer online portals for secure messaging, appointment scheduling, and viewing test results.
Not sure how to contact your doctor? Feel free to ask during your first visit or reach out to the medical office directly to learn the best way to contact them.
4. Establish Care with Your Doctor
Getting to know your PCP is an important step:
- Schedule your first visit to get to know your PCP and discuss your health needs.
- Bring your medical records, including any current prescriptions, and a list of specialists you see.
- If you’re in an HMO plan, your PCP is your health care guide; they coordinate referrals to necessary specialists and make sure your care is personalized to your needs. If you’re in a PPO plan, you are matched with a PCP that can help guide your care needs. However, you do not need a referral from your PCP to see specialists.
Why is this important? Having an established relationship with your PCP helps ensure you receive more coordinated care, making it easier to manage your health and improve your overall well-being.
5. Review Your Prescription Needs
To avoid interruptions with your medication, take these steps:
- Make sure your pharmacy is in your health plan’s network. Your health plan can help confirm this.
- Let your pharmacy know that you have a new ID card.
- Request refills on maintenance medication and talk to your doctor about any specialty prescriptions.
6. Explore Behavioral Health and Wellness Benefits
Your health plan offers more than just medical coverage — it also supports your mental and physical well-being. Take advantage of these resources:
- Health & Wellness Programs by Health Plan: Explore your health plan’s programs to find resources that support your overall health. These can include fitness programs, preventive programs, tools for managing chronic conditions, and other services designed to help you stay well throughout the year.
- Behavioral Health Programs: All CalPERS health plans offer access to behavioral health services to support your mental health and well-being. These services include therapy through virtual or in-person visits, and some health plans may include tools like mental health apps and stress management resources. To learn more about what’s available through your health plan, visit the Behavioral Health Programs by Health Plan webpage.
Why is this important? These programs empower you to take proactive steps toward better overall health, whether it’s managing stress, improving physical fitness, or addressing specific health concerns.
Make the Most of Your Health Plan This Year
These six steps will help you make the most of your benefits in the year ahead. Start now to ensure you’re ready for a healthy 2025.