Medical

Coverage Information

California Public Retirement System (CalPERS), is the administrator of our medical and retirement plans. CalPERS offers a variety of medical insurance plans, including HMO & PPO.

  • HMOs (Health Maintenance Organization) offer a range of health benefits including preventative care. Employees select a primary care physician who coordinates all care including referral to specialists. If you go outside the HMO's provider network without a referral, you may be responsible for the total cost of the services.

  • PPOs (Prefered Provider Organization) offer members the freedom to select primary care providers and specialists without referrals. If you go outside the PPO network, co-payments will be higher. Furthermore, annual deductibles must be met before some benefits apply.

2026 Health Plan Rates (PDF) 2026 Health Benefit Summary (PDF) CalPERS Health Plan Guide (PDF) CalPERS

Health Maintenance Organizations (HMO)


Contact: 855-839-4524

Preferred Provider Organizations (PPO)


Pharmacy Benefits


Effective January 1, 2026, CVS Caremark (CVS) will replace OptumRx as the new pharmacy benefits manager for the CalPERS Health Plans, aside from Kaiser, who has their own pharmacy.

CVS will manage retail, mail-order, and specialty pharmacy services, offering members enhanced experience through a nationwide pharmacy network, digital tools, and improved customer service.

Members will receive a welcome letter from CVS by early December 2025, that includes information about accessing Caremark.com and the CVS Health app prior to January 1, 2026. In addition, members will receive a new member ID card from their health plan with updated pharmacy information. Health plans will mail these cards starting mid-November 2025 through mid-December 2025.

  • Pharmacy Access: Most CalPERS members will be able to continue filling in prescriptions at the same pharmacy they currently use.

  • Formulary Changes: The new contract will result in some formulary changes that may impact copays for some members or involve a change in medication to an equally safe and effective alternative. Members impacted by the formulary change, CalPERS and CVS will have plans in place to minimize disruption, including a transition period for filling prescriptions no longer on the CVS formulary and an automatic transfer of approved prior authorizations.

You can also confirm whether a specific pharmacy will be in network using CVS’s Pharmacy Locator.

Contact CVS Caremark Customer Care – 833.291.3649

CVS Caremark Website

Resources

  • Allow 7-10 business days to receive medical cards for you and any eligible dependents in the mail.

  • CalPERS will mail medical cards based on physical address, not mailing address on file. To verify your address is up to date, log into your MyCPP portal AND MyCalPERS account.

  • Contact your health plan directly, if you do not receive your medical cards, by using Benefits Provider Contact List (PDF).

  • To find medical plans available in your area go to the CalPERS Health Plan Search by Zip Code.