CalPERS Adopts Health Rates With a 1.16 Percent Increase
The CalPERS Board of Administration today approved health care rate and plan changes for 2019 that include an average 1.16 percent overall premium increase, marking the lowest health premium increase CalPERS has negotiated in over two decades. Amid increasingly volatile health care markets across the industry, CalPERS continues to achieve historically competitive prices.
"Once again, we've negotiated premium increases that are among the lowest in the nation," said
Members enrolled in CalPERS' Basic (non-Medicare)
The new rates will take effect on
According to the
CalPERS is projected to spend
Among notable health plan and benefit changes for 2019:
Overall rates for seven HMO plans will be less than the 2018 rates. About 800,000 CalPERS HMO Basic members (excluding those in association plans) are expected to see their premiums decline in 2019.*
Health Net will leave the
Blue Shield Access+ will exit eight
Premiums for PERSCare are increasing by 19.8 percent,
A pilot program for reference-pricing pharmaceuticals will begin with three therapeutic classes: Nasal corticosteroids, thyroid medications, and estrogens. Reference-pricing has been shown to improve transparency in drug pricing by offering members lower-cost therapeutic alternative drugs.
The PERS Select Basic PPO plan will adopt a value-based insurance design. The approach aims to improve quality and lower costs associated with health care by emphasizing primary care and introducing cost incentives to lower deductibles.
SpineZone, an online back and neck pain program, and Wisdom, a study to optimize breast cancer screening, will be available to PPO members.
"CalPERS continues to champion health care innovation to improve health outcomes and reduce costs," said
To offset the financial impact of changes in patient utilization and other medical cost increases, the Board adopted two "buy down" efforts. Using funds from its health reserve, CalPERS allocated funds to buy down the premium for its PERSCare PPO plan and premiums for Medicare PPO plans. While the buy down efforts help, PERSCare members will still see a 19.8 percent increase in 2019 premiums. New rates for members of the PERS Select PPO plan, however, will drop by 25.5 percent.**** All members should pay close attention to their health plan options during open enrollment.
"The buy down of PERSCare is intended to smooth premium increases over the next two years," said
The 2019 premiums reflect the Board's decision last year to stop risk-adjusting rates.
Detailed information on 2019 rates for active and retired members are available on the CalPERS website.
CalPERS members can make changes to their health plan choices during the annual Open Enrollment period,
For the first time, members will be able to access Open Enrollment information on an application designed specifically for mobile devices, to be announced later this summer.
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