Health Benefits

6 Steps to Set Up Your New Health Plan

4 months ago

Did you switch health plans during CalPERS Open Enrollment? If so, it’s time to take a few simple steps to make the most of your benefits that take effect January 1.

Confirm Your Health Plan Details

Make sure you’ve received your new health plan ID card. This card contains information like your member ID number, health plan contact number, and, depending on your health plan, the name of your primary care physician (PCP).

  • 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.

Knowing your PCP helps you access care promptly. Contact your plan if:

  • You do not receive your card by January 1, 2026.
    • Check for a digital version through your health plan’s website or app.
  • You need care before your card arrives.
  • You need additional or replacement cards.

Review your paycheck to ensure your health plan premium deduction is correct. If it’s not, contact your employer, or CalPERS if you’re retired. More information on plan premiums can be found on our Plans & Rates page.

Review Key Documents

To maximize your health benefits, be sure to check your new plan’s:

  • Summary of Benefits and Coverage (SBC): This provides an outline of what your health plan covers, including costs and exclusions.
  • Evidence of Coverage (EOC): This details the terms and conditions of your health plan, including benefits, coverage, exclusions, cost-sharing requirements such as copayments and deductibles, and other important information.
  • You can view and download these health benefits forms and publications on our Forms & Publications page.

Set Up Your Digital Tools

Having an online account simplifies managing your health benefits. Here’s what you can do:

  • Create an online account with your health plan and medical group (if applicable) to track claims, access your digital ID card, and review health benefits details in one place.
  • Many medical groups and health plans offer online portals for secure messaging, appointment scheduling, billing, explanation of benefits, and viewing test results.

Unsure how to contact your doctor? Feel free to ask during your first visit or reach out to the medical office directly to learn about the best way to contact them.

Establish Care with Your Doctor

Getting to know your PCP is a critical step in receiving the care you deserve. Start this relationship by:

  • Scheduling an initial appointment with your PCP to discuss your health history, current health concerns, current medications, or preventive or chronic care needs.
  • Bringing key information, such as current prescriptions or a list of specialists you see.

Your PCP acts as your main point of contact for health care. In health maintenance organization (HMO) plans, your PCP also coordinates specialist referrals and manages your care. In preferred provider organization (PPO) plans, you’ll also be paired with a PCP to coordinate your care and support your health needs, while you still have the flexibility to see specialists without a referral.

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.

Review Your Prescription Needs

To avoid interruptions with your medication, take these steps:

  • Make sure your pharmacy is in your health plan or pharmacy benefits manager’s (PBM) network. Your health plan or PBM 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.
  • Confirm if your health plan is covered by our new PBM by visiting our CVS Caremark page.

Explore Behavioral Health and Wellness Benefits

Your health plan also supports your mental and physical well-being. Take advantage of these resources:

Health & Wellness Programs by Health Plan: Explore wellness programs for resources that support your overall well-being, such as fitness programs, preventive care programs, chronic condition management tools, and other services designed to help you stay healthy year-round.

Behavioral Health Programs: All CalPERS health plans provide access to behavioral health services. These services include individual and group therapy — available in-person or virtually – as well as medication management. Many plans offer tools like mental health apps and stress management resources.

Make the Most of Your Health Plan This Year

Use these six steps to take full advantage of your benefits in the year ahead. Begin today to set yourself up for a healthy 2026.