CalPERS Plans
True or False:
PCP copays are $10 if seeing designated PCP?
True
Who is the Preferred Pharmacy for CalPERS
Optum Rx
This is a type of plan where at least one family member is enrolled in a CalPERS Medicare health plan and at least one family member is enrolled in a CalPERS Basic health plan.
CalPERS requires all covered family members to be enrolled with the same health carrier.
Combo Plan
This plan is available to all CalPERS members across all zip codes and organizations in California.
The PERS Gold
Active member Member is looking for disability information... where would you route the member to:
- CalPERS Contact Center
- HR
- Insurance Carrier
CalPERS Contact Center
$10 Copay applies to designated PCP (or another PCP in the same location as the designated PCP) who is INN with PERS Gold
What is the name of the service that helps mothers and their baby?
They offer education, support, and guidance throughout your pregnancy and in the postpartum period, making sure that your prenatal care is on track and that you fully understand each step of your pregnancy journey.
CalPERS Maternity and Family Planning
This is a type of plan where members under age 65 or 65+ and working while not eligible for Medicare A
Basic Plan
This plan has no geographical restriction, providing coverage anywhere in the world.
The PERS Platinum
Non-Medicare Member wants to find out what their premiums would be for 2025... where would you route the member to:
- CalPERS Contact Center
- HR
- Handle the call
Handle the call
What is the fee for preventative care services for in network of Gold or Platinum plans?
No Charge
This Diabetes Prevention Program is designed to help you lose extra weight and prevent or delay the onset of type 2 diabetes.
Eligible members who enroll can get a Fitbit, digital scale, and health coaching at no additional cost. All programs adhere to the U.S. Centers for Disease Control and Prevention curriculum.
Wellvolution
The abbreviation for Health Benefit Officer - a CalPERS HR contact
HBO
This benefit coinsurance waived for deliveries if enrolled in Included Health’s maternity program (CCM).
Maternity benefit
Non-Medicare Member wants to know deductible amounts for 2025 Platinum PPO plan... where would you route the member to:
- CalPERS Contact Center
- Insurance Carrier
- Handle the call
Handle the call
What is the standard co-insurance for in network and out of network for Platinum members?
10% / 40%
This is a remote second opinion where members are able to ask questions about their diagnosis or treatment and receive responses in a written report by an expert in the field.
Expert Medical Opinions
This is a non-preferred network or provider: this is a network or provider that is out of network.
Non-PPO
Vision coverage is offered to CalPERS employees through who?
Vision Service Plan (VSP)
Active member with eligibility concerns or questions... where would you route the member to:
- CalPERS Contact Center
- HBO (HR)
- Handle the call
HBO (HR)
True or False:
Those with a PERS Platinum or Gold plan receive 100% coverage, no cost, for any lab services that are received at a Quest Diagnostics, Labcorp, and Bio America facility.
False: Those with a PERS Platinum or Gold plan receive 100% coverage, no cost, for any lab services that are received at a Quest Diagnostics and Labcorp facility.
These plans are not eligible for IH services
A CalPERS non-PPO plan includes HMO, EPO, or Medicare plans
This is an out of network exception process, criteria needs to be met and approved for 2025 coverage (such as qualifying conditions and previous provider must have been in network)
COC- Continuity of Care
What is the 2025 IH Virtual Services Costs for GOld and Platinum for Behavioral Health?
Gold: $10
Platinum: $20
Member is looking for Medicare information... where would you route the member to:
- CalPERS Contact Center
- HBO (HR)
- Handle the call
CalPERS Contact Center