A Guide to CalPERS Blue Shield of California’s Health Plan · Enclosed is your Health Benefits Officer Resource Guide, a desktop reference to provide CalPERS ... CalPERS. Blue Shield

A Guide to CalPERS Blue Shield of California’s Health Plan

Dear Health Benefits Officer:

Knowing that the employees at your organization often look to you to help them better understand their health benefits, we have designed a resource guide to help you answer their questions about Blue Shield.

Enclosed is your Health Benefits Officer Resource Guide, a desktop reference to provide CalPERS HBOs with key information about Blue Shield’s CalPERS health plan and services. With easy-to-use tabs and a detailed table of contents, this guide has been designed to help you easily locate key information on benefits, programs, plan highlights and resources. It is our goal to make sure you have the most current information, so that you can best serve your employees.

What you’ll find in the HBO Resource Guide

- Answers to Blue Shield member questions - Information regarding how your employees can earn up to $200 through Blue Shield’s

Healthy Lifestyle Rewards program - Information about benefits and special programs offered to Blue Shield members - Phone numbers, addresses, and website information - Open enrollment information

Should you have any questions, please contact our CalPERS Health Benefits Officer Priority Line at (800) 837-4251. Dedicated service representatives are available Monday through Thursday, 8:00 a.m. to 5:00 p.m., and Friday, 9:00 a.m. to 5:00 p.m. You may also contact Blue Shield’s Account Management team by email at [email protected].

We look forward to partnering with you and supporting your efforts to improve employee benefits and wellness.

Sincerely,

Ann De Rose Senior Manager, Account Management CalPERS Business Unit Blue Shield

www.blueshieldca.com A16407 (6/08)

contentsIntroduction ..................................................................................................................................Page A-1

Directory Health Benefits Officer contact information .............................................................................Page B-1

Member contact information .....................................................................................................Page B-2

Blue Shield Service Areas ………………………………………………………………………….......Page B-3

Open Enrollment How to request a Blue Shield team member for a fair ............................................................Page C-1

How to order material .................................................................................................................Page C-1

Why Blue Shield ............................................................................................................................Page D-1

CalPERS Blue Shield Benefits Health Maintenance Organization (HMO) Access+, NetValue HMO, EPO...........................Page E-1

How to Enroll Annual Open Enrollment .............................................................................................................Page F-1

How to enroll-CalPERS ACES ......................................................................................................Page F-1

How to enroll with Blue Shield .....................................................................................................Page F-1

Enrolling dependents ..................................................................................................................Page F-2

Modifications for Existing Members Changing Personal Physicians ..................................................................................................Page G-1

Continuation of coverage

COBRA .......................................................................................................................................Page G-1

Cal-COBRA ................................................................................................................................Page G-2

Workers’ compensation ...........................................................................................................Page G-3

Conversion plan .......................................................................................................................Page G-3

Leave of absence ....................................................................................................................Page G-3

Obtaining Medical Services General care ................................................................................................................................Page H-1

Emergency care ..........................................................................................................................Page H-1

Urgent care ..................................................................................................................................Page H-2

Within California ........................................................................................................................Page H-2

Outside California .....................................................................................................................Page H-2

Seeing a specialist .......................................................................................................................Page H-3

Alternative care ...........................................................................................................................Page H-4

Vision care ....................................................................................................................................Page H-6

Mental health ...............................................................................................................................Page H-6

Health and Wellness Programs Healthy Lifestyle Rewards Program…………………………………………………………………... Page I-1

blueshieldca.com ..........................................................................................................................Page I-1

LifeReferrals 24/7 ............................................................................................................................Page I-1

Lifepath Decision Guide ...............................................................................................................Page I-2

Disease management programs ................................................................................................Page I-2

Chart Your Course Diabetes Management Program .............................................................PageI-2

Alere® Heart Failure Program ...................................................................................................Page I-2

Reach Your Peak Asthma Management Program ................................................................Page I-3

Shield Your Heart Cardiovascular Risk Reduction Program ..................................................Page I-3

Joint Health Arthritis Self-Care Program ...................................................................................Page I-4

COPD Management Program ..................................................................................................Page I-4

Complex Case Management ......................................................................................................Page I-4

LifeMAPSM (Member Advocacy Program) ..................................................................................Page I-5

Out-of-Area Coverage Away From Home Care ...............................................................................................................Page J-1

BlueCard Program ........................................................................................................................Page J-1

Prescription Drug Benefits Drug formulary ..............................................................................................................................Page K-1

Brand vs. generic drugs ...............................................................................................................Page K-1

Pharmacy costs ............................................................................................................................Page K-1

Mail service pharmacy ................................................................................................................Page K-2

Grievance and Appeals Process ................................................................................................Page L-1

Frequently Asked Questions (FAQs) .........................................................................................Page M-1

Sample Forms Blue Shield member ID card .......................................................................................................Page N-1

BlueCard Worldwide international claim form .........................................................................Page N-2

CalPERS enrollment form HBD-12 ...............................................................................................Page N-5

Confidentiality release form .......................................................................................................Page N-6

PrimeMail Mail Service Pharmacy brochure ............................................................................Page N-8

Express Scripts Mail Service Pharmacy Prescription form ........................................................Page N-9

Grievance form ..........................................................................................................................Page N-10

Guest membership ....................................................................................................................Page N-12

Physician selection ...................................................................................................................Page N-15

Subscriber’s statement of claim form ......................................................................................Page N-16

Medicare Coordinated Care Plan How to find additional resources ..............................................................................................Page O-1

CalPERS Medicare Coordinated Care Plan Benefits ..............................................................Page O-2

Regional Pricing Regional Pricing Summary ..........................................................................................................Page P-1

Regional Pricing Map ..................................................................................................................Page P-2

HBO View

Introduction HBO Resource Guide to Blue Shield Health Plan Benefits This desktop guide gives you, the Health Benefits Officer (HBO), the information you need to introduce employees to Blue Shield of California (Blue Shield) and to support existing members. With easy-to-use tabs and a detailed table of contents, you’ll quickly find the benefits, programs, plan highlights and resource information you’re seeking.

What you’ll find in the HBO Resource Guide • Answers to Blue Shield member questions • Information about the benefits and special programs offered to

Blue Shield members • Phone numbers, addresses and Web site information • Open Enrollment information

How to use the HBO Resource Guide to assist your employees • Look in the table of contents for the subject you’re seeking • Scroll through the easily marked tabs • Distribute information to employees. Each page contains one subject only so you can remove,

photocopy and share information with members.

