A50230-CALPERS 8-17 CalPERSOEBrochuremrktoa.blueshieldca.com/rs/417-JXY-489/images/A50230-CALPERS_… · For new prescriptions, please allow 10 to 14 days to receive your covered

Access+ HMO plan Overview

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life is limitless.never stop.

blueshieldca.com/calpers

Access+ HMONow with lower rates!

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You don’t have to sacrifice choice for lower costs

Self-refer to a specialist within

your medical group, without going to your doctor first.1

Select a different primary care

physician (PCP) for each member of your family and

change that doctor anytime you want.

Contact a physician through Teladoc 24/7/365 when your doctor

isn’t available, even while

traveling, for only a $5 copay.10

Stay covered across the country for extended periods with the Away

From Home Care® program when you

have students, long-term travelers and families

living apart.7

Nothing matters more than your health. Except protecting it.

Get access to one of the largest networks of doctors, specialists and hospitals in California with Access+ HMO®. It offers you many care options, so you can choose what’s right for you and your family.

For 2018, we've worked to lower our rates for Access+ HMO to offer you a plan that delivers choice and affordability.

Here are some of the valuable Access+ HMO programs and services that offer you more choice, convenience and control over your own care:


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Self-refer to a specialist within your medical

group, without going to your doctor first.1

Select a different primary care

physician (PCP) for each member

of your family and change that doctor anytime

you want.

Contact a physician through Teladoc 24/7/365

when your doctor isn’t available, even while traveling for only a $5

copay.

Stay covered across the country for extended

periods with the Away From Home

Care® program when you have students,

long-term travelers and families living apart.7

Access emergency and urgent care services almost anywhere in

the United States and in more than 200 countries through the BlueCard®

Program and Blue Shield Global Core.

Receive up to 20 combined

chiropractic and acupuncture

treatments per year for a $15

copay per visit.

Get up to a 90-day supply for the cost of a 60-day supply of

prescriptions by mail or from select retail

pharmacies when you take medication for a

chronic condition.

Call Shield Concierge, our

team of experts, for help with healthcare

questions, concerns or decisions

About the Access+ HMO planBlue Shield’s 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.

With our Access+ HMO plan, you can expect zero or low copayments for most covered services, plus no deductible and virtually no claim forms.

Choosing a doctorWhen you enroll in the Access+ HMO plan, you will be asked to select a primary care physician (PCP) for you and each of your dependents. You and your covered dependents have the option to select different PCPs and medical groups within the Access+ HMO Network of providers.

To find out if your current doctor is in our network, or to locate a new doctor, go to blueshieldca.com/networkcalpershmo and select Primary Care Physician to search for a network PCP. Enter your city and state or ZIP code, then click Continue. Click on the PCP’s name to find the PCP’s provider number and medical group/Independent Practice Association number. You will need these numbers when you enroll in the plan for the first time.

If you don’t have access to the Internet or would like personal assistance, call Shield Concierge, our dedicated customer service team for CalPERS members, at (800) 334-5847, 7 a.m. to 8 p.m., seven days a week.

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Comprehensive benefit summaryfor the Access+ HMO plan

Calendar-year deductible

Member None

Family None

Physician services

Preventive health exam No charge

Gynecological/well-woman exam No charge

Pregnancy and maternity care; prenatal/postnatal office visits No charge

Well-baby care No charge

Immunization/inoculation No charge

Allergy testing/treatment No charge

Office/home visits $15/visit

Teladoc video or phone consultation $5/call

Urgent care $15/visit

Infertility testing and treatment 50% of allowable amount

Physician inpatient hospital visits No charge

Surgery/anesthesia No charge

Chiropractic and acupuncture services (Combined maximum of 20 visits per year)

$15/visit

Access+ SpecialistSM,1 – self-referral to specialists $30/visit

Hospital services

Inpatient No charge

Outpatient No charge

Ambulatory surgery centers No charge

Transgender surgical services No charge

Ambulance services No charge

Emergency care – no copayment if hospitalized or kept for observation

$50/visit

Diagnostic X-ray/lab No charge

Skilled nursing facility – up to 100 days per calendar year No charge

Hospice No charge

Mental health/substance use disorder

Inpatient No charge

Outpatient $15/visit


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Prescriptions2

Prescriptions for non-maintenance drugs and for the first three fills of maintenance drugs from a retail pharmacy (up to a 30-day supply)

$5 generic $20 formulary brand $50 non-formulary brand

Prescriptions for maintenance drugs after the first three fills from a retail pharmacy (up to a 30-day supply)3


Prescriptions for maintenance drugs from a select* retail pharmacy (up to a 90-day supply)


Prescriptions for maintenance drugs by mail order (up to a 90-day supply) $10 generic $40 formulary brand $100 non-formulary brand

Prescriptions for specialty drugs (up to a 30-day supply) $30

Prescription drugs to treat sexual dysfunction 50% of the cost of the drug

Maximum annual out-of-pocket payments for mail service formulary prescription drugs4

$1,000

Flu vaccine from participating retail pharmacies5 No charge

Vision care

Eye refraction to determine need for corrective lenses (This service is limited to one visit per calendar year for members 18 and older; no limit on number of visits for members under 18.)

No charge

Eyeglasses – not covered, except for those that are necessary after cataract surgery

20% discount available8

(See page 11.)

