PPO Plan Information Update

Effective January 1, 2025, Blue Shield of California will be the new administrator for all PPO plans. For members currently in a basic plan, they are partnering with Included Health to provide member services, including answering inquiries, guiding members to the most appropriate in-network and high-quality providers, and providing care coordination services for members, particularly those with complex health conditions. Included Health will also expand access to care through their supplemental virtual primary care and behavioral health care services. There are no changes to copays, coinsurance, or deductibles with the transition to Blue Shield.

New Providers
Both PERS Gold and Platinum members can access providers, hospitals, and facilities in the UC Health System. Due to this sudden network design adjustment, the providers, unfortuantely, will not show up in the Included Health directory, although CalPERS has included it within an FAQ section. 

Clarification on PERS Gold Out-of-State/Out-of-Country BlueCard Program
Dependents in out of area zip codes (along as the employee has a California zip code) and enrolled in PERS Gold are eligible for covered services outside of California under the BlueCard Program Benefit.  Additional details and information of this benefit are provided on pages 27-30 of the PERS Gold Basic PPO EOC. This also includes additional information on members who cannot find a provider due to their rural zip codes; guidance is provided on how to access virtual or a primary provider through the Included Health app.

Options for in-network PPO provider or plan information searches
Included Health Member Services is available by phone at (855) 633-4436 or by webchat with their Message Care Team. An Included Health account must be activated for this option.  

Important Links
PPO: CalPERS - Included Health
HMO: CalPERS Active (blueshieldca.com)
Health Plan Search by ZIP Code - CalPERS
Forms & Publications - CalPERS - has all forms and summaries included for all plans.