Keeping your HBO Resource Guide current Please make sure that your guide always has the most up-to-date information about Blue Shield. When there are changes, we will send you an email to notify you that there are updates to the “Answer Binder”. You can go to www.blueshieldca.com/calpershbo and select the “Resource Guide” link and download the updated pages. In order to keep you updated on the changes, please email [email protected] for any contact changes you may have.

Learn more If you ever need additional information that you don’t see in this guide, you can go to the blueshieldca.com/calpershbo or call the HBO Priority Line at (800) 837-4251. We’re always ready to help.

We appreciate your support in educating your employees about Blue Shield, and we hope this guide makes it even easier to understand Blue Shield’s value, benefits and programs.

Health Benefits Officer Resource Guide • A-1

mailto:[email protected]

Directory

Health Benefits Officer Contact Information To best serve you in getting timely information and problem resolution, the information in this section is for the use of Health Benefits Officers only and should not be distributed to members.

Health Benefit Officer Priority Line ............................................................................(800) 837-4251 Contact the HBO priority line when you need assistance with your employees’ Blue Shield benefits, claims or Personal Physician selection. For all other questions please contact your Account Manager directly.

Account Management Team

Manager, Account Management* Ann DeRose …............................................................................................................ (916) 329-4558

Account Manager

Heidi Van Gilse........................................................................................................... (916) 329-4569 (Northern California)

Account Service Representatives* Susan Vogt………………............................................................................................ (916) 329-4581 (Fresno, Kern, Kings, Los Angeles, Madera, San Luis Obispo, Santa Barbara, and Ventura Counties)

Rose Allen .................................................................................................................. (916) 329-4554 (Imperial, Orange, Riverside, San Bernardino and San Diego Counties)

Account Management and Health Fair Coordinator Leyla Hastings………………………………………………………………………………. (916) 329-4560 Communication Specialist Cynthia Arteaga…………………………………………………………………………… (916) 329-4582 General e-mail Inquiries

Account Management e-mail address.....................................calpersam@blueshieldca.com

HBO Correspondence Address 400 Capitol Mall, Suite 2580 Sacramento, CA 95814

Ordering Blue Shield Collateral COMAC ............................................................................................. http://calpers.litorders.com/

*See map on page B-3

Health Benefits Officer Resource Guide • B-1

continued from previous page

Member Contact Information

Dedicated CalPERS Blue Shield Member Service line ……….........................................(800) 334-5847 Access+ HMO and EPO benefit information Guest Membership Request new member ID card Select a physician by phone

Collections Claims Provider Billing Other information requests

Health and Wellness Programs LifeReferrals 24/7SM ...............................................................................................................1-866 543-3728

NurseHelp 24/7 SM.................................................................................................................1-866 543-3728

Healthy Lifestyle Rewards………………………………….……………………….……………(877) 932-3375

Reach Your Peak Asthma Self-Management Program ……......................................... (866) 816-5266

Chart Your Course Diabetes Management Program ....................................................(866) 816-5266

Shield Your Heart Cardiovascular Risk Reduction Program ...........................................(866) 816-5266

COPD Management Program ..........................................................................................(866) 816-5266

Joint Health Arthritis Self-Care Program ...........................................................................(877) 289-4415

Alere® Heart Failure Program ...........................................................................................(877) 289-4415

LifeMAPSM (Member Advocacy Program) .......................................................................(800) 394-3516

BlueCard Worldwide ..............................................................................................(800) 810-BLUE (2583)

Guest Membership ...........................................................................................................(800) 334-5847

Prescription Drug Benefits Blue Shield Pharmacy Services (For physician use ONLY, members may give this number to their Personal Physician, for the physician to provide prior authorization for the member’s prescription) ..................................................................(800) 535-9481

PrimeMail............................................................................................................................. (866) 346-7200

Discount Vision Program Eye Care Network Vision Program ....................................................................................(800) 877-6372

Mental Health and Substance Abuse Mental health services administrator (MHSA), U.S. Behavioral Health Plan, California (USBHPC) ............................................................(866) 505-3409

Blue Shield E-mail Address for Privacy Issues Privacy issues e-mail address ..............................................blueshieldca_privacy@blueshieldca.com

Member Correspondence Address Blue Shield P.O. Box 272540 Chico, CA 95927-2540



Blue Shield Service Areas

Open Enrollment Open Enrollment is an important opportunity to introduce your employees to Blue Shield and to give members information about their current health plan. We strive to make the experience smooth and successful for you, and informative and enjoyable for your employees.

During Open Enrollment fairs, Blue Shield representatives can be available to answer your questions, as well as discuss benefits and special wellness programs with members and prospective members.

Members can pick up helpful information such as Personal Physician selection forms and pharmacy mail service information and forms. They can also reference the Blue Shield provider directory and formulary.

Following are a few guidelines for getting the support you need from Blue Shield during Open Enrollment.

Request that a Blue Shield Representative attend an Open Enrollment fair To streamline the process of scheduling a CalPERS Health Fair, CalPERS and Health Plan Partners have developed an online registration system. You may access this online registration system at www.healthfairregistration.com By logging on using your Agency Code and ZIP Code, the Health Benefit Officer can view the health fair master calendar of available health fair dates and times, select and book a health fair, and alert the health plans simultaneously of their chosen fair date. Each health plan will contact you to confirm their attendance. Your Agency Code can be found on your CalPERS billing statement or by calling CalPERS Members Services at 1-888-CAL-PERS. If your code includes only 4 digits, please enter 000 in the second field (for example: 1234 000).Once you log in, you will be able to review step-by-step instructions of how to book your health fair.

HELPFUL HINTS FOR A SUCCESSFUL HEALTH FAIR: CalPERS and the Health Plan Partners want to help you and your employees have a successful Open Enrollment. We also want to supply you with the support that you need, but in order to service the needs of the CalPERS agencies, we ask that you please adhere to these suggested guidelines:

• Please reserve your date as soon as possible.

• Please limit the duration of your health fair to no more than three (3) hours in length.

• Please publicize the event as much as possible, highlighting the specific hours and health plan partners that will be available to answer questions. (For your convenience you can find down loadable email and flyer templates on this page.)

• Please invite your dental and vision health plan partners and other vendors such as local health clubs or life insurance providers to increase attendance and promote health.