Hearing-aid services

Evaluation No charge

Hearing aid – up to a maximum of $1,000 per member, every 36 months for both ears for the hearing-aid instrument and ancillary equipment

Charges in excess of $1,000

Durable medical equipment, including orthoses and prostheses No charge

Physical/occupational/speech therapy

Inpatient visits at a hospital or skilled nursing facility No charge

Outpatient and home visits $15/visit

Member calendar-year out-of-pocket maximum

Member: $7,350 – Medical: $1,500 maximum – Pharmacy: $5,850 maximum†

Family: $14,700 – Medical: $3,000 maximum– Pharmacy: $11,700 maximum†

* CalPERS network select pharmacies are Costco, CVS and Safeway/Vons. † Includes the $1,000 maximum annual out-of-pocket payments for mail service formulary prescription drugs per member.

This chart is a summary of the Access+ HMO plan benefit coverage. It is not a contract. For complete details, please visit our website, blueshieldca.com/calpers, where you can find in-depth information about the plan, as well as download the Access+ HMO Evidence of Coverage. Or you can contact Shield Concierge at (800) 334-5847 if you prefer a printed copy.

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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 both pharmacy and medical benefit questions.

Filling your prescription at a local pharmacyYou can locate a network pharmacy by calling Shield Concierge at (800) 334-5847 or by visiting blueshieldca.com/wellness/drugs.

Copayments for prescription drugs filled at a retail pharmacy:

Retail prescription drugs GenericFormulary

brand

Non-formulary

brand

Up to a 30-day supply of non-maintenance drugs and the first three fills of maintenance drugs*

$5 $20 $50

Up to a 30-day supply of maintenance drugs after the first three fills3 $10 $40 $100

Up to a 90-day supply of maintenance drugs from a select retail pharmacy (Costco, CVS and Safeway/Vons)

$10 $40 $100

You may also receive your flu immunization from participating pharmacies as well as your primary care physician’s office at no charge.

Mail service prescriptionsBlue Shield provides the convenience of mail service6 delivery of prescription drugs through CVS Caremark®. You may receive up to a 90-day supply of covered maintenance drugs delivered to your home or office, with no charge for shipping.

Mail service prescription drugs (90-day supply)


* Maintenance drugs are prescribed to treat chronic health conditions such as asthma, diabetes, high blood pressure or high cholesterol and are taken on an ongoing, regular basis to maintain health. You can view the list of covered maintenance drugs by visiting blueshieldca.com/wellness/drugs/formulary and scrolling down to the formularies under Large Groups (100+ employees).


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To receive medications from CVS Caremark, go to blueshieldca.com/wellness/drugs and then click on Mail Service Prescriptions.

For new prescriptions, please allow 10 to 14 days to receive your covered maintenance medications. Once your prescription is on file with CVS Caremark, please allow five to eight days to receive refills of your covered medications.

About our drug formularyThe Blue Shield Plus Drug Formulary is a list of preferred generic and brand drugs that are eligible for coverage under the outpatient prescription drug benefit. You can help lower your out-of-pocket prescription drug costs by requesting generic and formulary brand medications when you see your doctor because these medications are usually covered at a lower copayment than non-formulary drugs. To see our drug formulary, visit blueshieldca.com/wellness/drugs/formulary and select the link Plus Drug Formulary under Large Groups (100+ employees).

Specialty drugsSpecialty drugs are drugs that may require coordination of care, close monitoring or extensive patient training for self-administration. Most specialty drugs must be filled through CVS Caremark, our network specialty pharmacy.

Prescriptions for specialty drugs are available for up to a 30-day supply per fill, with a copayment of $30. A complete list of specialty drugs is available at blueshieldca.com/wellness/drugs/formulary; scroll down to the specialty drug list under Large Groups (100+ employees).

Out-of-pocket expensesThe annual out-of-pocket maximum for pharmacy expenses is $5,850 for an individual and $11,700 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.)

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Additional care options

Self-refer to a specialistWith Access+ Specialist, you can self-refer to a participating specialist in the same medical group for a fixed office copayment of $30 per visit.1

TeladocTeladoc gives you remote access to the same type of board-certified physicians you would visit in person. They are available by phone or video, even while you are traveling10. Physicians can provide you with a prescription if medically necessary and consults are always a $5 copay.

Coverage while travelingYou have access to care for emergency and urgent care services across the United States and around the world through the BlueCard® Program and Blue Cross Blue Shield Global Core. If you use providers in the BlueCard Program, you will pay only your regular copay at the time of service and will not have any claim forms to fill out when you return.

Coverage for students or families living apartThe Away From Home Care program7 offers students, long-term travelers, workers on long-distance assignments and families living apart access to health coverage from Blue Shield and Blue Cross plans across the country. The program is available in 31 states and the District of Columbia, but availability varies by county within each state. HMO benefits vary by state.

Chiropractic and acupuncture servicesYou can visit any participating chiropractor or acupuncturist from the American Specialty Health Networks, Inc. (ASH Networks) without a referral from your primary care physician. There is a $15 copay per visit and a combined maximum of 20 visits per year.

NurseHelp 24/7With NurseHelp 24/7SM, registered nurses are available to answer your health questions at any time, every day.

LifeReferrals 24/7With LifeReferrals 24/7SM, experienced professionals are ready to help you with personal, family and work issues at any time.

Plus lots more


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Health and wellness programs

WellvolutionAn online wellness program that makes getting serious about your health some serious fun. Wellvolution® includes:

Well-Being Assessment Take a quick and confidential assessment to receive a personalized report with

suggestions for ways to improve your health.

