Medical Insurance coverage for eligible Cal Poly employees is administered by the California Public Employee's Retirement System (CalPERS). CalPERS offers a variety of plan choices.
There are two types of plans to choose between - Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).
An HMO offers members a range of health benefits, including preventive care, for a monthly fee, with no deductibles or maximums, and minimal co-payments. You will need to choose a primary care physician (PCP) within a network of contracting doctors. The PCP coordinates all your care, including referrals to specialists, when necessary. If you go outside of the HMO without a referral from the plan, you'll be responsible for the total cost of services, except for emergencies or urgent care services. HMOs are available only in designated California services areas.
A PPO is a form of managed care, but it is more similar to a traditional "fee-for-service" type plan. PPOs contract with doctors, hospitals, and other providers to provide services for an agreed-upon charge. You may choose to use a doctor outside their network, but you will pay a higher co-payment. These plans are available statewide and outside of California.
Unlike an HMO, where a primary care physician directs all your care, a PPO allows you to select a provider and a specialist without referral. There are annual deductibles to meet before the plan will pay benefits and you are responsible for a certain percentage of the charges (co-payments). The plan pays the balance up to the agreed-upon amount. The covered benefits vary by plan.
Please refer to each plan’s Evidence of Coverage (EOC) booklet for the exact terms and conditions of coverage. In case of a conflict between this summary and your plan’s EOC, the EOC booklet determines the benefits that will be provided.
Health Benefits into Retirement
CalPERS' Webinar describing various benefits during retirement (including Medicare).
A Few Words About Medicare
Medicare eligible active employees and/or their spouses/domestic partners who are currently enrolled in one of the CSU group health plans do not need to enroll in Medicare before retirement. There will be no penalties assessed to these employees and/or their dependent spouses/domestic partners when they elect to enroll later. (See "Special Enrollment Period" on the Social Security website by clicking here.)
If retired, at age 65, by law, you must enroll in both Part A (hospital) and Part B (medical) of Medicare in order to maintain your eligibility for health benefits under CalPERS. Enrollment is not automatic, and the retiree must contact Social Security directly for enrollment information.
IMPORTANT CHANGE EFFECTIVE JANUARY 1, 2013: CalPERS is converting its Blue Shield HMO Plans and its PERS Select/Choice/Care PPO Supplement to Medicare Plans from a Retiree Drug Subsidy to an Employer Group Waiver Plan (EGWP). Retirees will have a choice to opt-out of EGWP without otherwise affecting their health coverage, but they will be financially responsible for all prescription drug costs if they do so. However, if they then choose to enroll in a non-CalPERS Medicare Part D plan, then the CalPERS health plan will be cancelled. A list of Frequently Asked Questions on EGWP is available at www.calpers.ca.gov.
Note: FERPs are retired, and therefore must enroll themselves and/or their 65-year-old spouses/domestic partners in Medicare.
Retirees must notify CalPERS once they are enrolled in Medicare. Upon receipt of enrollment confirmation, the CalPERS health plan converts to a Medicare Supplement plan.
The Evidence of Coverage Publications for the Medicare Health Plan Supplements can be found on the CalPERS page here.
Enrolling Family Members/Domestic Partners
You can cover only yourself or include your family members in the CalPERS Health Program. If you decide to cover your family members, you must cover all eligible family members as a single group.
- Guidelines for enrolling family members
- Definition of Domestic Partner
NOTE: All employees enrolled in a CalPERS health plan will be required to validate that the individuals on their plans are eligible dependents as defined by CalPERS. There will be an amnesty period running through June 30, 2013, during which time you can identify ineligible dependents and remove them from your coverage. CalPERS will be sending notifications directly to enrolled employees, with specifics about the project and requirements.
Premium Assistance Available Under Medicaid and CHIP
Potential opportunities for premium assistance under Medicaid and CHIP for your family's health coverage (whether or not you are enrolled in a health plan) are described on this notice.
Medical Insurance Plan Details
CalPERS Health Plan Chooser (Compare health plans available to you)
Blue Shield of California Access+ HMO 2013 Evidence of Coverage
Group No. PH0001
Blue Shield of California NetValue HMO 2013 Evidence of Coverage
Group No. PH0010
PERS Select PPO 2013 Evidence of Coverage
Group No. SB050
PERS Choice PPO 2013 Evidence of Coverage
Group No. CB010A
PERS Care PPO 2013 Evidence of Coverage
Group No. KB010A
PORAC (for Peace Office Assn Members Only) 2013 Evidence of Coverage
Evidence of Coverage information for all plans, including Medicare supplemental plans for 2013
- CVS Caremark Cost Descriptions for PPO Plans
- CVS Mail Order Form for PPO Plans
- PrimeMail for (HMO plans)
Medical Insurance Comparisons, Rates and Providers
- 2013 Summary of Covered Services Comparison Chart
- 2013 Monthly Premium Rates for Health Plans
- PERS Anthem PPO Online Provider Directory
- Blue Shield HMO Online Provider Directory
Blue Shield Access+ HMO or Blue Shield NetValue
PERS Choice, PERS Select, or PERS Care
PORAC PPO (Unit 8 only)