Access+ HMO Welcome brochure. Important HMO resources. Phone numbers: Websites: Other useful phone numbers:

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1 Important HMO resources Access+ HMO 2017 Welcome brochure How to make the most of your benefits Phone numbers: Shield Concierge... (800) NurseHelp 24/7... (877) LifeReferrals 24/7... (800) Teladoc (24/7 physician services)... (800) CVS Caremark Mail Service Pharmacy...(866) Coverage when you travel... (800) Away From Home Care...(800) Condition management programs...(866) Alternative Care Discount Program...(888) Mental health services... (866) Websites: CalPERS member website...blueshieldca.com/calpers Find a Doctor... blueshieldca.com/fap Member Overview... register at blueshieldca.com Teladoc (24/7 physician services)... teladoc.com/bsc Urgent care center locator... blueshieldca.com/urgent CVS Caremark Mail Service Pharmacy... caremark.com Daily Challenge... blueshieldca.com/wellvolution Health & Wellness resources (including discount programs)...blueshieldca.com/hw Other useful phone numbers: My physician My specialist My dentist My pharmacy Urgent care center

2 Questions to ask your doctor Knowing more about your health status can help you reduce your risk of health problems and better manage any conditions you might have. Use this card to help you get the most out of visits with your doctor. 1. What are my numbers and what do they mean? 2. What should my targets be, and how do I improve my results? When should they be rechecked? 3. Given my family medical history, what health screenings are recommended? 4. What do my symptoms mean? 5. Are there any tests that I need? 6. Can I make any lifestyle changes that might help my condition? 7. Are there treatments that you would recommend? 8. Is there a generic version available for any medications I need to take? 9. How will these medications interact with other medicines and supplements I am taking, and are there possible side effects? 10. When should I come back for my next checkup? Notes for your doctor Use this space to write down any other questions so they are handy for your next appointment.

3 Welcome, CalPERS member! Thank you for choosing Blue Shield of California s Access+ HMO plan. We encourage you to read your Evidence of Coverage and Disclosure Form (EOC&D), which contains all the details of your health plan. We ve also created this handy brochure to make it easier for you to learn about all the programs, services and resources now available to you, along with the relevant links and phone numbers you ll need to access each. Here s what you can find on the following pages: Convenient reference card... Inside front cover Start here Benefit summary Medical benefit highlights Pharmacy benefits Programs and resources Smart discounts Endnotes Access+ HMO service area...22

4 Start here Your Personal Physician blueshieldca.com Now that you re a Blue Shield HMO member, you have access to a large network of doctors. When you enrolled in the Access+ HMO plan, you may have selected, or Blue Shield may have assigned you and each of your enrolled dependents, a primary care physician. At Blue Shield, we call them Personal Physicians. Except for emergency services, your Personal Physician will provide or coordinate all of your medical care. You can change your Personal Physician unless you are in the hospital or in your third trimester of pregnancy. If you change your Personal Physician, your new doctor will be effective on the first day of the following month. You and your covered dependents also have the option to choose different Personal Physicians and medical groups. There are two ways to change your Personal Physician. Once you have received your new Blue Shield member ID card, you can make the change online by registering at blueshieldca.com. On the Member Overview page, choose Change Personal Physician or Medical Group. (Effective February 1, 2017: On the Dashboard, click Manage Health Team. Then click Change PCP.) Subscribers with family can request access to their family members plan and update their Personal Physicians as well. You can also change your Personal Physician by calling Shield Concierge, our dedicated customer service team for CalPERS members, at (800) , 7 a.m. to 8 p.m., seven days a week. To locate a new Personal Physician, you can use our Find a Doctor tool. Simply log in to blueshieldca.com and select Find a Doctor at the top of the page. Then select Primary Care Physician, enter your ZIP code and click Find now. If you don t have access to the internet or would like personal assistance, contact Shield Concierge at (800) We realize how important it is to find the right doctor for you and your family, so we re happy to recommend these trustworthy resources: The American Medical Association s website at for information about the qualifications of doctors. The DocFinder feature at to access information from state government licensing boards. The Blue Shield provider profiles to obtain performance information that rates medical groups, hospitals and physicians on medical care, patient satisfaction and affordability. You can view the provider performance profiles through Find a Doctor at blueshieldca.com. 2