• Provide healthy snacks for your employees who attend the health fair.

• Please try and avoid scheduling your health fair on heavily booked dates.

• Please schedule your health fair in a room with adequate space whenever possible.

Ordering materials for an Open Enrollment fair Blue Shield Account Management will send the materials you need for the Open Enrollment fair. You do not need to request the materials. If you need additional supplies, you can contact your Account Manager. Or, you can always order them online at: calpers.litorders.com.

Health Benefits Officer Resource Guide • C-1

http://www.healthfairregistration.com/

Great reasons to choose Blue Shield Not-for-profit health plan

Blue Shield of California is a San Francisco-based, not-for-profit health plan with nearly 70 years of service to our community.

Blue Shield of California Foundation

Blue Shield of California endows the Blue Shield of California Foundation through annual contributions supporting the foundation’s work to make health care effective, safe, and accessible for all Californians, and to end domestic violence.

Competitive monthly rates

The Blue Shield Access+ HMO® and NetValueSM HMO plans offer comprehensive health benefits at competitive rates.

The doctors and hospitals you trust

The Access+ HMO plan offers one of the largest HMO networks in the state. Or opt for the NetValue HMO with a smaller network of physicians and medical groups, and pay less.

Self-refer to a specialist

Your Access+ HMO and NetValue HMO plans give you plenty of choice. You can see a specialist recommended by your Personal Physician, or you can choose to self-refer to a specialist within your medical group or IPA (Independent Practice Association).* While this self-referral feature has a slightly higher copayment, the choice is yours.

Dedicated CalPERS Blue Shield Member Services

Your dedicated Member Service representatives are trained on all the features and benefits of your CalPERS health plan. Call (800) 334-5847, Monday through Friday, 7 a.m. to 7 p.m.

Chiropractic, acupuncture, and massage therapy discounts

Get at least 25% off published fees for chiropractic, acupuncture, and massage therapy from participating practitioners.**

$200 cash with Healthy Lifestyle Rewards

Healthy Lifestyle Rewards is a confidential, online program that rewards CalPERS Blue Shield members 18 and older with up to $200 when you participate in the program. It provides valuable tools to help you get in shape, eat right, reduce stress, or quit smoking – all at no extra charge.

NurseHelp 24/7SM and LifeReferrals 24/7SM

Get round-the-clock access to medical information from a registered nurse by phone or online. Or talk to master’s-level counselors for support with work and personal issues. All communications are completely private and available 24 hours a day, seven days a week.

Urgent care away from home

Through the BlueCard® Program, you and your covered family members have access to urgent care across the country and around the world.

Mail service prescriptions

Use Blue Shield’s mail service pharmacy to fill maintenance medications with stabilized dosages for the treatment of long-term conditions such as high blood pressure. The mail service benefit can be used for up to a 90-day supply.

Health Benefits Officer Resource Guide • D-1

What is the difference between Access+ HMO, NetValue and EPO Access+ HMO Blue Shield knows that choice and affordability in a healthcare plan are important to you. Your Access+ HMO plan offers the same comprehensive benefits as NetValue HMO, but from a wider network of physicians for a higher monthly rate.

Find out if your doctor is an Access+ HMO provider

To find out if your Personal Physician is an Access+ HMO plan provider, go to blueshieldca.com/calpers and click on Find a Provider. Or, for personal assistance, you can call your CalPERS-dedicated Blue Shield Member Services team at (800) 334-5847 from 7 a.m. to 7 p.m., Monday through Friday.

For complete details on your Blue Shield Access+ HMO please refer to your HMO Evidence of Coverage or visit www.blueshieldca.com/calpers.

NetValue HMO Blue Shield’s NetValue HMO plan offer you lower monthly rates, yet provides the same comprehensive Blue Shield benefits, self-referral to specialist, programs, and value-added services as the Access+ HMO Plan.

CalPERS members enrolled in the NetValue HMO plan will have address to a smaller number of selected medical groups and affiliated Personal Physicians and specialists than are available in Blue Shield’s Access+ HMO plan; at a lower monthly rate.

You and all eligible dependents must choose to enroll in the same Blue Shield plan. It is important to note that except for certain situations, you will not be able to change plans until the next CalPERS open enrollment period. You can change plans during the plan year under circumstances for special enrollment specified in the CalPERS Health Program Guide. These include such circumstances as marriage and new dependents.

Find out if your doctor is a NetValue HMO provider

To find out if your personal physician is a NetValue HMO provider, go to blueshieldca.com/calpers and click on Find a Provider. Or, for personal assistance, you can call your CalPERS-dedicated Blue Shield Member Services team at (800) 334-5847, from 7 a.m. to 7 p.m.

Some physicians may practice with more than one medical group/IPA; therefore, in order for you to continue seeing your current Personal Physician in NetValue HMO plan, you may need to change medical groups. If you would like to continue care with a specialist you are currently seeing, be sure to find out if he or she participates in the NetValue HMO plan medical group you select.

For complete details on your Blue Shield NetValue HMO plan, refer to the addendum to your NetValue HMO Evidence of Coverage and Disclosure Form or visit www.blueshieldca.com/calpers.

continued on next page

Health Benefits Officer Resource Guide •E-1

http://www.blueshieldca.com/calpers


Exclusive Provider Organization (EPO) Blue Shield's Exclusive Provider Organization (EPO) Basic Plan offers the same comprehensive, flexible health coverage as the Access+ HMO throughout Sierra, Colusa, and Mendocino counties. As an EPO plan member, you don't need to select a Personal Physician.

Health Benefits Officer Resource Guide • E-2

CalPERS Blue Shield Benefits: HMO/Net Value* and EPO**

* Available in certain areas. Please refer to Evidence of Coverage ** Colusa, Mendocino and Sierra Counties

Health Benefits Officer Resource Guide • E-3

How to Enroll Annual Open Enrollment Please see the “Open Enrollment” section on page C-1 for information regarding Open Enrollment fairs and materials.

How to enroll – CalPERS ACES Information about enrollment can be found in the CalPERS Health Program Handbook. To enroll, employees must complete CalPERS form HBD-12.

How to enroll with Blue Shield

1. Enroll If an employee is already enrolled with Blue Shield, that employee doesn’t need to do anything during Open Enrollment to keep the plan and physician he or she chose last year.

If an employee is not yet enrolled with Blue Shield, that employee will need to submit a health plan enrollment form to his or her employer. Employees can get this form (HBD-12) from their employer or download it online from CalPERS at www.calpers.ca.gov.