Diabetes Prevention Program This program can help qualifying members lose weight, adopt healthier habits and

reduce the risk of developing type 2 diabetes.

Daily Challenge With Daily Challenge®, each day receive an email message for one simple wellness-

related activity to help you live healthier and improve your overall well-being.

Walkadoo Simply wear a wireless device that tracks your steps throughout the day, and the

Walkadoo® walking program will keep track of your activity and goals. When you join the program, you are eligible to get a Fitbit® activity tracker at no extra cost.

QuitNet Get online and mobile peer support from QuitNet®, the largest quit-smoking

community in the world for those who want to quit smoking.

Condition Management Program Get guidance and information on conditions such as asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), diabetes, heart failure and musculoskeletal conditions.

Prenatal ProgramExpectant parents get 24/7 phone access to maternity nurses and other support and guidance during pregnancy.

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Shield ConciergeAs a CalPERS member, you have access to one-on-one support from our Shield Concierge team of healthcare experts who can support your various needs with:

Customer service representatives who can answer your questions about plan coverage, doctor selection, claims, ID cards, pre-authorization and referrals

Registered nurses who can follow your condition, case or illness, answer health-related questions and consult on medical issues and symptoms

Social workers who can provide support and assistance with your physical and emotional well-being and provide information about community resources

Health coaches who can help you with disease prevention, nutrition, weight management, stress reduction and general lifestyle health

Pharmacy technicians who can answer your questions about benefits, formulary alternatives and prior authorization of prescriptions

Pharmacists who can answer your questions relating to medications, side effects, drug safety, costs and treatment options

Shield Connect in a FlashWhen you register on blueshieldca.com, you’ll automatically receive our Shield Connect in a Flash e-newsletter every other month. This online newsletter will keep you current on benefits and services available to you throughout the year.

Blueshieldca.comWhen you become a member, you can register at blueshieldca.com where you will be able to manage your health plan online, from changing your primary care physician to accessing your plan benefits and downloading temporary Blue Shield member ID cards.

Take us with you anywhereDownload the Blue Shield of California mobile app and keep your health plan information at your fingertips. Our mobile app is available on the App StoreSM and Google PlayTM. Or connect with us using our mobile-friendly website at blueshieldca.com. Find a doctor and access important plan and benefits information such as claims, copays and your member ID card.

ID protection and credit monitoringGet covered right down to your identity with credit monitoring, identity repair assistance and identity theft insurance.

Other services and resources


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Your wellness is important to us. To make it easier for you to take better care of yourself, we offer a wide range of member discounts8 on popular programs that can help you save money and get healthier. Learn more at blueshieldca.com/wellnessdiscounts.

Discount Vision ProgramMembers have access to participating providers in the Discount Vision Program network and can get a 20% discount for the following:

• Routine eye examinations

• Frames and lenses (including photochromic)

• Tints and coatings

• Extra pair of glasses

• Non-prescription sunglasses

• Hard contact lenses

LASIK discount programLASIK and PRK correction surgery, an alternative to contacts or glasses, is one of the fastest-growing vision treatments. The discount program gives covered members access to:

• A 15% discount through the NVISION, Inc. provider network in California, or

• Savings on LASIK surgery at more than 45 QualSight surgery centers in California.

MESVisionOptics.com Members receive competitive prices on many contact lens brands as well as a selection of sunglasses, reading glasses and eye care accessories.9 Free shipping is available for all orders over $50.

24 Hour FitnessNow it is easier to get in shape and stay fit with:

• Waived enrollment and processing fees

• Discounted initiation fees and monthly dues – as low as $24.99 a month

ClubSport or Renaissance ClubSport

Get fit and save a bundle:

• 60% discount on enrollments when joining on a month-to-month agreement.

• $0 enrollment fee when joining with a 12-month agreement. A one-time $25 processing fee applies at the time of enrollment.

Discount programs

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Alternative Care Discount Program

Relax and save on alternative healthcare services from participating practitioners participating with American Specialty Health Group, Inc. (ASH Group):

Acupuncture services Members receive 25% off the usual and customary fees for:

• Examinations

• Acupuncture or electro-acupuncture

• Adjunctive therapeutic procedures

Chiropractic services Members receive 25% off the usual and customary fees for:

• Examinations

• Manipulative treatment

• Adjunctive therapeutic procedures

• X-rays

• Supports and appliances

Massage therapy Members receive 25% off the usual and customary fees for massage therapy visits. Techniques may include:

• Swedish massage

• Deep-muscle massage

• Deep-tissue massage

Health and wellness products Members may browse and purchase a broad selection of health improvement and wellness products, fulfilled by an e-retail site. These include:

• Vitamins and minerals

• Food supplements

• Sports nutrition

• Herbs and botanicals

• Relaxation resources

• Pilates, yoga and tai chi

• Fitness and activity

• Health books and videos

• Beauty and personal


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San Diego

San Bernadino

Nevada

Placer

El Dorado

VenturaLos Angeles

OrangeRiverside

SantaClara

KernSan Luis Obispo

Sacra-mento

Yolo

Humboldt

Glenn

Mariposa

Butte

Sonoma

Santa Barbara

Imperial

Merced Madera

Fresno

Kings

Tulare

Solano

SanJoaquin

Stanislaus

ContraCosta

Alameda

Marin

San Mateo

Santa Cruz

San Francisco

Monterey

Inyo

TuolumneCalaveras

Mono

San Benito

Amador

Alpine

Del NorteSiskiyou Modoc

Trinity

Shasta Lassen

Mendocino

Tehama

Plumas

LakeColusa Su

tter

Yuba

Sierra

Napa

Access+ HMO service area

County coverage* No coverage

The Access+ HMO plan is offered in 35 counties and includes about 300 medical groups.