5 Your health plan at your fingertips blueshieldca.com As soon as you receive your member ID card, please take a few minutes to register at blueshieldca.com. Once registered as a member, you will be able to manage your plan online, from changing your doctor to reviewing your plan s details and getting a temporary ID card. The site offers many features that allow you to easily: View your plan s benefits and coverage or claims history Change your Personal Physician or find a new provider Print a temporary member ID card Find doctors, hospitals and other facilities in your area Check drug coverage Confirm coverage effective dates for you and your family members Shield Concierge with questions regarding claims, benefits, technical issues, etc. Shield keeps you connected blueshieldca.com/calpers By registering at blueshieldca.com, you ll automatically receive our updates, which will keep you current on your plan benefits and services. It s a great way to be reminded of the health and wellness programs that are available to you as a member all at no extra cost to you! Shield Concierge (800) We ve made your plan even easier to use with Shield Concierge, a personalized customer service experience. With just one call, you have access to one-on-one support from our team of healthcare experts, such as: Customer service representatives who can answer your questions about plan coverage, doctor selection, claims, ID cards, pre-authorizations and referrals Registered nurses who can monitor your condition, case or illness, answer health-related questions and consult on medical issues and symptoms Pharmacists who can answer your questions relating to medications, side effects, drug safety, costs and treatment options Health coaches who can help you with disease prevention, nutrition, weight management, stress reduction and general lifestyle health Social workers who can help connect you with community resources Shield Concierge is available seven days a week, from 7 a.m. to 8 p.m. Start here 3

6 Benefit summary Access+ HMO plan benefit summary Calendar-year deductible Member Family Physician services Preventive health exam Gynecological Pregnancy and maternity care; prenatal/postnatal office visits Well-baby care Immunization/inoculation Allergy testing/treatment Office/home visits Teladoc video or phone consultation Urgent care Infertility testing and treatment Physician inpatient hospital visits Surgery/anesthesia Chiropractic and acupuncture services (Combined maximum of 20 visits per year) Access+ Specialist 1 self-referral to specialists Hospital services Inpatient Outpatient Ambulatory surgery centers Transgender surgical services Ambulance services Emergency care no copayment if hospitalized or kept for observation Diagnostic X-ray/lab Skilled nursing facility up to 100 days per calendar year Hospice Mental health/substance abuse Inpatient Outpatient None None $15/visit $5/session $15/visit 50% of allowable amount $15/visit $30/visit $50/visit $15/visit 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 EOC&D. Or you can contact Shield Concierge at (800) if you prefer a paper copy. 4

7 Prescriptions 2 Prescriptions for non-maintenance drugs and for the first three fills of maintenance drugs from a retail pharmacy (up to a 30-day supply) 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) Prescriptions for specialty drugs (up to a 30-day supply) $30 Prescription drugs to treat sexual dysfunction Maximum annual out-of-pocket payments for $1,000 mail-service prescription drugs 4 Flu vaccine from network retail pharmacies Vision care Eye refraction to determine need for corrective lenses: This service is limited to one visit per calendar year for members age 18 and older; no limit on number of visits for members under age 18. Eyeglasses not covered, except for those that are necessary after cataract surgery Hearing-aid services Evaluation Hearing aid up to a maximum of $1,000 per member, every 36 months, for the hearing-aid instrument and ancillary equipment for both ears Durable medical equipment, including orthoses and prostheses Physical/occupational/speech therapy Inpatient visits at a hospital or skilled nursing facility Outpatient and home visits Calendar-year out-of-pocket maximums Member: $7,150 Medical: $1,500 maximum Pharmacy: $5,650 maximum $5 generic drugs $20 formulary brand-name drugs $50 non-formulary brand-name drugs $10 generic drugs $40 formulary brand-name drugs $100 non-formulary brand-name drugs $10 generic drugs $40 formulary brand-name drugs $100 non-formulary brand-name drugs $10 generic drugs $40 formulary brand-name drugs $100 non-formulary brand-name drugs 50% of the cost of the drug 20% discount available 5 Charges in excess of $1,000 $15/visit Family: $14,300 Medical: $3,000 maximum Pharmacy: $11,300 pharmacy maximum * Prescriptions for maintenance drugs (up to a 90-day supply) can be obtained at Costco, CVS and Safeway/Vons retail pharmacies. Includes the $1,000 maximum annual out-of-pocket payments for mail-service formulary prescription drugs per member. Benefit summary 5

