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CalPERS Members Have Options as Blue Shield Access+ Withdraws from 8 Bay Area Counties

Posted 5 years 175 days ago ago by Jamee V   

September 5, 2018

Communications & Stakeholder Relations
Contact: Stephanie Buck
(916) 795-3991 - newsroom@calpers.ca.gov

SACRAMENTO, Calif. – CalPERS members affected by the Blue Shield Access+ Bay Area exit have the option of enrolling in several other health plans. And through conversations with their providers, most members will find their doctors are in-network under other CalPERS plans.

After CalPERS negotiated its lowest overall health premium increase in 21 years, at 1.16 percent, the agency's Board of Administration approved Blue Shield's request to exit eight Bay Area counties for members enrolled in the Access+ plan. The board approved this change because CalPERS confirmed Blue Shield Access+ members would have access to the same provider networks through other plan options.

The impacted counties that will no longer offer Blue Shield Access+ for CalPERS members are Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara, Solano, and Sonoma. The change takes effect January 1, 2019.

CalPERS members in those counties will be defaulted to Health Net SmartCare in 2019, unless they elect a different plan during the Open Enrollment period, which runs from September 10 to October 5, 2018.

Health maintenance organization (HMO) plans remaining in the Bay Area include:

  • Anthem HMO Traditional
  • Anthem HMO Select
  • Health Net SmartCare
  • Kaiser
  • UnitedHealthcare (state/CSU members only)
  • Western Health Advantage

The CalPERS Preferred Provider Organization (PPO) plans in the area include:

  • PERS Select
  • PERS Choice
  • PERSCare

Association plans available for dues-paying members include:

  • California Association of Highway Patrolmen (CAHP)
  • California Correctional Peace Officers Association (CCPOA)
  • Peace Officers Research Association of California (PORAC)

CalPERS chose Health Net SmartCare as the default plan based on similar plan type, coverage area, and premium cost. Members can expect similar benefits and the same co-payments under Health Net's SmartCare plan as they receive from the Blue Shield Access+ plan.

In most cases, members can keep their current doctors or medical groups under a different CalPERS plan in the area. Members are encouraged to ask their doctors what other plans are in-network and compare that with CalPERS' offerings.

Plan availability varies based on ZIP Code. The Find a Medical Plan Tool in my|CalPERS presents available plans based on a member's eligibility ZIP Code. Members should research all available plans and make the decision that best fits their needs and circumstances. CalPERS customer service representatives are also on-hand to guide members through the Open Enrollment process.

“As CalPERS Blue Shield subscribers transfer to other plans in the eight counties, our goal is to assist those members in retaining their current HMO physicians and hospitals,” says Kathy Donneson, chief of CalPERS' Health Plan Administration Division.

CalPERS notified all primary care groups in the eight Bay Area counties, and provided alternative plans so they can assist with outreach to CalPERS members and families. Members may contact the CalPERS Customer Contact Center at 888 CalPERS (or 888-225-7377) or their health benefits officer with questions.

“We aim to help all members make a positive health plan selection during our Open Enrollment period,” says Liana Bailey-Crimmins, CalPERS chief health director.

The action affects State of California and contracting agency subscribers through CalPERS, numbering 12,139 total members. Of the total, 9,908 are active members and 2,231 are retirees.

The CalPERS Board of Administration approved the Blue Shield Access+ exit in June, along with 2019 health premium rates and plan changes.