2. Select a Personal Physician If an employee is enrolling in our Access+ HMOSM or Net Value plan, or wishes to change his or her Personal Physician, our provider directory is available online at blueshieldca.com. Employees can click on the Find a Provider tab to search the most current physician, hospital, mental health provider and alternative care practitioner listings.

Members must tell us who they have selected as their Personal Physician. They can either enter this information on blueshieldca.com/calpers or call Member Services at (800) 334-5847.

If the member does not select a Personal Physician at the time of enrollment, Blue Shield will designate a Personal Physician for the member and send notification of the designated Personal Physician. This designation will remain in effect until the member notifies Blue Shield of his or her selection of a different Personal Physician.

Members living in Colusa, Mendocino, and Sierra are part of the EPO plan and do not need to select a Personal Physician. They will have access to providers in our PPO network. They can go to the Find a Provider section of blueshieldca.com, then click “Find a doctor” and select “CalPERS EPO.”

3. Register online at blueshieldca.com Members should be sure to register on blueshieldca.com – their online resource for health and benefit information 24 hours a day, seven days a week. At our Web site, they will access the tools and information they need to help them make important decisions about their health.


Health Benefits Officer Resource Guide • F-1

continued from previous page Enrolling dependents When adding dependents to their health coverage plans, members will need to tell Blue Shield the names of each dependent’s Personal Physician within three business days of returning their HBD-12 form. Dependents’ Personal Physicians must be in the Blue Shield network.

A Personal Physician must be selected for a newborn or child placed for adoption, preferably prior to birth or adoption, but within 31 days from the date of birth or placement for adoption. For the first 30 days, the baby must be in same medical group or Independent Practice Association (IPA) as the mother. For further information, members can refer to their current Evidence of Coverage (EOC) booklet. Dependants are eligible for coverage up to the age of 23.

Members can provide dependent information in one of three ways. They can: 1. Go online at blueshieldca.com/calpers. Once there, they should select the “search for a

physician” box and click “go.” They will select a Personal Physician for each eligible family member from the search results. They will then fill in the online form, confirm the information and click “submit.”

2. Complete a physician selection form, which is included in the Blue Shield enrollment material. As an HBO, you can order these materials at blueshieldca.com/calpershbo.

3. Call Blue Shield Member Services at (800) 334-5847.

Health Benefits Officer Resource Guide • F-2

Modifications for Existing Members Changing Personal Physicians A member may change Personal Physicians by calling Member Services at (800) 334-5847. The change will be effective the first day of the month following notice of approval by Blue Shield. Once the Personal Physician change is effective, all care must be provided or arranged by the new Personal Physician, except for:

• OB/GYN services provided by an obstetrician/gynecologist or a family practice physician within the same medical group or IPA as the member’s Personal Physician

• Access+ Specialist visits Please have members refer to their current Evidence of Coverage booklet for additional information.

Continuation of coverage COBRA: The COBRA plan will cost an employee 102 percent of their current premium rate. For example, if the member is currently on an employee-only rate of $315.22, their monthly cost on COBRA will be $321.52.

To help facilitate an employee’s request for COBRA, HBOs should do the following: 1. Have the employee complete the COBRA HBD-85 form. The form can be downloaded from

the CalPERS Web site at: www.calpers.ca.gov/msspub/pdf/cobraelection.pdf. 2. Update ACES with COBRA information (if HBO has access) 3. Send the completed COBRA HBD-85 form to CalPERS at:

CalPERS Health Benefit Services Division P.O. Box 942714 Sacramento, CA 94229-2714

4. Send the check for initial dues to: Blue Shield Attention: V. Ludovissy PO Box 769025 Woodland, CA 95776

5. If you are unable to update ACES, send the payment check with the HBD-85 form directly to CalPERS.

When CalPERS receives the form, it does the following: 1. Processes the COBRA HBD form and updates ACES if needed. 2. Mails the stamped COBRA HBD form to:

Blue Shield of California EDH - CalPERS Bookkeeping Dept A-2 P.O. Box 629019 El Dorado Hills, CA 95762-9019


Health Benefits Officer Resource Guide • G-1

continued from previous page 3. Forwards the employee’s COBRA check to:

Blue Shield of California Attn. V. Ludovissy PO Box 769025 Woodland, CA 95776

After the member’s records have been updated to reflect COBRA the member will receive a COBRA dues notice/billing from Blue Shield, and should pay Blue Shield directly.

Blue Shield currently has two addresses for handling CalPERS COBRA payment: Members who have a statement mail their payment to:

Blue Shield of California Cash Receiving P.O. Box 51827 Los Angeles, CA 90051-6127

Members who do not have a statement mail their payment to: Blue Shield of California Attn. V. Ludovissy PO Box 769025 Woodland, CA 95776

Cal-COBRA: Effective January 1, 2003, any employee who currently has federal COBRA coverage is eligible for an extension under Cal-COBRA legislation resulting from Assembly Bill 1401. Ninety days prior to their termination of COBRA, they will receive a letter from Blue Shield advising them of this option. They then have 60 days to notify Blue Shield that they are electing the extension. The rates will be 110 percent of regular rates, rather than the 102 percent that COBRA will charge.

The purpose of this law is to offer Cal-COBRA coverage to extend employees’ coverage up to 36 months total coverage, with the two plans (COBRA and Cal-COBRA). If they have 29 months of federal COBRA, they would have only 7 months of Cal-COBRA available to them. Blue Shield bills members for Cal-COBRA coverage, similar to COBRA billing.

Blue Shield is responsible for providing potential COBRA enrollees with a 90-day notice of their COBRA rights. Under Cal-COBRA the COBRA notification must also include information about CalCOBRA.

If the enrollee elects to apply for coverage under Cal-COBRA he or she may enroll by notifying Blue Shield’s CalPERS Member Services team at (800) 997-3770. COBRA participants must contact Blue Shield at least 30 days before their COBRA coverage terminates. Upon notification, Blue Shield will send an application packet to the CalPERS member.

When switching to Cal-COBRA there will be no changes for members and they will continue to receive a Cal-COBRA dues notice/billing from Blue Shield.