8 Medical benefit highlights Acupuncture and chiropractic benefit You are covered for the following acupuncture and chiropractic services: Acupuncture evaluation and treatment by a licensed acupuncturist Chiropractic exam and treatment from a Doctor of Chiropractic Copayment: $15 per visit. Covered up to a combined maximum of 20 visits per calendar year. These benefits are offered through an arrangement with American Specialty Health Group, Inc. (ASH). To find a network provider, visit blueshieldca.com/ash and choose from the drop-down menu, or call ASH at (800) Away From Home Care program You and your family can stay covered with HMO benefits for extended periods with the Away From Home Care program. 6 Students, long-term travelers and families living apart can rely on access to health care across the country. Away From Home Care is available in the following 31 states plus the District of Columbia. HMO benefits vary by state. Call (800) for more information about coverage. Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico New York North Carolina Ohio Oklahoma Pennsylvania Texas Virginia Wisconsin Flu vaccine You may receive your flu vaccine at a participating retail pharmacy at no charge. You also have the option to continue receiving the flu vaccine at your doctor s office. You can find a pharmacy by visiting the Plans and Benefits section of our website at blueshieldca.com/calpers and clicking on Pharmacy Benefits, then Pharmacy Resources. No prescription is required. Simply show your Blue Shield ID card at the pharmacy. To learn more about this benefit, please call Shield Concierge at (800)

9 Network hospitals As a CalPERS member, you have a large network of hospitals available to you. To minimize your out-of-pocket costs, it is important to verify coverage when choosing a facility for non-emergency care. To identify a facility that is in your network, you can log in to blueshieldca.com/calpers and click on the Plans and Benefits tab, or call Shield Concierge at (800) Urgent care options When you are injured or not feeling well, but it s not an emergency, visiting a local urgent care center or calling Teladoc are both great alternatives to the emergency room (ER). While the average wait time at a California ER is four hours and 34 minutes, your wait at an urgent care center is usually less than an hour.* With Teladoc, the average time to speak with a doctor is 10 minutes. And, with lower copayments than ER visits, both Teladoc and urgent care centers offer you quality care at a lower out-of-pocket cost for non-emergency conditions. If you are having a medical emergency, always call 911 or go to the nearest ER. However, if you are not sure whether your condition needs to be seen in an ER versus an urgent care center, call your doctor s office for instructions. As a Blue Shield HMO member, you must always call your doctor s office before you seek care at an urgent care center, and follow the instructions they give you. Also, you need to receive care at an urgent care center that is affiliated with your doctor s medical group or IPA in order for your Blue Shield HMO plan to cover the services you receive. Urgent care centers routinely treat many conditions, including the following: Cough, sore throat, respiratory infections Earaches Back pain, body aches Burning with urination Colds, sinus infections, allergies Eye irritation, swelling or pain Muscle strains Rashes, minor cuts, scrapes, wounds Nausea, vomiting, diarrhea Animal bites Migraines To find the urgent care center nearest you, visit blueshieldca.com/urgent or call Shield Concierge at (800) , from 7 a.m. to 8 p.m., seven days a week. For more information about Teladoc, please see page 12 of this brochure or visit blueshieldca.com/calpers and select Plans and Benefits, Programs and Services and then Teladoc. * 2010 Emergency Department Pulse Report from American College of Emergency Physicians and Press Ganey. Medical benefit highlights 7

