Medical Insurance

CalPERS

Medical Plans for 2024

The City offers both HMO and PPO style medical plans. Basic services for the HMO plans are the same and basic services for the PPO plans are the same. The main difference between all plans are doctor networks and hospital availability. It is the employee's responsibility to ensure your selected doctor or hospital is in network. Additional information about doctor networks can be found on the medical plan websites at the bottom of this page.

Useful Guides for Health Information

What benefits am I eligible for?

  • Full-time employees are eligible for: medical, dental, vision, life insurance, long term disability, flexible spending, and deferred compensation (traditional and/or ROTH).
  • Part-time benefited employees are eligible for: medical, dental, and vision.
  • If you would like to waive medical coverage for the 2024 calendar year, please ensure that HR receives a signed Waiver of Coverage form and proof of alternate coverage. For full-time employees, proof of alternate coverage is required to receive the City waiver amount.

What is an HMO?

A health maintenance organization (HMO) offers members a range of health benefits, including preventative care. The HMO will give you a list of doctors from which you select a primary care physician (PCP). Your PCP coordinates your care, including referrals to specialists. Other than applicable co-payments, you pay no additional costs when you receive pre-authorized services from the HMO's contracted providers, except for emergency and urgent care. If you receive care outside of the HMO's provider network without a referral from the health plan, you will be responsible for the total cost of service.

HMO plan options include Anthem Select, Anthem Traditional, Blue Shield Access +, Blue Shield Trio (only available in Los Angeles, Orange, San Luis Obispo, Santa Barbara, and Ventura), Health Net Salud Y Mas, Kaiser, Sharp (only available in San Diego county), United Healthcare, and United Healthcare Signature Value Harmony.

NOTE: For 2024, Health Net SmartCare is no longer offered in either region.

To view a comprehensive Summary of Benefits and Coverage (SBC) for each of the available HMO plans, please select from the following options:

What is a PPO?

Unlike an HMO, where a primary care physician directs all your care, a PPO allows you to select a primary care physician (PCP) and see specialists without a referral from your PCP. A PPO is similar to a traditional "fee-for-service" health plan, but you must use doctors in the PPO network or pay the higher co-insurance (percentages of charges). In a PPO health plan, you must meet an annual deductible before some benefits apply. You are responsible for a certain co-insurance amount, and the health plan pays the balance up to the allowable amount. When you use a non-participating provider you are responsible for any charges above the amount allowed.

PPO plan options include PERS Gold and PERS Platinum. Sworn Police personnel may also select PORAC for medical coverage.

To view a comprehensive Summary of Benefits and Coverage (SBC) for each of the available PPO plans, please select from the following options.

Pharmacy Benefits

OptumRx administers the prescription drug benefits for CalPERS members and their dependents enrolled in PERS Gold, PERS Platinum, Anthem HMO plans, Health Net, United Healthcare and Sharp. Kaiser Permanente and Blue Shield continue to administer their own prescription drug benefits.

Medical Premiums

CalPERS determines medical premiums based on region. Below are the counties included within each region and the medical plan premiums for each area. If you live in ORANGE or SAN DIEGO county, you will look at Region 2. If you live in LOS ANGELES, RIVERSIDE, or SAN BERNARDINO county, you will look at Region 2 or Region 3 since those living in Region 3 have the option of electing a plan using the employer's zip code.

REGION 2 COUNTIES: FRESNO, IMPERIAL, INYO, KERN, KINGS, MADERA, ORANGE, SAN DIEGO, SAN LUIS OBISPO, SANTA BARBARA, TULARE, VENTURA

Plan Name Emp Only Emp + 1 Dep Emp + Family
Anthem Blue Cross Select (HMO) $807.71 $1,615.42 $2,100.05
Anthem Blue Cross Traditional (HMO) $1,034.38 $2,068.76 $2,689.39
Blue Shield Access + (HMO) $869.14 $1,738.28 $2,259.76
Blue Shield Trio (HMO) $810.24 $1,620.48 $2,106.62
Health Net Salud y Mas (HMO) $684.77 $1,369.54 $1,780.40
Kaiser Permanente (HMO) $904.95 $1,809.90 $2,352.87
Sharp Performance Plus (HMO) $833.24 $1,666.48 $2,166.42
United Healthcare SignatureValue Alliance (HMO) $837.88 $1,675.76 $2,178.49
United Healthcare SignatureValue Harmony (HMO) $792.65 $1,585.30 $2,060.89
PERS Gold (PPO) $799.44 $1,598.88 $2,078.54
PERS Platinum (PPO) $1,151.50 $2,303.00 $2,993.90
PORAC (PPO) $926.00 $1,863.00 $2,371.00

REGION 3 - LOS ANGELES, RIVERSIDE, OR SAN BERNARDINO COUNTY

Please note: If you live in Region 3 and you would like to use the City's eligibility zip code for the Region 2 health plan rate, you may elect to do so during Open Enrollment.

Plan Name Emp Only Emp + 1 Dep Emp + Family
Anthem Blue Cross Select (HMO) $841.13 $1,682.26 $2,186.94
Anthem Blue Cross Traditional (HMO) $1,012.67 $2,025.34 $2,632.94
Blue Shield Access + (HMO) $756.65 $1,513.30 $1,967.29
Blue Shield Trio (HMO) $704.69 $1,409.38 $1,832.19
Health Net Salud y Mas (HMO) $630.13 $1,260.26 $1,638.34
Kaiser Permanente (HMO) $865.41 $1,730.82 $2,250.07
United Healthcare SignatureValue Alliance (HMO) $826.44 $1,652.88 $2,148.74
United Healthcare SignatureValue Harmony (HMO) $734.76 $1,469.52 $1,910.38
PERS Gold (PPO) $785.28 $1,570.56 $2,041.73
PERS Platinum (PPO) $1,131.47 $2,262.94 $2,941.82
PORAC (PPO) $926.00 $1,863.00 $2,371.00

2024 Allocations and Waiver Information

The City will contribute the following dollar amounts towards an employee's medical plan based on the number of dependents (if any) covered. Allocations are negotiated by bargaining unit. If you are waiving medical because you are covered under another plan, you will receive the waiver amount below. You must complete the Insurance Waiver form and return it to Human Resources with a copy of your medical card or a letter from your carrier indicating the effective date and an end date (if applicable).

Bargaining Unit Emp Only Emp + 1 Emp + Family Waiver Amt
Employees' Association $1,005.00 $1,545.00 $1,900.00 $455.00
Employees' League $1,005.00 $1,545.00 $1,900.00 $455.00
Mid-management $1,005.00 $1,545.00 $1,900.00 $455.00
Central Management $1,005.00 $1,545.00 $1,900.00 $455.00
Police Association $1,005.00 $1,545.00 $1,900.00 $455.00
Police Management $1,005.00 $1,545.00 $1,900.00 $455.00
Police Recruits $1,005.00 $1,005.00 $1,005.00 $0.00
City Council $1,005.00 $1,545.00 $1,900.00 $0.00
Part-time Benefited $157.00 $157.00 $157.00 $0.00

Medical Plan Websites