Blue Shield currently has two addresses for handling CalPERS Cal-COBRA payments as follows:

Members who have a statement mail their payment to: Blue Shield Cash Receiving P.O. Box 51827 Los Angeles, CA 90051-6127

Members who do not have a statement mail their payment to: Blue Shield CalCOBRA/PERS P.O. Box 769022 Woodland, CA 95776-9022

Workers’ compensation Blue Shield does not provide benefits for any employment-related injury or disease covered by workers’ compensation law, occupational disease law or similar legislation.

Conversion plan Within 30 days following the loss of eligibility of CalPERS health coverage or COBRA group continuation coverage, a member can request an individual conversion policy through his or her Blue Shield health plan, but the medical benefits and premium costs may differ from the group coverage. Members can call Individual and Family Plan Member Services at (800) 431-2809 to learn about benefits and costs under the conversion plan.

Leave of absence (LOA) When an employee is taking a leave of absence, CalPERS will notify the employee if he or she may continue their medical coverage at their own expense. The HBO can update LOA employment status change, discontinuation and direct pay election through ACES. The HBO determines that the employee is eligible to change from automatic payroll reduction to Direct Pay coverage. With Direct Pay, Blue Shield bills the member directly and the employee pays Blue Shield directly for the full amount of his or her healthcare coverage. When the employee returns to work, the employment and health enrollment status will not change until the HBO has updated the employment information with the return-to-pay status. The HBO must also change the premium payment method to discontinue the direct pay election.

If the HBO is not able to process the transactions associated with the LOA employment status and direct pay election due to lack of ACES access, then CalPERS will process the transaction. In this case, an HBD-21 form can be downloaded online at www.calpers.ca.gov.

Send to: CalPERS Health Benefits Branch PO Box 942714 Sacramento, Ca. 94229-2714


Obtaining Medical Services

These are guidelines that Blue Shield asks its providers to follow. In general, members can expect to obtain an appointment within these time frames:

Emergency care .....................................................................................................Immediately Urgent care .........................................................................................................Within 24 hours Non-urgent care with Personal Physician ........................................Within 14 calendar days Routine physical exam or well-baby exam .....................................Within 30 calendar days Specialist referral/consultation (non-urgent) ...................................Within 30 calendar days

Guidelines for accessing care

General care When HMO members need preventive care, such as routine checkups and immunizations, or other non-urgent care, they should call their Personal Physician to make an appointment. The Personal Physician is responsible for providing primary care and coordinating or arranging for a referral to other necessary healthcare services.

A female member may arrange for OB/GYN services provided by an obstetrician/gynecologist or family practice physician who is not her designated Personal Physician without a referral. However, this doctor must be in the same medical group or IPA as her Personal Physician.

To see which preventive services are covered under their Access+ HMO plan, members should refer to their Evidence of Coverage booklet.

Getting emergency and urgent care Please read the following definitions to understand how emergency and urgent care services are defined for Blue Shield HMO plans.

Emergency care Emergency care is defined as services provided for an unexpected medical condition mani-festing itself by acute symptoms of sufficient severity (including severe pain), including a psychiatric emergency medical situation, such that the absence of immediate medical attention would reasonably be expected to result in any of the following: • Placing the member’s health in serious jeopardy • Serious impairment to bodily functions • Serious dysfunction of any bodily organ or part

What members should do in an emergency? If they reasonably believe that an emergency exists, they should call 911 or go to the nearest hospital. They should contact their Personal Physician as soon as reasonably possible after receiving emergency care. If they need any follow-up care, they should make sure their Personal Physician coordinates it.


Health Benefits Officer Resource Guide • H-1


Coverage levels for emergencies If a member receives non-authorized services in a situation that Blue Shield determines was not a situation in which a reasonable person would believe that an emergency condition existed, the member will be responsible for the costs of those services.

Urgent care Urgent care is defined as services provided in response to the patient’s need for a prompt diagnostic work-up and/or treatment of a medical or mental disorder that could become an emergency if not diagnosed and/or treated in a timely manner and delay is likely to result in prolonged temporary impairment, unwarranted prolongation of treatment increasing the risk of treatment by the need of more complex or hazardous treatments, development of chronic illness or inordinate physical or psychological suffering of the patient.

How to get urgent care Within their Personal Physician’s service area, members should always call their Personal Physician before getting treatment for an urgent care situation. Urgent care must be provided or arranged by their Personal Physician. If they need urgent care or get sick after hours, their doctor’s office will have someone on call 24 hours a day, seven days a week to help them.

Urgent care within California When members need urgent care in a part of California that’s outside their Personal Physician’s service area, they must contact their Personal Physician, who is responsible for providing or arranging their urgent care. Their Personal Physician has telephone access available 24 hours a day, seven days a week.

If members are unable to reach their Personal Physician when they need urgent care in another part of California, they should call Member Services at (800) 334-5847 for help locating an urgent care provider.

Urgent care outside of California Through the BlueCross BlueShield Association’s BlueCard® Program, HMO members and their eligible family members have coverage for urgent care across the country and around the world. They can locate a BlueCard provider at any time by calling (800) 810-BLUE (2583) or by visiting our website, blueshieldca.com, click “Find a Provider,” then the link for providers outside of California. If members are traveling outside the U.S. and territories, they should click the link for providers outside of the U.S. and follow the search instructions.




Follow-up to urgent care obtained outside California If members receive urgent care through the BlueCard Program, their medically necessary follow-up care is also covered through the BlueCard Program when they remain temporarily outside of California.

However, they will need to contact Member Services at (800) 334-5847 to receive authorization for more than two medically necessary follow-up outpatient visits, for surgical or other procedures and for inpatient hospital stays. There is a possibility that we may direct them to obtain these types of follow-up care from their Personal Physician in California.

Seeing a specialist HMO members may choose a specialist themselves through the Access+ Specialist option. This option allows them to visit a specialist or primary care physician without a referral. Their co-payment is $30 for this office visit. Members need to know that the specialist they choose must be in their Personal Physician's medical group or IPA and the provider must participate in the Access+ Specialist program. They can use Find a Provider on blueshieldca.com to find a specialist in their Personal Physician’s IPA or medical group. The specialist will inform the member’s Personal Physician of the results of the examination or consultation, and provide any test results.

An Access+ Specialist visit includes: • An examination or other consultation provided to the member by a medical group

or IPA plan specialist without referral from their Personal Physician. Note: Except for mental health and substance abuse visits, the Access+ Specialist must be in the same medical group or IPA as the member’s Personal Physician.