10 Pharmacy benefits In addition to offering a large pharmacy network that includes all national chains, we feature a convenient mail service pharmacy. Filling your prescription at a local pharmacy You can locate a network pharmacy by calling Shield Concierge at (800) or by visiting the Plans and Benefits section of our website at blueshieldca.com/ calpers and clicking on the Pharmacy Benefits tab, then Pharmacy Resources. Retail prescription drugs Up to a 30-day supply of nonmaintenance drugs and the first three fills of maintenance drugs* Generic Formulary brand-name Non-formulary brand-name $5 $20 $50 Up to a 30-day supply of maintenance drugs after the first three fills 3 $10 $40 $100 Up to a 90-day supply of maintenance drugs from a select retail pharmacy $10 $40 $100 Filling your prescription through the mail service pharmacy Blue Shield provides access to mail service prescriptions through CVS Caremark Mail Service Pharmacy, which offers you the convenience of receiving up to a 90- day supply of covered maintenance drugs* delivered to your home or office, with no charge for shipping. 7 This also offers you savings, as you will pay only one-third of the retail pharmacy copayment for the same amount of covered maintenance drugs. Prescription copays for maintenance drugs (up to a 90-day supply) Generic Formulary brand-name Non-formulary brand-name $10 $40 $100 Note: If a brand-name drug is chosen when there are FDA-approved generic equivalents available, the cost difference between the brand-name drug and the generic equivalent drug, plus a generic copay, will apply. Prescription drugs to treat sexual dysfunction are 50% of the cost of the drug. Copayments for non-formulary brand-name drugs and drugs to treat sexual dysfunction do not accumulate toward the annual $1,000 mail-service out-of-pocket maximum. * Maintenance drugs are those 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. For a list of covered maintenance medications, please visit the Plans and Benefits section of our website at blueshieldca.com/calpers and click on the Pharmacy Benefits tab. Prescriptions for maintenance drugs (up to a 90-day supply) can be obtained at Costco, CVS and Safeway/Vons retail pharmacies. 8

11 Getting started Step 1: Register with CVS Caremark Mail Service Pharmacy To receive covered medications from CVS Caremark, you must first register and provide basic information such as your name, shipping address, payment method and drug allergies. Instructions for each registration method are listed below: Online Register online at By phone Call CVS Caremark at (866) , 24 hours a day, seven days a week. Note: If you use TTY equipment, you can order forms by calling 711. By mail Print and complete the CVS Caremark mail order form by going to clicking on Be Well, then Drugs, and selecting Mail Service Prescriptions. Step 2: Send your prescription to CVS Caremark Once you are registered, CVS Caremark will need your prescription. This can be sent electronically, or by phone, fax or mail: Electronically Ask your doctor to send an electronic prescription for a 90-day supply to CVS Caremark. This is called e-prescribing and is the simplest way to send a prescription. By phone or fax Request your doctor to submit your prescription for a 90-day supply by phone or fax to CVS Caremark. CVS Caremark MD Phone line: (800) CVS Caremark MD fax line: (800) By Mail Mail your prescription, completed order form, and payment to: CVS Caremark Mail Service Pharmacy PO Box San Antonio, TX Step 3: Receive your prescription from CVS Caremark Please allow 10 to 14 business days to receive your covered maintenance medications through CVS Caremark. Once your prescription is on file at CVS Caremark, please allow five to eight business days to receive refills of your covered medications. Pharmacy benefits 9

12 Pharmacy benefits continued Refilling your mail service prescriptions Online: Refill a prescription on the Internet by going to click on Be Well, then Drugs, and select Mail Service Prescriptions. If you are accessing the site for the first time, you will be prompted to register. By phone: Call (866) and follow the telephone prompts for the automated reorder system. Members using TTY equipment can order refills by calling 711. By mail: Complete the CVS Caremark Refill Order form included in your last medication shipment and mail to CVS Caremark at: CVS Caremark Mail Service Pharmacy PO Box San Antonio, TX Specialty drugs Specialty drugs are covered on the specialty tier (Tier 4) in Blue Shield s Plus Drug Formulary, and can be filled through our contracted network specialty pharmacy, CVS Specialty. CVS Specialty Customer Care Phone: (800) ; Monday - Friday, 6:30am - 8:00pm CST Fax: (800) Prescriptions for specialty drugs are available for up to a 30-day supply, with a copayment of $30. A complete list of specialty drugs is available at blueshieldca.com/calpers. Click on the Plans and Benefits tab, select Pharmacy Benefits, then Pharmacy Resources and select the Plus Drug Formulary link. 10