* Partial coverage in El Dorado, Nevada, Placer, San Bernardino and San Diego counties. Full county coverage elsewhere. To find out if the Access+ service area includes the ZIP code where you reside or work, please contact Shield Concierge at (800) 334-5847. You may also use CalPERS’ online service, the Health Plan Search by ZIP Code, available at www.calpers.ca.gov.

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Endnotes1 The Access+ Specialist option allows HMO members direct access to participating specialists in the same medical group or IPA as their Personal

Physician. Not all medical groups or IPAs participate in this program.

2 If a brand drug is chosen when there are FDA-approved generic equivalents available, then the cost difference between the brand drug and the generic equivalent drug, plus a generic copay, will apply. Exceptions for medical necessity are available via prior authorization; if approved, the applicable brand copay applies.

3 Does not apply if filled at a select retail pharmacy. CalPERS network select pharmacies are Costco, CVS and Safeway/Vons.

4 Non-formulary brand drugs and drugs to treat sexual dysfunction do not accumulate toward the $1,000 mail service out-of-pocket maximum.

5 Flu shots are available at participating retail pharmacies. To find participating pharmacies, visit blueshieldca.com/wellness/drugs, scroll down to Locate Pharmacies then click on Find a Pharmacy. You also have the option to continue receiving the flu vaccine at your doctor’s office.

6 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.

7 Availability varies from area to area. The coverage through the Away From Home Care program is that of the host plan, not the coverage offered by Blue Shield of California. For more information, please call (800) 622-9402.

8 These discount program services are not a covered benefit of Blue Shield health plans and none of the terms or conditions of Blue Shield health plans apply. Discount program services are available to all members with a Blue Shield medical, dental, vision, or life insurance plan. The networks of practitioners and facilities in the discount programs are managed by the external program administrators identified below, including any screening and credentialing of providers.

Blue Shield does not review the services provided by discount program providers for medical necessity or efficacy. Nor does Blue Shield make any recommendations, representations, claims, or guarantees regarding the practitioners, their availability, fees, services, or products. Some services offered through the discount program may already be included as part of the Blue Shield plan covered benefits. Members should access those covered services prior to using the discount program.

Blue Shield reserves the right to terminate this program at any time without notice. Discount programs are administered by or arranged through the following independent companies:

• Alternative Care Discount Program – American Specialty Health Systems, Inc. and American Specialty Health Group, Inc.

• Discount Vision Program and MESVisionOptics.com – MESVision

• Fitness facilities – 24 Hour Fitness, ClubSport and Renaissance ClubSport

• LASIK – QualSight, Inc. and NVISION, Inc.

The Discount Vision Program network is currently available in Arizona, California, Colorado, Idaho, Nevada, Oregon, Texas, Utah and Washington.

9 Requires a prescription from your doctor or licensed optical professional.10 Teladoc visits are unavailable outside of the United States.

© 2017-2018 Teladoc, Inc. All rights reserved.

Daily Challenge, Walkadoo and QuitNet are registered trademarks of MYH, Inc.

The Diabetes Prevention Program is provided by Solera Health, an independent company.

App Store is a service mark of Apple Inc.

Google Play is a trademark of Google Inc.

Access+ HMO, Access+ Specialist, NurseHelp 24/7, LifeReferrals 24/7 and Wellvolution are service marks or registered trademarks of Blue Shield of California. Blue Shield and the Shield symbol are registered trademarks of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans.


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Still have questions? Call or visit us online.Go online: blueshieldca.com/calpersA custom website for CalPERS members with full-time access to plan benefits, services, Find a Doctor and more.

Call us: (800) 334-5847Our Shield Concierge team is ready to help from 7 a.m. to 8 p.m., seven days a week.

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Participating physician groups Hospitals

Alameda CountyAffinity Bay Valley RegionAffinity Medical GroupAlta Bates Medical GroupBrown & Toland Medical GroupHill Physicians Medical Group IncJohn Muir Physician NetworkPalo Alto Medical FoundationPhysicians Medical Group San JoseSutter East Bay Medical FoundationSutter East Bay Medical Foundation Diablo Division

Alta Bates Medical Center Herrick CampusAlta Bates Medical Center Alta Bates Campus Alta Bates Medical Center Summit CampusChildren's Hospital Oakland Research InstituteKindred Hospital San Francisco Bay AreaValleyCare Medical Center Valley Memorial Hospital Washington Hospital

Butte CountyButte County Blue Shield of California AdministeredGlenn County Blue Shield of California Administered

Enloe Medical Center Cohasset Enloe Medical Center Esplanade Enloe Rehabilitation Center Feather River Hospital Orchard Hospital Oroville Hospital

Contra Costa CountyAffinity Medical GroupAlta Bates Medical GroupBrown & Toland Medical GroupHill Physicians Medical Group IncJohn Muir Physician NetworkPalo Alto Medical FoundationSutter East Bay Medical FoundationSutter East Bay Medical Foundation Diablo Division