• Mental health services. Members may arrange for an Access+ Specialist office visit for mental health and substance abuse services without a referral from the Mental Health Services Administrator (MHSA), as long as the provider is an MHSA preferred provider.

• Conventional X-rays such as chest X-rays, abdominal flat plates and X-rays of bones to rule out the possibility of fracture (not including any diagnostic imaging such as CT, MRI or bone density measurement).

• Laboratory services. • Diagnostic or treatment procedures that a plan specialist would regularly provide under a

referral from the Personal Physician.




An Access+ Specialist visit does NOT include: • Any services that are not covered or not medically necessary. • Services provided by a non-Access+ provider (such as podiatry and physical therapy), except

for the X-ray and laboratory services described above. • Allergy testing. • Endoscopic procedures. • Any diagnostic imaging including CT, MRI or bone density measurement. • Injectables, chemotherapy or other infusion drugs, other than vaccines and antibiotics. • Infertility services. • Emergency services. • Urgent care services. • Inpatient services or any services that result in a facility charge, except for X-ray and

laboratory services. • Services for which the medical group or IPA routinely allows members to self-refer without

authorization from the Personal Physician. • OB/GYN services by an obstetrician/gynecologist or family practice physician within the same

medical group/IPA as the Personal Physician. • Internet-based consultations with specialists. • Psychological testing and written evaluation.

Alternative care Our Mylifepath Alternative Health Services Discount Program offers discounts for:

Acupuncture Receive at least 25 percent off: • Examinations • Acupuncture or electro-acupuncture • Adjunctive therapeutic procedures or modalities • Other related acupuncture services

Note: Does not include herbs




Chiropractic Receive at least 25 percent off: • Examinations • Manipulative treatment • Adjunctive therapeutic procedures or modalities • Chiropractic appliances • Other related chiropractic services

Massage therapy Receive at least 25 percent off: • Swedish massage • Deep muscle and deep tissue massage • Trigger point therapy • Shiatsu and acupressure • Reflexology • Sports massage

To receive these discounts, members need to: • Select a practitioner in the Mylifepath Alternative Health Services Discount Program. • Call the practitioner or facility to make an appointment. • Present their Blue Shield member ID card at the time of their appointment. They must show

their card to receive the discount.

Members can go to blueshieldca.com, click and search in the Find a Provider section to find a Mylifepath Alternative care provider in their area. Please note: The Mylifepath Alternative Health Services Discount Program is an exclusive offer to Blue Shield members, made available through an arrangement with American Specialty Health Networks (ASH Networks) and is not a covered service of any Blue Shield health plan. ASH Networks credentials and manages the program’s practitioners. None of the terms and conditions of Blue Shield health plans apply. Blue Shield and ASH Networks do not review the program’s practitioner services and products for medical necessity or efficacy and make no representations, claims or guarantees regarding their services or products. Members who use the discount program are responsible for the payment of services provided by participating network practitioners, including payment for cancelled or missed appointments. Members who are not satisfied with services received from the program’s practitioners may use the Blue Shield grievance process. Blue Shield reserves the right to terminate this program without notice.




Vision care Eye refraction to determine need for corrective lenses is $0 per visit and must be referred by a primary care physician (frames and lenses not covered). However, this service is limited to one visit per calendar year for members.

In addition, Blue Shield members benefit from the Eye Care Network Discount Vision Program (ECN), which offers 20 percent discounts on eye exams, glasses, contacts and more, including: • Routine eye examinations • Frames and lenses • Contact lenses • Photochromatic lenses • Tints and coatings

This program is not a covered service of the member’s health plan, but an additional offer of savings to Blue Shield members.

To receive discounts from providers found in the ECN directory, members simply present their Blue Shield member ID card when purchasing the products or services listed above. They pay participating providers’ published fees, less the 20 percent discount. Members are responsible for all incurred charges, so there is no need to file a claim.

Members can locate an ECN provider near them using the Find a Provider search feature on blueshieldca.com.

ECN does not apply to disposable or replaceable contact lenses, eyeglass frame repairs, promotional eye care offers, medical or surgical eye treatments or any other services or supplies not specifically covered under this program. Please note: The Eye Care Network Vision Program is a value-added feature exclusively for Blue Shield members who reside in California and is not a covered benefit of Blue Shield health plans. None of the terms or conditions of Blue Shield’s health plans apply. Disposable and replaceable contact lenses, eyeglass frame repairs, promotional eye care offers, medical and surgical eye treatment and any services not specifically included in this program are excluded from the Eye Care Network Vision Program.

Mental health Blue Shield has contracted with a mental health services administrator (MHSA), U.S. Behavioral Health Plan, California, to deliver mental health and substance abuse services to our members through a unique network of mental health preferred providers. All non-emergency mental health and substance abuse services, except for Access+ Specialist visits, must be arranged through the MHSA. Members do not need to arrange for mental health and substance abuse services through their Personal Physician.

A MHSA preferred provider must provide all mental health and substance abuse services, except for emergency or urgent services. MHSA preferred providers are listed in the Find a Provider section of blueshieldca.com and in the Blue Shield Behavioral Health Provider Directory. Members may contact the MHSA directly for more information and to select a MHSA preferred provider by calling (866) 505-3409. For details about these benefits, members should consult their Evidence of Coverage booklet.



Health and Wellness Programs Healthy Lifestyle Rewards Program Healthy Lifestyle Rewards Program is a confidential, online program that rewards CalPERS Blue shield members 18 and older with up to $200 when you participate in the program. It provides valuable tools to help you get in shape, eat right, reduce stress, or quit smoking – all at no extra charge.

blueshieldca.com blueshieldca.com is Blue Shield’s online health and wellness Web site. To take full advantage of the site features, members need to register at the site. When they register, they will find answers to most of their benefit and health and wellness program questions. • Plan and benefit information: The password protected My Health Plan section contains CalPERS

benefit information, frequently asked questions, downloadable forms, Member Services contacts and more.

• Health and wellness tools and news: Our online health and wellness resources provide members with interactive tools, up-to-date health information from the nationally recognized Mayo Clinic, health news from Reuters Health Information, plus information on Blue Shield member programs to help them better manage their health.

• Pharmacy and prescription coverage information: Members can search the Pharmacy section for a list of formulary drugs, find generic alternatives, check for drug interactions, find out information about their medications, refill maintenance prescriptions by mail and locate a participating pharmacy. They can also submit questions about prescription drugs or over-the-counter medications, herbal products or dietary supplements securely online to a clinical pharmacist at the University of California, San Francisco, School of Pharmacy, and receive a personal, confidential answer within two business days.