13 About our drug formulary The Blue Shield Plus Drug Formulary is a list of commonly prescribed medications that are approved by the Food and Drug Administration (FDA) and are eligible for coverage under the Blue Shield outpatient prescription drug benefit. You can help lower your out-of-pocket prescription drug costs by requesting generic and formulary brand-name medications when you see your doctor since these medications are usually covered at a lower copayment than non-formulary drugs. To see our drug formulary, visit blueshieldca.com/calpers. Click on the Plans and Benefits tab, select Pharmacy Benefits, then Pharmacy Resources, and select the Plus Drug Formulary link. Save with generic drugs In general, using generic drugs instead of brand-name drugs is one of the easiest ways you can reduce your out-of-pocket prescription drug costs, as generic drugs typically cost less than brand-name drugs. Ask your doctor to prescribe generic medication when it s right for you, or ask your pharmacist to fill your prescription with a generic version whenever possible. Out-of-pocket expenses Your maximum annual out-of-pocket payments for pharmacy expenses is $7,150 for an individual and $14,300 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. (Nonformulary brand-name drugs and drugs to treat sexual dysfunction do not accumulate toward this mail-service out-of-pocket maximum.) Pharmacy benefits 11

14 Programs and resources Additional care options Self-refer to a specialist (800) As an Access+ HMO member, you can use Access+ Specialist SM to refer yourself to a participating specialist in the same medical group as your Personal Physician for a fixed office copayment of $30 per visit. 1 Call your Personal Physician s office and ask if your doctor belongs to an IPA/medical group that offers the Access+ Specialist option. Or you can check the inside of your ID card to see if there is an A+ next to the name of your medical group. For more information, please consult your Evidence of Coverage and Disclosure Form online at blueshieldca.com/calpers or call Shield Concierge at (800) Second opinion (800) If you have any questions about your diagnosis, plan of care or recommended treatment, you can request a second opinion from any contracted Blue Shield of California physician in the state. Call Shield Concierge at (800) to arrange for a second opinion. Teladoc (800) TELADOC As a CalPERS Blue Shield member, you have 24/7/365 care available to you when your physician is not available. Teladoc s network of board-certified physicians and pediatricians can treat non-emergency medical issues, and when medically appropriate, may also write short-term prescriptions. There is a $5 copay for a Teladoc phone or video consultation, which can be paid with a debit or credit card. To use the service, simply complete a medical history data form just like you would when visiting a physician for the first time. You can set up your account and complete your medical history form at or by calling (800) TELADOC or (800) Chiropractic and acupuncture services (800) You can visit any participating chiropractor or acupuncturist in the American Specialty Health Group, Inc. (ASH) network without a referral from your Personal Physician. There is a $15 copay per visit and a combined maximum of 20 visits per year. To find a network provider, go to blueshieldca.com/ash. 12

15 NurseHelp 24/7 (877) We have nurses available around the clock. You can talk to a registered nurse anytime and receive a recommendation of where and when to seek care based on the symptoms you are experiencing. Nurses also provide reliable information about illnesses and injuries, chronic conditions, medical tests, medications and preventive care. NurseHelp 24/7 SM services are confidential and available through our toll-free phone number or online chat. Log in to blueshieldca.com and click on Expert Help and NurseHelp 24/7 from the Help & Support menu or through our mobile app. LifeReferrals 24/7 (800) With our LifeReferrals 24/7 SM service, you have access to support and advice from experienced professionals in all areas of life, including child and elder care, marriage and relationships, career and lifelong learning, and financial and legal issues. Face-to-face personal counseling sessions are also available. Covered when you travel (800) You can receive emergency and urgent care from doctors and hospitals while on vacation or traveling for business anywhere in the world. And, if you use 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. Providers in more than 200 countries belong to the BlueCard Worldwide Network, while 92% of physicians and 96% of hospitals in the United States belong to BlueCard s national network. Wherever you are, if you need to see a doctor, simply call Blue Shield s Shield Concierge number collect and you will be referred to the nearest urgent care facility. Of course, you should always call 911 or seek care at the nearest medical facility if you believe you have a medical condition that requires an emergency response. Away From Home Care (800) You and your family can stay covered with HMO benefits for extended periods with the Away From Home Care program. 6 Students, long-term travelers and families living apart can rely on access to health care across the country. Away From Home Care is available in 31 states, plus the District of Columbia, and benefits vary by state. For more information about coverage, call (800) Programs and resources 13

