Plan overview
Access+ HMO
Access one of the largest networks of doctors and hospitals in California with Blue Shield's Access+ HMO® plan.

The Access+ HMO plan is designed to provide both comprehensive coverage and access to one of the largest, quality networks of doctors, specialists and hospitals throughout the state. And, CalPERS members 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.
Exclusive Provider Organization (EPO)
The Blue Shield Exclusive Provider Organization (EPO) Plan is available to CalPERS members in only 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 members do not need to select a primary care physician.

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

2019 CalPERS plan documents

2018 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 formulary generic and formulary brand medications that are approved by the Food and Drug Administration (FDA) and are eligible for coverage under the Blue Shield outpatient prescription drug benefit. This list serves as a guide for members, physicians and other healthcare professionals in the selection of cost-effective drug therapy. This list is available as a PDF or, if you prefer you can search by brand and generic names here.

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 $6,400 for an individual and $12,800 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.)

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
7 a.m. - 8 p.m. Pacific Time | 7 days a week
*Your mail service benefit does not provide coverage for prescriptions used to treat short-term conditions, such as antibiotics or drugs used on an as-needed basis, including drugs for pain. In addition, home self-injectable drugs are not covered under the mail service benefit. This program applies to outpatient prescription drug benefits available through plans underwritten by Blue Shield of California.