John Muir Medical Center Concord Campus John Muir Medical Center Walnut Creek Campus San Ramon Regional Medical CenterSutter Delta Medical Center

El Dorado CountyHill Physicians SacramentoMercy Medical Group

No listings

Fresno CountySaint Agnes Medical GroupSante Community Physicians Inc Sante Health System

Adventist Medical Center Reedley Clovis Community Hospital Coalinga Regional Medical CenterFresno Community Hospital Fresno Surgical HospitalSan Joaquin Valley Rehabilitation HospitalSelma Community HospitalSaint Agnes Medical Center

Glenn CountyButte County Blue Shield of California AdministeredGlenn County Blue Shield of California Administered

Glenn Medical Center

Access+ HMO Network*

This Access+ HMO Network listing is a general guide only and is subject to change. For the most up-to-date listing and to verify a provider is in the network, please visit blueshieldca.com/networkcalpershmo.


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Humboldt CountyHumboldt Del Norte IPA Mad River Community Hospital

Redwood Memorial HospitalSt. Joseph Hospital Eureka

Imperial CountyImperial County Physicians Medical Group El Centro Regional Medical Center

Pioneers Memorial Hospital

Kern CountyBakersfield Family Medical GroupGemcare Medical Group DelanoGemcare Medical Group MCS of Kern CountyHealth Now IPAIndependence Medical Group

Adventist Health Medical Center TehachapiBakersfield Memorial Hospital Delano Regional Medical Center Good Samaritan Hospital Bakersfield HealthSouth Bakersfield Rehabilitation Hospital Kern Medical Center Kern Valley Hospital Mercy Hospital Bakersfield Ridgecrest Regional Hospital San Joaquin Community Hospital

Kings CountyKey Medical GroupSante Community Physicians Inc Sante Health System

Adventist Medical Center

Los Angeles CountyAccess Medical Group IncAccess Medical Group Santa MonicaAffiliated Doctors of Orange CountyAlamitos IPAAll Care Medical Group A Division Of DCHSMFAllied Healthcare ProvidersAllied Pacific of CaliforniaAlpha Care Medical GroupAltamed Health ServicesAngeles IPAApplecare Medical GroupApplecare Medical Group SelectApplecare Medical Group St Francis RegionApplecare Medical Group WhittierAssociated Hispanic Physicians IPAAxminster Medical Group IncAxminster Medical Group Little Company of Mary – IPA TorranceAxminster Medical Group Little Company of Mary – San PedroAxminster Medical Group OlympiaAxminster Providence Care NetworkBella Vista Medical Group IPABrookshire IPACentinela Valley IPAChaffey Medical Group EHPCitrus Valley Physicians GroupDaehan Prospect Medical GroupECMG Avalon Medical GroupECMG Greater LA HealthcareECMG Greater San Gabriel Valley PhysiciansECMG Mabuhay Medical GroupECMG Mid Cities IPAECMG Pasadena Primecare Physicians

Alhambra Hospital Medical Center Antelope Valley Hospital Medical Center Barlow Respiratory Hospital Beverly Hospital California Hospital Medical Center Los Angeles Catalina Island Medical CenterChildren’s Hospital Los Angeles Citrus Valley Medical Center IC Campus Citrus Valley Medical Center QV Campus City of Hope National Medical Center Coast Plaza Hospital Community Hospital of Huntington ParkCommunity Hospital of Long Beach Earl and Lorraine Miller Children’s Hospital East Los Angeles Doctors HospitalFoothill Presbyterian HospitalGarfield Medical Center Glendale Adventist Medical CenterGood Samaritan Hospital Los Angeles Greater El Monte Community Hospital Henry Mayo Newhall Hospital Hollywood Presbyterian Medical Center Huntington Memorial Hospital Keck Hospital of USC Kindred Hospital Baldwin Park Kindred Hospital La Mirada Kindred Hospital Los Angeles Kindred Hospital San Gabriel Valley Kindred Hospital South Bay LAC+USC Medical Center Lakewood Regional Medical Center Long Beach Memorial Medical Center Los Angeles Community HospitalMarina Del Rey Hospital Martin Luther King Jr. Community Hospital

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ECMG PCP IPAECMG Serendib HealthwaysFacey Medical Foundation BurbankFacey Medical Foundation San Fernando ValleyFacey Medical Foundation Santa ClaritaFamily Care Specialists IPAFamily Care Specialists MontebelloFamily Health AllianceGlobal Care Medical Group IncGNP Long Beach MemorialGood Samaritan Medical Practice AssociationGreater Covina Medical Group Inc Harriman Jones Medical Group A Division of Healthcare PartnersHCP IPA Arta Health NetworkHCP IPA South CoastHCP Northridge Medical GroupHCP PA Beverly MontebelloHCP PA CitrusHCP PA Glendale Greater San GabrielHCP PA Pasadena ArcadiaHCP PA San GabrielHCP Talbert Medical GroupHealthcare LA IncHealthcare PartnersHealthcare Partners IPA ArcadiaHealthcare Partners IPA East Los AngelesHealthcare Partners IPA East WestHealthcare Partners IPA GlendaleHealthcare Partners IPA HillcrestHealthcare Partners IPA Little Company of MaryHealthcare Partners IPA Long BeachHealthcare Partners IPA Los Angeles CountyHealthcare Partners IPA MontebelloHealthcare Partners IPA PasadenaHealthcare Partners IPA San Fernando ValleyHealthcare Partners IPA South BayHealthcare Partners Medical Group ArcadiaHealthcare Partners Medical Group Bay Shores MGHealthcare Partners Medical Group East Los AngelesHealthcare Partners Medical Group Glen OaksHealthcare Partners Medical Group GlendaleHealthcare Partners Medical Group GlendoraHealthcare Partners Medical Group Long BeachHealthcare Partners Medical Group Los AngelesHealthcare Partners Medical Group MonroviaHealthcare Partners Medical Group MontebelloHealthcare Partners Medical Group PasadenaHealthcare Partners Medical Group San FernandoHealthcare Partners Medical Group Temple CityHealthcare Partners Network Magan CovinaHealthcare Partners Santa AnitaHigh Desert Medical GroupHispanic Physicians IPAInland Valleys IPAKorean American Medical GroupLakeside Medical Organization Agoura HillsLakeside Medical Organization Burbank North HollywoodLakeside Medical Organization Central ValleyLakeside Medical Organization GlendaleLakeside Medical Organization North Valley