16 Programs and resources continued Health and wellness programs blueshieldca.com/calpers Wellvolution Making the time to take care of yourself can be difficult. Wellvolution makes it easier. Based on the latest research and best practices, these programs offer healthy encouragement, realistic goals and enjoyable social connections. Walkadoo Walkadoo is a fun, easy-to-use walking program. Each morning, you receive a daily step goal via or SMS that is based on your activity level. Wear your wireless pedometer, track your steps and earn points to be eligible for cash drawings in 2017! QuitNet Based on the latest science and best practices, QuitNet integrates many intervention modalities. Participants in this smoking cessation program can choose from methods including online and mobile support from experts and peers, personalized s and SMS text support. Daily Challenge With Daily Challenge, small actions add up to big changes over time, especially when you do them with friends. Each day you receive a message with one simple activity to complete and a reason why it will help to improve your wellbeing. Complete the challenge, share how you did it and improve your health one day at a time. Well-Being Assessment Measures your productivity, overall outlook, emotional and physical health, healthy behaviors, work environment and access to health/life resources so you know what areas need attention. To register for any of the Wellvolution programs, visit mywellvolution.com. To find out more about the programs before registering, visit blueshieldca.com/calpers and click on the Plans and Benefits tab, followed by Programs and Services and then Wellvolution. Shield Support (877) Our comprehensive, integrated care management program includes an experienced care team of registered nurses, clinical social workers, dietitians, physicians and pharmacists to help you navigate the healthcare system and provide support to help you recover, live better with illness and develop skills to manage your condition. To apply for the Shield Support program, call us at (877)

17 Condition management programs (866) Our condition management programs offers support by showing you how to take an active role in managing your chronic condition. The programs include one-on-one nurse coaching, in-person community workshops (where available), online workshops with interactive discussion boards and self-paced toolkits. These programs provide support for members with: Asthma Diabetes Heart failure Coronary artery disease (CAD) Chronic obstructive pulmonary disease (COPD) Musculoskeletal conditions To apply for a condition management program, call (866) Prenatal Program (888) We want you and your baby to be healthy. Our Prenatal Program offers support while you are trying to get pregnant and throughout your pregnancy. You ll receive 24/7 maternity nurse support as well as learn what to expect when planning a pregnancy and while you re pregnant, ways to be healthier after the baby is born and more. You ll receive educational mailings that include preconception information, nutrition guidance, your choice of a top-rated pregnancy or parenting book, a prenatal planner and access to free text-message reminders, as well as other materials that offer practical advice and helpful tips. A nurse will call you to provide ongoing pregnancy assessments and support, and those needing extra support will get personalized, ongoing coaching. To apply for the Prenatal Program, call us at (888) Diabetes Prevention Program (800) Our Diabetes Prevention Program is compliant with the U.S. Centers for Disease Control and Prevention (CDC) standards for members with prediabetes, a condition that occurs when blood glucose (sugar) levels are higher than normal, but not high enough to be diagnosed as diabetes. Many people with prediabetes will develop diabetes unless they take action. The program is conducted in person, online or a combination of both. It lasts for 12 months, with 16 sessions during the first six months, followed by at least one session per month for the next six months. The in-person option features one-onone meetings with a trained lifestyle coach. For more information, visit blueshieldca.com/calpers or call (800) Programs and resources 15

18 Programs and resources continued Other services and resources A site dedicated to CalPERS blueshieldca.com/calpers At our dedicated site for CalPERS members, you can find information and tools that can answer your questions and help you get the most from your benefits. We also provide you with hundreds of useful tips, such as: Finding the right provider Learning which types of health care work best Improving your odds for a healthy back Pharmacy tools Preventing illness with screenings Knowing what to ask the doctor at your kids next checkup Understanding what to do before, during and after an appointment blueshieldca.com In the Pharmacy Benefits and Claims sections of blueshieldca.com, you can view and access the following information: Claim History, which displays up to 24 months of claim history information Drug Pricing, which lets you compare drug prices Coverage Limits and Payment Details, which tracks each pharmacy claim Drug Information, which covers conditions, drug side effects and drug interactions Pharmacy Locator, which allows you to search for pharmacies within your network Blue Shield mobile As a member, you can access key health plan and healthcare services information while on the go by downloading the Blue Shield of California app from the App Store SM or Google Play ṬM Our mobile features allow convenient access to important plan and benefits information such as copays, your member ID card, or turn-by-turn directions from your current location to the closest emergency room or urgent care center. No matter how you choose to access Blue Shield on your computer, tablet or smartphone you can use the same user-name and password. Social media support Follow our Facebook (at Blue Shield of California), Twitter (@BlueShieldCA), and Instagram (@BlueShieldofCA) for healthy tips, daily inspiration, member information and support. It s not just an easy way to stay connected, you ll also discover healthy recipes, fitness recommendations and great ways to get outdoors as a Californian. And, if you have questions about your Blue Shield plan, programs or services, our Social Customer Service team on Twitter (@TeamShieldBSC) is ready to help. 16

