How do I contact my HMO directly??
To contact your HMO directly call their toll free line. Keep a copy of the toll free phone numbers for your health, dental, and vision providers with your other benefits documents.
What type of plan should I choose?
Preferred Provider Organizations (PPO's) and Indemnity plans offer the option to receive services from preferred providers who contract with the plan to provide services for a set amount. There are usually annual deductible amounts that must be met before some benefits apply. You are responsible for a certain percentage of the charges (co-payments) and the plan pays the balance up to the contract amount. If you choose to receive services from non-exclusive/non-preferred providers, you generally will be responsible for a much larger percentage of the charges. The plan may require that certain services be pre-approved and you or your provider will need to file a claim for reimbursement.
Health Maintenance Organizations (HMO's) require that you obtain services from specific medical providers who contract with the plan. You select a primary care physician or medical group who coordinates your total health care, including arranging for referrals to specialists, laboratory tests, x-rays, hospitalization, and medications. If medical treatment, hospitalization, or medication is received from other than the specified providers, without prior authorization, you will be responsible for these charges. There are no deductibles or claim forms; however, some co-payments may apply.
Note: It is important to know that when you enroll in an
HMO, services are provided through the plan's delivery system and the continued
participation of any one doctor, hospital, or other provider cannot be guaranteed.
What plans are offered in my area?
The Service Area By County table in the back
of the Health Plan Guide (you may request one from the Human Resources Department) provides a
guideline as to what plans are generally available in your county. Eligibility is based on
your home address zip code.
What benefits do I need in a health plan?
Many benefits are standardized but there are still some
differences between plans. Review the benefit comparison fold out chart (located in the
Health Plan Guide) to determine which plan fits your health care needs. This chart is only
a summary and you should review the plan's Evidence Of Coverage booklet or contract the
health plan for further information.
When You Want More Info...
Need help finding a doctor? Have a doctor, but need help finding out what health plans your doctor accepts? CalPERS has added a new on-line physician directory to our web site (www.calpers.ca.gov). Your can get background information on the thousands of physicians located in California, Nevada, and Arizona that are affiliated with our health plans. You can search by geographic area, medical specialty, health plan, or physician's name. You can get information on all available physicians in your community and get directions to their offices.
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Reaching the CalPERS Health Benefit Services Division |
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You can reach CalPERS Monday through
Friday, 8:00 a.m. to 5:00 p.m. at 1(800)237-3345. The busiest
times of the month are the first five working days after benefit checks
are released and all Mondays. If you can wait to call outside these
times, you'll find it much easier to reach them. Member and
Benefit Contact Center |
Does the plan offer adequate medical providers and are they conveniently located?
Contact the health plan directly for a list of doctors,
hospitals, pharmacies, and other health care providers available in your area. Also,
contact the doctor to be sure he or she is accepting new patients.
What are my costs?
Depending upon your employer's contribution amount, you may have a monthly premium that would be deducted from your salary or retirement check. You will also be required to pay the co-payments and deductibles associated with the plan you choose.
Deductibles and benefits are not transferable from one plan to another. Calendar year deductibles and benefits renew every January 1.