Plan overview
Access+ HMO
The Access+ HMO® plan offers you one of the largest provider networks in California with access to more than 12,000 primary care physicians, more than 300 hospitals, and more than 32,0000 specialists. And, you can expect zero or low copayments for most covered services, plus no deductible and virtually no claim forms.

Below, you can find the documents you need to understand our plans, benefits and programs.
Trio HMO
The Trio HMO plan is designed to provide both comprehensive coverage at a low premium rates and access to a select network of doctors, specialists and hospitals. CalPERS members get zero or low copayments for most covered services, plus no deductible and virtually no claim forms. Trio is offered in Los Angeles, Sacramento, El Dorado, Placer, Nevada and Yolo counties.*

To enroll in Trio HMO, you must live or work in Trio ZIP code service area. View the CalPERS Trio service area ZIP codes and network providers. Below you can find other documents to help you understand the Trio HMO plan benefits and programs as well.

*Partial coverage
Exclusive Provider Organization (EPO)
The Blue Shield Exclusive Provider Organization (EPO) Plan is available to CalPERS members in only the three counties where the Access+ HMO plan is not available: Colusa, Mendocino and Sierra. The EPO plan has the same benefits as those in the Access+ HMO plan, except that you do not need to select a primary care physician.

Below, you can find the documents you need to understand our plans, benefits and programs.

2020 CalPERS plan documents

2019 CalPERS plan documents

Pharmacy benefits
Blue Shield’s pharmacy benefits are fully integrated with the medical benefits, offering you the convenience of one Blue Shield member ID card and one Member Services phone number for pharmacy and medical benefit questions. Visit blueshieldca.com/pharmacy to find prescription information as well as locate a network pharmacy near you.
Drug formulary
The Blue Shield Plus Drug Formulary is a list of medications that are approved by the Food and Drug Administration. These medications are eligible for coverage under the Blue Shield outpatient prescription drug benefit. We have a guide to help you select cost-effective drug therapy. It is available as a PDF or, if you prefer you can search by brand and generic names here.

The Blue Shield Plus Drug Formulary effective January 2020 is also available.

You can help lower your out-of-pocket prescription drug costs by requesting formulary generic and formulary brand medications when you see your doctor. These medications are usually covered at a lower copayment than non-formulary drugs.

Specialty drugs
Refer to this specialty drug list for specialty drugs that are only available through a Blue Shield Network Specialty Pharmacy.
Out-of-pocket expenses
The annual out-of-pocket maximum for pharmacy expenses is $6,650 for an individual and $13,300 for a family. Additionally, once you have paid $1,000 for formulary mail service prescriptions, you will pay $0 for formulary prescriptions filled at CVS Caremark for the remainder of the year. (Non-formulary brand drugs and drugs to treat sexual dysfunction do not accumulate toward this mail service out-of-pocket maximum.)

Trio HMO, Access+ HMO and EPO CalPERS pharmacy copays

Up to a 30-day supply of non-maintenance drugs or the first 3 fills of maintenance drugs Up to a 30-day supply of maintenance drugs after the first 3 fills or up to a 90-day supply of maintenance drugs from select retail pharmacies
$5 generic
$10 generic
$20 brand-name
$40 brand-name
$50 non-formulary
$100 non-formulary
$30 for specialty drugs
Brand-name drugs when generic equivalent is available: $5 plus difference in cost between generic drug and brand-name drug.
Brand-name drugs when generic equivalent is available: $5 plus difference in cost between generic drug and brand-name drug
Up to a 90-day supply of maintenance drugs from select retail pharmacies: Costco, CVS and Safeway/Vons.

Reminder: With your Blue Shield plan, you can get a flu shot at no extra cost to you at your doctor’s office or at any participating network pharmacy, including most major chains.
Contact us at Shield Concierge
(800) 334-5847
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