19 Reach your doctor online blueshieldca.com/hw Communicate with your doctor through Patient Ally, an easy-to-use, secure web-based tool. Call your Personal Physician s office and ask if your doctor participates before using the service. To learn more, visit blueshieldca.com/hw, select Professional Help and then Reach Your Doctor Online. Health library blueshieldca.com/hw Here you ll find a comprehensive selection of information collected in one place. We ve compiled thousands of topics and interactive tools to help you take a more active role in your health. Research a specific health topic or condition, or learn about complimentary treatments and how the body holistically interacts with itself. Topics include: Fitness and exercise Healthy weight Common health conditions Healthy eating Alternative health Disease and injury prevention To access this wealth of information, visit blueshieldca.com/hw and select Health Library. Preventive health guidelines blueshieldca.com/hw Our preventive health guidelines for men, women, children and seniors give you health recommendations by age, including preventive health screenings, immunizations and more. We put it all together in an easy-to-read and easy-to-print format. So all you have to do is point, click and print. Visit blueshieldca.com/hw and select either Women s health, Men s health, Children s health, or Seniors health. Drug interaction checker blueshieldca.com/calpers Check for interactions among your prescription drugs, over-the-counter medications, dietary supplements and herbal products. Visit blueshieldca.com/ calpers. Click on the Plans and Benefits tab, select Pharmacy Benefits, then Pharmacy Resources, and then select the link Drug Interactions. Symptom checker blueshieldca.com/hw With this interactive tool, you will be guided through a series of questions and given a treatment recommendation based on the urgency of the symptom. Selfcare information is included to help explain how to treat the condition at home, when appropriate, and to prevent a future occurrence. Visit blueshieldca.com/ hw, select Tools and then Symptom Checker. Hearing and visual resources blueshieldca.com/hw You have access to resources and lists of groups that offer guides and assistance for people with hearing and visual impairments. Visit blueshieldca.com/hw, click on Professional Help, and then Hearing and Visual Resources. Programs and resources 17

20 Smart discounts Alternative Care Discount Program blueshieldca.com/hw or (888) Relax and save on alternative healthcare services from practitioners participating with American Specialty Health Group, Inc. 5 To find a participating provider, visit blueshieldca.com/hw, select Professional Help and Wellness Discount Programs and then click on the Alternative Care link or call (888) 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 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 the Amazon online store. These include: Beauty and personal Fitness and activity Food supplements Health books and videos Herbs and botanicals Pilates, yoga and tai chi Relaxation resources Sports nutrition Vitamins and minerals 18

21 Weight Watchers Save while you lose those extra pounds and keep them off, with these special offers: Online savings Special rates on three- and 12-month subscriptions blueshieldca.com/hw Monthly pass Special rates for unlimited local meetings each month, plus free etools To receive your discounts, go to blueshieldca.com/hw and select Professional Help, Wellness Discount Programs and then View program details under Weight Watchers. 24 Hour Fitness blueshieldca.com/hw Now it is easier to get in shape and stay fit with discounted initiation fees and monthly dues. To receive your discounts, go to blueshieldca.com/hw, select Professional Help, Wellness Discount Programs and then View program details under 24 Hour Fitness. ClubSport and Renaissance ClubSport blueshieldca.com/hw You have two options for saving on membership dues and fees when selecting ClubSport or Renaissance ClubSport for gym memberships: 60% discount on enrollments when joining with 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 ClubSport or Renaissance ClubSport membership includes: Two complimentary personal training sessions for each new member (a $150 value) MicroFit testing and goal setting Nutritional support online Free wellness seminars Hundreds of free in-club programs included in monthly dues Three hours of complimentary child care with a family membership To receive your discounts, go to blueshieldca.com/hw, select Professional Help, Wellness Discount Programs and then Get fit with ClubSport or Get fit with Renaissance ClubSport under ClubSport and Renaissance ClubSport. Smart discounts 19

