CalPERS - CalPERs Member Support

Member Support

Find care

Let us help you find the care you need.

Your primary care provider (PCP) focuses on your overall health and offers coordinated personalized care to support your total well-being.

If you enroll in the PERS PPO plan, you will have the opportunity to choose your primary care physician. This is your main doctor and usually your first point of contact. Having a strong connection with your primary care provider allows them to gain a deep understanding of your medical history, enabling them to deliver the most appropriate treatment and guidance.

If you do not select a primary care provider, one will be matched to you. You can change your primary care provider at any time.

How to find your primary care provider or select a new one:
To search for a primary care physician and other providers, call Included Health or log in.

To change your PCP, call Included Health at 855-633-4436 or visit the Blue Shield member portal.

Find the right healthcare provider that meets your specific needs.  You can search by condition, procedure, or specialty to access a curated list of high-quality, in-network doctors, specialists, and clinics. By leveraging this tool, you can identify the best-matched physicians for your unique health requirements. Access your Included Health account from your phone or computer to get started.

We can help find and schedule in-network, local care for complex needs. Included Health identifies high-quality, in-network physicians and referrals best matched to your specific needs. Personalized physician recommendations are provided based on your unique requirements and preferences. We can also request that your patient records are shared between participating providers and referred specialists to ensure comprehensive and coordinated care. Message a Care Coordinator in the Included Health app in or call 855-633-4436 to learn more and get started today.

We provide you with 24/7 telephonic support from registered nurses who can help direct you to the next clinically appropriate step, whether it be home care, urgent in-person care, or other integrated health services and benefits. You can consult with a nurse at any time or speak with a staff clinician for personalized advice on the best course of action for your care. This service includes education and support on your condition, symptoms, and treatment next steps via live phone consultations with Included Health staff clinicians. If applicable, the staff clinician will share educational materials, such as weblinks to various resources, and provide a written after-call summary through the Member Portal. Log in or call 855-633-4436 to learn more and get started today.

Include Health offers a convenient way to access care anytime anywhere.

Our services include:

Urgent care
When you need urgent care, get it from the convenience of your home or wherever you may be. You have 24/7 access to our best-in-class virtual care network.

Virtual primary care
Get primary care with virtual PCPs who write and refill prescriptions, order tests and labs, and offer dedicated support no matter where you are in your healthcare journey.

Virtual mental health care
Mental health is an important part of your overall well-being. Book a virtual visit with a therapist or psychiatrist for compassionate care.

Log in or call 855-633-4436 to learn more and get started today.

Member services

We offer member advocacy services to help you navigate your health plan and answer questions about your plan benefits.

Included Health can help you navigate your health plan.

We offer assistance with making sense of deductibles and out-of-pocket expenses. Our Care Coordinators also assist with requests for pre-authorization information, ensuring you understand all aspects of your coverage and can make informed decisions about your healthcare. You can access comprehensive plan coverage information. You can access comprehensive plan coverage information by logging in or calling 855-633-4436.

We are dedicated to helping you resolve issues related to your claims. We support you through denial of services, can help with pre-authorizations and can review any balanced billing statements. Log in or call 855-633-4436 to learn more and get started today.

We can help you understand the costs associated with receiving care. You can access estimates of out-of-pocket costs for common procedures with preferred providers or at recommended facilities, taking into account your specific coinsurance and deductibles, and any out-of-pocket maximums. Log in or call 855-633-4436 to learn more and get started today.

Access your historical medical and pharmaceutical claims, including claims for provider visits, through a convenient self-service app. You can view detailed information about each claim, including the claim type, facility, and your payment responsibility. Log in or call 855-633-4436 to learn more and get started today.

If you are undergoing treatment for certain medical conditions and have been receiving care from a provider who is no longer in-network, you may qualify for continuity of care. Please contact us for more information.

Call 855-633-4436 to learn more.

You can dynamically track your spending progress towards medical deductibles and out-of-pocket maximums, helping you stay informed. Log in or call 855-633-4436 to learn more and get started today.

The value-based site of care program is designed to help you save on out-of-pocket costs, other than your deductible and coinsurance.

ASC Value-based Purchasing Flyer

Lab Services. Reduce your out-of-pocket costs by obtaining routine lab services at Labcorp or Quest Diagnostics.

Laboratory Site of Care Flyer

Find a Quest near you.  

Find a Labcorp near you.

For details regarding Lab Exceptions, please refer to your Evidence of Coverage (EOC) or contact Included Health at (855) 633-4436.

Outpatient Surgery. If you need a procedure, such as an arthroscopy (a surgical procedure to examine and treat a joint in an area like the knee) or a colonoscopy, you can save money by going to an ambulatory surgical center (ASC) instead of a hospital. By using an ASC that is part of the Value-based Site of Care program, you will have little to no out-of-pocket costs, other than the plan’s deductible and your coinsurance.

Other procedures that are part of the program include gallbladder removal, sigmoidoscopy (a test that examines your large intestine, similar to a colonoscopy), hernia repair, and nasal or sinus corrective surgery.

Hospital Outpatient Facility Form

Hip and Knee Joint Replacement Surgery. CalPERS and Blue Shield of California have enhanced the value-based pricing program for elective hip and knee replacement. As a result of breakthroughs in clinical care and technology, most joint replacement surgeries now occur on an outpatient basis. Outpatient surgery offers many advantages, including a shorter recovery time, less pain, and a lower risk of infection.

As a PPO member, you have the option to choose any facility. However, if you get care from one of the preferred participating facilities, you can lower your out-of-pocket costs. We can help you make sure a center or lab is part of the program.

To learn more about ways to save money, log in or call Included Health at (855) 633-4436.

PPO Value-based Pricing Program for Hip and Knee Replacement Flyer

Save money on labs

CalPERS and Blue Shield of California offer 100% coverage for lab services when you use Quest Diagnostics or LabCorp. Simply print or screenshot this one-page lab request document and ask your provider to send your lab order directly to an in-network lab to save.

Download the lab request document

NEW!

Progyny

Effective July 1, 2027, CalPERS members enrolled in a PERS Platinum Basic or PERS Gold Basic plan will have family building coverage available through Progyny.

This includes:

Infertility testing, diagnostics, and counseling*
Infertility treatment, including IUI and IVF (up to 3 attempts to collect or retrieve sperm, 3 completed egg retrievals and unlimited embryo transfers) *
Infertility medications used as part of covered infertility care*
The services listed above for surrogates, gestational carriers, or donors
Fertility preservation when medical treatment or your medical condition will cause infertility (e.g., before cancer treatment)*
Adoption counseling with access to adoption-focused Progyny Care Advocates to provide support and resources

* Requires medical necessity as determined by your fertility specialist in the Progyny network

For more information, please visit benefits.mypgny.com/calpers or download the Progyny benefit overview. Phone lines open 6/1/2027.

Contact Us

Included Health Member Services

Phone: 855-633-4436
TTY 711
Access your Included Health account to message your Care Team Coordinator.
Hours: 24/7/365

CVS Caremark - Pharmacy Member Services

Phone: 1-833-291-3649

Health Benefit Officer Resources

Email: calperssupport@includedhealth.com
Phone: 855-393-7348
Hours: 8 a.m.–6 p.m. PST, Monday to Friday