Note: Personal health information is confidential and will not be shared.

LifeRefferals 24/7 This program helps members better manage the demands of everyday life. They can receive information, referrals, resources and support 24 hours a day, seven days a week – at no extra charge. All communications are completely confidential.

Here are some additional details about this helpful program: • Counseling service: Members can access experienced counselors for a range of work and

personal issues and work-life specialists for when they need help balancing work and life. Members can call for essential healthcare, financial, legal and other resources 1-866-LIFEPATH (543-3728). TDD 1-866-216-9926. Or they can go to the “Health & Wellness” section of blueshieldca.com/calpers and click the “lifepath resources” link.

• Nurseline: Members can speak with a registered nurse over the phone toll-free for medical information they can trust. These nurses are also available anytime by calling 1-866-LIFEPATH (543-3728), 1-TDD 866-216-9926.

• Nurse Chat: Members can have a secure, confidential online chat with a registered nurse. They simply log on to blueshieldca.com and go to the “Health & Wellness” section and click the “lifepath advisers” link to use these online services and to get more information privately.


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Lifepath Decision Guide Members will find relevant information about hospitals, treatment options and medications that might be appropriate for their specific situation. Through blueshieldca.com, the Lifepath Decision GuideSM includes: • Hospital Comparison Tool: Members can compare hospitals’ quality and cost for their

condition or procedure. • Treatment Options Tool: This tool helps members find potential treatment options for their

condition or diagnosis • Drug Database and Formulary: Members can access drug copayment information and look

up which drugs are available as generics, to better manage out-of-pocket prescription expenses and learn which drugs are on Blue Shield's formulary.

• Drug Interactions: Members can check for potential side effects caused by the medications they take.

Disease management programs We’ve designed a suite of health management programs to help members feel better and manage their conditions. When they participate in our programs, they get practical resources and support – at no additional charge. Participation will not affect their benefits or their access to providers in any way, and all information is kept confidential.

Chart Your Course Diabetes Management Program Members with diabetes can participate in our diabetes management program. If they choose to participate they will receive a workbook that contains information and tools about the diabetes management program. Additionally each participating member will receive a welcome call by a program nurse to review their current health status and identify educational topics that may be useful.

Participation will not affect their benefits or their access to providers in any way, and all information is kept confidential.

For more information, members can contact: (866) 816-5266

Hearing or speech-impaired members should call TDD (866) 782-7237

Alere Heart Failure Program Blue Shield has partnered with Alere® Medical Inc. to offer qualified members diagnosed with severe heart failure a program to help monitor their condition. If they have had a recent hospitalization or ER visit due to heart failure they will receive an information packet and a phone call from an Alere representative. If a member’s status seems to have worsened (e.g., if the member is experiencing increased symptoms or rapid weight gain), an Alere nurse will notify the member’s physician to so that clinical follow-up can occur immediately if necessary.


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Participation will not affect their benefits or their access to providers in any way, and all information will be kept confidential.

For more information about the Alere Heart Failure Program, members can contact: (877) 289-4415

Hearing or speech impaired members should call: (800) 794-1099

Reach Your Peak Asthma Management Program Reach Your Peak helps members create a personal action plan to manage asthma symptoms. This program is designed to help members who have daily or nightly symptoms more than once a week. They’ll learn to understand how best to respond to their symptoms and form a strong partnership with their healthcare provider. If they choose to participate they will receive a workbook that contains information and tools about the asthma management program. Additionally each participating member will receive a welcome call by a program nurse to review their current health status and identify educational topics that may be useful.


For more information about the Reach Your Peak asthma program members can contact: (866) 816-5266

Hearing or speech impaired members should call TDD: (866) 782-7237

Shield Your Heart Cardiovascular Risk Reduction Program Making necessary lifestyle changes to manage cardiovascular disease can be very difficult. Designed for members who have had a heart attack, bypass surgery or angioplasty, Shield Your HeartSM can help reduce cardiovascular risk and help prevent future heart problems. If they choose to participate they will receive a workbook that contains information and tools about the asthma management with cardiovascular risk reduction program. Additionally each participating member will receive a welcome call by a program nurse to review their current health status and identify educational topics that may be useful.

Participation will not affect members’ benefits or their access to providers in any way, and all information is kept confidential.

For additional information about the Shield Your Heart Cardiovascular Risk Reduction Program, members can contact: (866) 816-5266





Joint Health Arthritis Self-Care Program The Joint Health Arthritis Self-Care Program is an education program for adult members with arthritis. The program was developed in collaboration with the Arthritis Foundation.

Joint Health helps members manage their arthritis by providing information about arthritis and treatment and by encouraging members to practice self-care skills to stay active, increase their sense of control and enhance their quality of life.

Participation will not affect members’ benefits or their access to providers in any way, and all information is kept confidential.

For additional information about the Joint Health arthritis program members can contact: (877) 289-4415

Chronic Obstructive Pulmonary Disease (COPD) Management Program Members with Chronic Obstructive Pulmonary Disease (COPD) can participate in the COPD self-management program. If they choose to participate they will receive a workbook that contains information and tools about the COPD management program. Additionally each participating member will receive a welcome call by a program nurse to review their current health status and identify educational topics that may useful.


For additional information about the COPD program, members can contact: (866) 816-5266


Complex Case Management Blue Shield, in collaboration with ParadigmHealth, manages care for some CalPERS members with complex medical conditions. These patients have progressive and/or life-threatening illnesses, suffer from multiple comorbidities, have numerous care providers, and require more intensive interventions and coordination than provided by traditional case management or disease management programs. The program is an intensive intervention typically lasting four to six months.



continued from previous page ParadigmHealth provides its clinical team, comprised solely of doctors and nurses, with key tools to enable them to manage these patients successfully • Time – Low caseloads, approximately 20 to 22 patients per nurse, give nurses time to attend to

the numerous challenges these patients face. All patients receive a home visit from their personal, community-based registered nurse.

• Training – All clinicians are trained in palliative care and end-of-life issues. • Systematic approach – Nurses create a care plan organized around seven Care Domains

(Knowledge and Choice, Treatment Plan, Family and Living Environment, Pain and Symptom Management, Terminal Care Planning, Provider Support and Benefit Plan Management). This helps structure conversations with patients and their physicians to help ensure a comprehensive approach to the patient's care needs.