Memorial Hospital of Gardena Methodist Hospital of Southern California Miracle Mile Medical Center Monterey Park Hospital Motion Picture & Television HospitalNorthridge Hospital Medical Center Roscoe Campus Olympia Medical Center Pacifica Hospital of the Valley Pacific Alliance Medical Center Palmdale Regional Medical Center PIH Health Hospital – DowneyPomona Valley Hospital Medical CenterPresbyterian Intercommunity HospitalPromise Hospital of East LA Promise Hospital of East LA Suburban Campus Providence Holy Cross Medical Center Providence Little Company of Mary Medical Center – San PedroProvidence Little Company of Mary Medical Center – Torrance Providence Saint John’s Health CenterProvidence Saint Joseph Medical Center Providence Tarzana Medical Center Ronald Reagan UCLA Medical CenterSan Dimas Community Hospital San Gabriel Valley Medical Center Santa Monica UCLA Medical Center Southern California Hospital at Culver City St. Francis Medical Center St. Vincent Medical Center Torrance Memorial Medical Center USC Kenneth Norris Jr. Cancer Hospital Valley Presbyterian Hospital White Memorial Medical Center Whittier Hospital Medical Center


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Lakeside Medical Organization Santa ClaritaLakeside Medical Organization Tarzana A Medical Group IncLakeside Medical Organization VerdugoLakeside Medical Organization West CovinaLakeside Medical Organization West Valley A Medical Group IncLakewood IPAMaverick Medical Group IncMemorialCare Medical GroupMemorialCare Medical Group Long BeachNuestra Familia Prospect Medical GroupOmnicare Medical GroupPIH Health Physicians Affiliated PhysiciansPIH Health Physicians Medical GroupPioneer Provider Network A Medical Group IncPomona Valley Medical Group Inc DBA PROMED Health NetworkPremier Physician Network Valley DivisionPremier Physicians NetworkPrimecare Medical Group of Chino Valley IncProspect Gateway Medical GroupProspect Genesis HealthcareProspect Health Source Medical GroupProspect Medical Group OrangeProspect Medical Group Van NuysProspect Northwest Orange County Medical GroupProspect Professional Medical Group IPAPrudent Medical GroupRegal Burbank GroupRegal Glendale Physicians Alliance HPNRegal Los AngelesRegal Medical Group NW Orange CountyRegal Pomona ValleyRegal San Fernando ValleyRegal San Gabriel ValleyRegal Ventura CountySeaside Health PlanSeoul Medical Group Integrated Physician ServicesSerra Community Medical ClinicSierra Medical Group HPNSt Jude Affiliated PhysiciansSt Jude Heritage Medical GroupSt Mary IPASt Vincent IPA Medical CorporationSuperior Choice Medical GroupTorrance Health IPAUCLA Medical GroupUCLA Medical Group NorthwestUCLA Medical Group SMBPUpland Medical Group

Madera CountySaint Agnes Medical Group Madera Madera Community Hospital Sante Community Physicians Inc Sante Health System Valley Children's Hospital

Marin CountyBrown & Toland Medical Group Kentfield Hospital

Marin General HospitalNovato Community Hospital

Meritage Medical Network

Mariposa CountyMariposa County Blue Shield of California Administered John C. Fremont Hospital

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Merced CountyAllcare IPA Merced Mercy Medical Center Merced Community Campus

Mercy Medical Center Merced Dominican Campus

Nevada CountySierra Sacramento Blue Shield of California Administered

Sierra Nevada Memorial Hospital Tahoe Forest Hospital

Orange CountyAffiliated Doctors of Orange County Anaheim Global Medical Center Alamitos IPA Anaheim Regional Medical Center Allied Pacific of California IPA Chapman Global Medical Center Altamed Health Services Children's Hospital at Mission AMVI Medical Group Children's Hospital of Orange County Angeles IPA College Hospital Costa Mesa Applecare Medical Group Fountain Valley Regional Hospital & Medical Center Applecare Medical Group Select HealthBridge Children’s Hospital Orange Applecare Medical Group Whittier HealthSouth Tustin Rehabilitation HospitalBrookshire IPA Hoag Hospital Irvine Daehan Prospect Medical Group Hoag Memorial Hospital Presbyterian ECMG United Care Hoag Orthopedic Institute Edinger Medical Group Kindred Hospital Brea Family Choice Medical Group Kindred Hospital Santa Ana GNP Hoag Hospital Kindred Hospital Westminster GNP Long Beach Memorial Los Alamitos Medical Center GNP Orange Coast Memorial Mission Hospital Laguna Beach GNP Saddleback Memorial Mission Hospital Regional Medical Center Harriman Jones Medical Group A Division of Healthcare Partners

