Center for Human Resources

CalPERS Health Plan Benefits Changes

Highlights of the 2013 benefit changes are listed below. These benefit modifications are designed to focus on quality, patient safety, and engaging members in their care. Refer to the health plan's Evidence of Coverage (EOC) booklet for a complete explanation of the benefits covered, as well as limitations and exclusions that apply. Be sure to review this information carefully to determine whether you want to, or need to, make a health plan change.

Evidence of Coverage

• Blue Shield Access+ HMO
• Blue Shield NetValue HMO
• Kaiser Permanente HMO
• PERS Care PPO
• PERS Choice PPO
• PERS Select PPO

Benefit Changes

The benefit change for 2013 is the conversion of CalPERS HMO and PPO Supplement to Medicare plans from the Medicare Part D Retiree Drug Subsidy (RDS) program to Employer Group Wavier Plans (EGWP).

EGWP results in significantly greater reimbursement than the current RDS program, but all of it must be used to lower premiums, while RDS funds can be used by the employer for any purpose.

PERS Choice, PERSCare, and PERS Select Basic plans:
There are no benefit changes this year.

Kaiser Permanente Basic and Medicare plans:
There are no benefit changes this year.

Blue Shield Basic and Medicare plans:
There are no benefit changes this year.

Association plans:
The following benefit modifications will be made to the CCPOA health plan for 2013:

• Behavioral health treatment - Applied Behavior Analysis (ABA) coverage is provided for professional services and treatment programs, including applied behavior analysis and evidence-based intervention programs that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder, or autism. Treatment is covered when prescribed, authorized, and rendered by designated providers.
• The Employer Group Wavier Plan (EGWP) will be adopted for the Medicare Coordinated plan.

Service Area Changes

PERS Select (Basic & Medicare):

• Expanding service area to include Alameda, Placer and Solano counties.

Blue Shield NetValue (Basic and Supplement to Medicare)

• Expanding service area to Marin, Sonoma, Humboldt, and Stanislaus counties.

Blue Shield 65 Plus:

• Expanding service area to more ZIP codes in Contra Costa County.

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