22 Smart discounts continued Discount Vision Program network blueshieldca.com As part of our wellness discount program, members have access to participating providers in the Discount Vision Program network 5 and can get a 20% discount off the following products and services: Routine eye examinations Extra pair of glasses Frames and lenses Photochromic lenses Tints and coatings Non-prescription sunglasses Contact lenses (except disposable extended wear or replacement) To find a participating discount provider: Visit Find a Doctor at blueshieldca.com. Click on Select a Plan. Choose Discount Vision Providers (no plan needed) from the Vision care plan field and click Set plan. Select Vision care under Provider types. Enter your location information under located near and click Find now. Save, download, or print your search results. LASIK discount program LASIK 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 A 20% discount through the QualSight provider network in California and nationwide Discounted online eyewear MESVisionOptics.com Members receive competitive prices on many contact lens brands as well as a selection of sunglasses, readers and eyecare accessories. 8 Free shipping is available for all orders over $50. 20

23 Endnotes 1 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-name drug is chosen when there are FDA-approved generic equivalents available, then the cost difference between the brand-name 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 (Costco, CVS and Safeway/Vons). 4 Non-formulary brand-name drugs and drugs to treat sexual dysfunction do not accumulate toward the annual $1,000 mail-service out-of-pocket maximum. 5 These discount program services are not covered benefits 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. Members who are not satisfied with products or services received from the discount program may use Blue Shield s grievance process described in the Grievance Process section of the Evidence of Coverage. 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 provided by American Specialty Health Group, Inc. (ASH Group) Discount Vision Program and MESVisionOptics.com MESVision Weight control Weight Watchers North America Fitness facilities 24 Hour Fitness, ClubSport and Renaissance ClubSport LASIK QualSight, Inc. and NVISION Laser Eye Centers The Discount Vision Program network is currently available in Arizona, California, Colorado, Idaho, Nevada, Oregon, Texas, Utah and Washington. 6 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) 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. 8 Requires a prescription from your doctor or licensed optical professional. Daily Challenge, QuitNet and Walkadoo are registered trademarks of MYH, Inc. Wellvolution is a registered trademark of Blue Shield of California. App Store is a service mark of Apple Inc. Google Play is a trademark of Google Inc. Endnotes 21

24 Access+ HMO service area The Access+ HMO plan is offered in 35 counties and includes about 300 medical groups. Del Norte Siskiyou Modoc Humboldt Trinity Shasta Lassen Tehama Mendocino Glenn Butte Colusa Yuba Lake Sutter Plumas Sierra Nevada Placer Full county coverage Partial county coverage* No coverage Sonoma San Francisco San Mateo Marin Santa Cruz Yolo Napa Santa Clara Sacramento Solano San Contra Joaquin Costa Alameda Stanislaus El Dorado Amador Calaveras Merced Alpine Tuolumne Mariposa Madera Mono San Benito Fresno Inyo Monterey Kings Tulare San Luis Obispo Kern San Bernardino Santa Barbara Ventura Los Angeles Orange Riverside San Diego Imperial * The Access+ HMO plan is available only in portions of these counties. To find out if the Access+ HMO service area includes the ZIP code where you reside or work, please contact Shield Concierge at (800) You may also use CalPERS online service, the Health Plan Search by ZIP Code, available at and on my CalPERS at 22

25 Notes Access+ HMO 23

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28 Still have questions? Call or visit us online. Go online: blueshieldca.com/calpers A custom web portal for CalPERS members with full-time access to plan benefits, services, Find a Doctor and more. Call us: (800) From 7 a.m. to 8 p.m., seven days a week, our CalPERS-dedicated Member Services team is ready to help. Blue Shield of California, an Independent Member of the Blue Shield Association A46440-CALPERS (9/16)