Orange Coast Memorial Medical Center Orange County Global Medical Center Placentia-Linda Hospital Saddleback Memorial Medical Center South Coast Global Medical CenterSt. Joseph Hospital Orange St. Jude Medical Center University of California Irvine Medical Center

HCP IPA Arta Health NetworkHCP IPA South CoastHCP Talbert Medical GroupHispanic Physicians IPAHoag Affliated PhysiciansHoag Medical GroupLakewood IPAMemorialCare Medical GroupMemorialCare Medical Group SaddlebackMission Heritage Medical GroupMission Hospital Affliated PhysiciansNoble AMA IPAOrange County Blue Shield of California AdministeredPIH Health Physicians Affiliated PhysiciansProspect Gateway Medical GroupProspect Genesis HealthcareProspect Medical Group OrangeProspect Northwest Orange County Medical GroupProspect Professional Medical Group IPARegal Los AngelesRegal Medical Group NW Orange CountySeaside Health PlanSeoul Medical Group Integrated Physicians ServicesSt Joseph Heritage Medical GroupSt Joseph Hospital Affiliated PhysiciansSt Jude Affiliated PhysiciansSt Jude Heritage Medical GroupSt Mary IPAUC Irvine Health Affiliated PhysiciansUC Irvine Health Medical Group

Placer CountyHill Physicians Sacramento No listingsMercy Medical GroupSierra Sacramento Blue Shield of California Administered


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UC Davis Health SystemUC Davis Health System Auburn

Riverside CountyAlpha Care Medical Group Corona Regional Medical Center Alpha Care Medical Group Region 3 Hemet Valley Desert Regional Medical Center Alpha Care Medical Group Region 4 Low Desert Eisenhower Medical Center Beaver Medical Group EHP Hemet Valley Medical Center Blythe Blue Shield of California Administered John F. Kennedy Memorial Hospital Coachella Valley Physicians Inc Kindred Hospital Riverside Desert Oasis Healthcare Loma Linda University Medical Center Murrieta Empire Physicians Medical Group Menifee Valley Medical Center Hemet Community Medical Group Global Medical Services

Palo Verde Hospital Parkview Community Hospital Medical Center Riverside Community HospitalSan Gorgonio Memorial HospitalSouthwest Healthcare System Murrieta Southwest Healthcare System Wildomar Temecula Valley Hospital

Hemet Community Medical Group MenifeeHemet Community Medical Group TemeculaInland Valleys IPAInland Valleys IPA Coachella ValleyInland Valleys IPA Temecula ValleyLakeside Medical Group San BernardinoPrimecare of Citrus ValleyPrimecare of Corona IncPrimecare of Hemet Valley IncPrimecare of Moreno Valley IncPrimecare of Riverside IncPrimecare of Sun City IncPrimecare of Temecula IncProspect Health CoronaRady Children’s Health NetworkRegal Medical Group Temecula ValleyRegal RiversideRegal San BernardinoRiverside Medical ClinicRiverside Physician NetworkSharp Community Medical Group Graybill TemeculaSt Joseph Hospital Affliated PhysiciansUpland Medical GroupValley Physicians Network IncVantage IPA Riverside

Sacramento CountyHill Physicians Sacramento Mercy General Hospital Mercy Medical Group Mercy Hospital of Folsom Sierra Sacramento Blue Shield of California Administered

Mercy San Juan Hospital

UC Davis Health System Methodist Hospital of Sacramento UC Davis Health System Auburn Shriners Hospitals for Children Northern California Woodland Medical Group UC Davis Medical Center

Vibra Hospital of SacramentoSan Bernardino County

Alliance Desert Physicians EHP Arrowhead Regional Medical CenterAllied Pacific of California IPA Barstow Community Hospital Alpha Care Medical Group Bear Valley Community Hospital Beaver Medical Group EHP Colorado River Medical Center Chaffey Medical Group EHP Desert Valley Hospital Choice Med Group Apple Valley Hi-Desert Medical Center Choice Medical Group Barstow Kindred Hospital Ontario Citrus Valley Physicians Group Kindred Hospital Rancho Desert Oasis Healthcare Loma Linda University Medical CenterDesert Valley Medical Group Mountains Community Hospital Dignity Health Medical Group Inland Empire Redlands Community Hospital Heritage Victor Valley Medical Group San Antonio Community Hospital Hispanic Physicians IPA St. Bernardine Medical CenterInland Valleys IPA St. Mary Regional Medical Center Lakeside Medical Organization San Bernardino Victor Valley Global Medical CenterLakeside Medical Organization West Covina

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My Family Medical GroupPinnacle Medical Group EHPPomona Valley Medical Group Inc DBA ProMed Health NetworkPremier Healthcare IPAPrimecare Med Group of Chino Valley IncPrimecare of Inland Valley IncPrimecare of Redlands IncPrimecare of San Bernardino IncRedlands Yucaipa Medical GroupRegal Medical Group NW Orange CountyRegal Pomona ValleyRegal RiversideRegal San BernardinoSan Bernardino Medical GroupSt Mary High Desert Medical GroupUpland Medical GroupVantage IPA RiversideVantage IPA San Bernardino