The Blue Shield program goes beyond helping patients manage their benefits and navigate the medical system; it provides a full range of personalized services, such as pain and symptom management, early crisis management, psychosocial and spiritual support and access to community resources. By focusing on the patient’s needs, the program enhances the relationship between the patient, family and doctor.

LifeMAPSM (Member Advocacy Program) This program is available to members facing certain types of surgical procedures. LifeMAP is a program that gives patients personal support from registered nurses to help them prepare for and recover from surgical procedures.

Before surgery, members get a “recovery map” that provides useful information specific to each procedure, including information about pre-operative testing and preparation, expected post-operative recovery milestones and the return to work. A registered nurse answers general questions about the planned surgery and recovery, helping to identify and coordinate any discharge needs.

Following discharge, the care manager contacts the member to check on his or her recovery, confirming that discharge needs are met, prescriptions are filled, instructions are understood, pain is controlled and follow-up appointments are scheduled.

Participation will not effect members’ benefits or their access to providers in any way, and all information is kept confidential.

For more information about the LifeMAP program members can contact: (800) 394-3516


Out-of-Area Coverage

Away From Home Care®

Blue Shield offers members who are long-term travelers, students and families living apart, Away From Home Care (AFHC), previously referred to as Guest Membership. AFHC offers full HMO benefits with a member’s ID card. Their eligibility is applicable to their spouse and dependents who are away from home for at least 90 days, or to the member when they are away form home for at least 90 days but not more than 180 days. There is no additional charge to the member.

AFHC also offers a special short-term service, which is available to members, if they require specific follow-up treatment. This option is particularly beneficial for members who will be out-of-state on a short-term basis but require special treatment.

To coordinate AFHC members should call Blue Shield CalPERS Member Services at (800) 334-5847.

BlueCard Program BlueCard® provides access assistance for member’s emergency care needs anywhere in the world. However, they are not required to use the BlueCard program or BlueCard Worldwide Network for emergency care. If they have an emergency, they should seek care at the nearest medical facility.

To identify hospitals, which participate in the BlueCard Program, members should call: (800) 810-BLUE (2583) or they can use “Find a Provider” on blueshieldca.com to search for providers outside of California before traveling. Or in an emergency they can call collect from a foreign country to (804) 673-1177, 24 hours a day, seven days a week.

Hospitals participating in the BlueCard program will bill Blue Shield – not the member – for their covered inpatient expenses. However, they may be asked to pay their copayment or deductible and will need to pay for services such as physician visits or outpatient care while traveling internationally. Members should be sure to get an itemized bill for these services so that Blue Shield can process their claim.

Members can reference their Blue Shield Evidence of Coverage and Disclosure booklet for complete details regarding the BlueCard Program, the BlueCard Worldwide Network and their appropriate copayment for out-of-area urgent care.

Member’s who would like to know more about BlueCard program details, should contact the dedicated Blue Shield CalPERS Member Services at (800) 334-5847 before they travel. We’ll send them more information.

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Prescription Drug Benefits Drug Formulary The Blue Shield drug formulary is a comprehensive list of preferred drugs maintained by our Pharmacy and Therapeutics Committee for use under the Blue Shield Outpatient Prescription Drug Program, which is designed to assist physicians in prescribing drugs that are medically necessary and cost effective. The formulary is updated quarterly. If not otherwise excluded, the formulary includes all generic drugs.

Members can review the most updated drug formulary online at blueshieldca.com by clicking on “Pharmacy” on the top navigation bar. From the menu, they can select Drug Database & Formulary. From there, they can search by a specific drug name, medical condition or drug class. Or, they can download the most current formulary from the navigation bar on the right-hand side. Members can also obtain a printed copy of the Blue Shield Drug Formulary by calling Member Services at (800) 334-5847.

A non-formulary drug is any medication that is not listed in the drug formulary. CalPERS’ benefits provide coverage for non-formulary drugs at a higher non-formulary copayment. Some formulary and non-formulary medications require prior authorization for medical necessity.

Brand vs. generic drugs The Food and Drug Administration (FDA) has deemed that generic drugs are therapeutically equivalent to the correlated brand-name drug. Generic drugs must contain the same active ingredients in the same amounts as their brand-name counterparts. Additionally, the same rigorous FDA quality and safety reviews apply to generic drugs as they do to brand-name drugs. Generic drugs must also cost less than the brand-name drug. Since they cost less, generic drugs help lower members’ healthcare expenses. Under the Blue Shield Outpatient Prescription Drug Benefit, members pay a lower copayment if they choose generic drugs over brand-name medications.

When appropriate, using generic drugs is one way members can play an active role in helping control the overall costs of health care. Furthermore, copayments are less for generic products, so using generic drugs can help members maximize the value of prescription drug benefits. Members should talk to their doctor about generic alternatives that would be right for them.

Pharmacy costs Pharmacy costs are listed in the Benefit Summary on pages E-1, O-3.


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PrimeMail Mail Service Pharmacy Members have the option of obtaining up to a 90-day supply per prescription for covered maintenance drugs through the mail service pharmacy, PrimeMail. To have PrimeMail fill prescriptions, members may use the special order forms available from you (the Health Care Benefits Officer), from Blue Shield Member Services or online.

Prescription refills are available online by visiting blueshieldca.com, clicking “Pharmacy,” then clicking “Participating Pharmacies,” and then “mail-service prescriptions.” Members will need to mail a new prescription for a 90-day quantity with refills to PrimeMail using the procedure outlined in the mail service brochure, obtained by calling PrimeMail at 866.346.7200 Hearing Impaired TTY/TDD 866.346.7197, Fax Refills 877.774.6360

Members should allow up to 14 days to receive mail service prescriptions. Once the prescription is received by PrimeMail, it normally takes one to two days to be filled and mailed if there are no questions. Some situations that can delay a prescription from being filled are an incomplete or illegible prescription, manufacturer backorders and drugs that require prior authorization by Blue Shield.

If prior authorization is required, the member’s physician must request a review by Blue Shield Pharmacy Services at (800) 535-9481. Blue Shield Pharmacy Services obtains clinical information from the doctor and, based on the information provided, makes a decision regarding coverage of the medication.

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Documents

A Guide to CalPERS Blue Shield of California’s Health Plan · Enclosed is your Health Benefits Officer Resource Guide, a desktop reference to provide CalPERS ... CalPERS. Blue Shield