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CalPERS Health Carrier Information


Summary of Benefits & Coverage Notice

2026 Prescription Drug Plan Changes
  • Effective January 1, 2026, CVS Caremark (CVS) will replace OptumRx as the new pharmacy benefits manager
  • All CalPERS Basic Health plans EXCEPT Blue Shield Access + (HMO and EPO), Blue Shield Trio and Kaiser Permanente will use CVS Caremark.
  • A Welcome Kit will be sent to all affected employees in December.
  • New Health Insurance ID cards reflecting the new prescription drug benefit will be mailed by the health carrier before January 1st (contact your health carrier if you do not receive your new id card(s)).
  • The CVS microsite and CVS Customer Care phone line 833-291-3649 are available now.

For additional information visit: 

HMO Plans

An HMO (Health Maintenance Organization) is a plan that provides healthcare from specific doctors and hospitals under contract with the plan. While you pay co-payments for some services, you have no deductibles, have an assigned Primary Care Physician (PCP), and a California geographically restricted service area.  The PCP manages all your care, including referrals to a specialist.  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.

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PPO Plans

A PPO plan gives the patient freedom of choice, allowing to see a provider of choice without referrals. With PPO plans, you typically meet an annual deductible before some benefits apply. You are responsible for a certain co-insurance amount and the plan pays the balance up to the allowable amount.  If the provider is "in-network", the plan will pay more, than if the provider is "out-of-network".

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