San Diego CountyEncompass Medical Group Alvarado Hospital Medical Center Greater Tri Cities IPA Grossmont Hospital Mercy Physicians Medical Group Kindred Hospital San Diego Mid County Physicians Medical Group Palomar Health Downtown Campus Multicultural Primary Care Medical Group Palomar Medical Center Primary Care Associates Medical Group Inc Paradise Valley Hospital Rady Children’s Health Network Pomerado Hospital Regal Medical Group Temecula Valley Rady Children's Hospital San Diego Scripps Clinic Medical Group Scripps Green Hospital Scripps Physicians Medical Group Scripps Memorial Hospital Sharp Community Inland North Scripps Memorial Hospital Encinitas Sharp Community Medical Group Chula Vista Scripps Mercy Hospital Sharp Community Medical Group Graybill Escondido Fallbrook

Scripps Mercy Hospital Chula Vista Sharp Chula Vista Medical Center Sharp Coronado Hospital and Healthcare Center Sharp Mary Birch Hospital for Women & Newborns Sharp McDonald CenterSharp Memorial Hospital Tri-City Medical CenterUCSD La Jolla John Sally ThorntonUCSD Medical Center Vibra Hospital of San Diego

Sharp Community Medical Group GrossmontSharp Community Medical Group San DiegoSharp Rees StealySHPS Scripps Coastal Medical Center

San Francisco CountyBrown & Toland Medical Group Chinese Hospital Chinese Community Healthcare Associates Medical Center at UCSFHill Physicians San Francisco Inc St. Francis Memorial Hospital

St. Mary's Medical Center San Francisco UCSF Medical Center at Mission Bay UCSF Medical Center at Mount Zion

San Joaquin CountyAllcare IPA Dameron Hospital Association Hill Physicians San Joaquin Doctors Hospital of Manteca

Lodi Memorial Hospital St. Joseph's Medical Center of Stockton

San Luis Obispo CountyCoastal Communities Provider Network French Hospital Medical Center Physician Choice Medical Group of San Luis Obispo Marian Regional Medical Center Arroyo Grande

Sierra Vista Regional Medical Center Twin Cities Community Hospital

San Mateo CountyAffinity Medical Group South Bay Menlo Park Surgical Hospital Brown & Toland Medical Group Mills Health Center Hill Physicians San Francisco Inc Mills-Peninsula Medical Center


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Palo Alto Medical Foundation Sequoia Hospital PAMF Mills Peninsula Division Seton Coastside San Mateo Blue Shield of California Administered Seton Medical Center Sequoia Physicians Network

Santa Barbara CountyNorth Santa Barbara Blue Shield of California Administered Goleta Valley Cottage HospitalSansum Clinic Central Lompoc Valley Medical Center Sansum Clinic South Marian Regional Medical Center Santa Barbara Select IPA Medical Group Inc Santa Barbara Cottage Hospital

Santa Ynez Valley Cottage HospitalSanta Clara County

Affinity Medical Group South Bay El Camino Hospital DCHS Medical Foundation El Camino Hospital Los Gatos Palo Alto Medical Foundation Good Samaritan Hospital Palo Alto Medical Foundation Camino Lucile Packard Children's Hospital Physicians Medical Group San Jose Mission Oaks Hospital Santa Clara County IPA O'Connor Hospital

Regional Medical Center of San Jose Saint Louise Regional Hospital Stanford Health Care

Santa Cruz CountyPalo Alto Medical Foundation Santa Cruz Dominican Hospital Santa Cruz Physicians Medical Group of Santa Cruz Sutter Maternity & Surgery Center of Santa Cruz

Watsonville Community HospitalSolano County

Hill Physicians Medical Group Solano Sutter Solano Medical CenterJohn Muir Physician NetworkNorthbay Healthcare Group

Sonoma CountyMeritage Medical Network Healdsburg District Hospital Sonoma County Blue Shield of California Administered Petaluma Valley Hospital

Santa Rosa Memorial Hospital Sonoma Valley Hospital

Stanislaus CountyAllcare IPA Central Valley Specialty Hospital

Doctors Medical Center Emanuel Medical Center Oak Valley District Hospital Stanislaus Surgical Hospital

Tulare CountyKey Medical Group Kaweah Delta District Hospital Sante Community Physicians Inc Sante Health System Sierra View District Hospital

Tulare Regional Medical Center Ventura County

Lakeside Medical Organization Simi Valley Community Memorial Hospital of San Buenaventura Lakeside Medical Organization Thousand Oaks Ojai Valley Community Hospital Regal Ventura County Santa Paula Hospital Seaview IPA Simi Valley Hospital and Health Care ServicesUCLA Medical Group Northwest St. John's Pleasant Valley Hospital Valley Care IPA Valley Care Select IPA

St. John's Regional Medical Center – Mercy Healthcare VenturaVentura County Medical Center

Yolo CountyHill Physicians Sacramento Woodland Memorial Hospital UC Davis Health SystemWoodland Clinic

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Documents

A50230-CALPERS 8-17 CalPERSOEBrochuremrktoa.blueshieldca.com/rs/417-JXY-489/images/A50230-CALPERS_… · For new prescriptions, please allow 10 to 14 days to receive your covered