[{"_1":2,"_112":-5,"_113":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6124041,"mediaKeyId","2686672-a62ced09ddddb4eac65ddeb35b2c762e","parentId",2686672,"title","CalPERS committee approves VBID updates for 2026, votes against adding PERS Gold for out‑of‑state members","audioSeconds",3174,"startMs",7266000,"endMs",10440000,"viewUrl","/Search/View?dp=1&key=2686672-a62ced09ddddb4eac65ddeb35b2c762e&start=7266&end=10440","thumbnailUrl","https://assets.pipeline.soar.com/2686672-a62ced09ddddb4eac65ddeb35b2c762e/thumbnail_7266000.jpg","articleUrl","/articles/6124041/California/CalPERS-committee-approves-VBID-updates-for-2026-votes-against-adding-PERS-Gold-for-outofstate-members","mediaUrl","https://secure.pipeline.soar.com/6124041-3fbeb55eb1099706e54ecc9c07fce37b/orig.mp4?Expires=1770541963&Signature=C74W4aUyoOGeevWMli0OAeyOgr0qGEAk8QD2rR~rLexg62LpLzDBHm-TfLtEQ0ONCQNuxDoKFVHP6M4v6Ln-CeEVdqmLKsCpsBUil1WjTfID7-eOjl7kS221Ud09B72R1dfKyYzVyq3swW0RHdMOStNi0XOWvWlYSTXrI5gwwM-7mS3f~fl5tcXhTiVoSkYj~9Z~t3ll1e1jyiQVCKNW89-~F00~lEMN9CFatDHwU7Q6QmEzD6~bNTiE15~fVE~a24CgQFOkmcckMPFMP2NZv6jchOdg2dou-TZ7xAMd-em13I0Nk86~hPOnsDV1hk6VXHyE0PLsPLWT95MpXg3S1g__&Key-Pair-Id=KUT5TJCACFTXG","author","California Public Employees Retirement System","date","2025-03-18T22:26:28Z","article","The CalPERS Pension and Health Benefits Committee on March 2025 approved changes to the value‑based insurance design (VBID) for the PERS Gold basic PPO for plan year 2026 and separately declined to expand the PERS Gold service area to all 50 states.

The VBID changes, approved first by the committee, revise the program’s deductible offset credits and expand the activities members can complete to earn up to five $100 credits to offset the $500 inpatient deductible. The credits will be available across three activity categories — engagement and self‑care, mental health monitoring and preventive care — and will require active participation with Included Health care coordinators or completion of specified preventive services to earn some credits, CalPERS staff said.

Why it matters: Staff said the VBID refinements aim to improve care quality and equity across CalPERS PPO members while maintaining premium neutrality. Julia Logan, a CalPERS team member, said the changes “maintain the overall structure of the VBID program beginning with a $10 office co payment for primary care” while expanding opportunities to earn credits, and adding a mental‑health screening component for 2026.

What the committee approved: The motion to approve staff’s VBID recommendation was moved and seconded by trustees and passed by voice vote; the meeting transcript records the motion was approved by majority voice vote but does not list an exact roll‑call tally.

Out‑of‑state PERS Gold: Staff also presented three modeled options for out‑of‑state basic PPO members, roughly 26,000 members (about 11% of the Basic PPO population). Option 1 would expand PERS Gold’s service area nationwide while keeping the existing 80/20 benefit design, but staff modeled it would raise PPO premiums by about 2%–3% for in‑state and out‑of‑state members. Option 2 would create a new lower‑premium out‑of‑state Gold with steeper benefit changes — in‑network coinsurance rising from 20% to 35%, the individual deductible increasing from $1,000 to $5,500, maximum out‑of‑pocket moving from $3,000 to about $8,300 and out‑of‑network cost‑sharing rising to 50% — producing roughly 30% lower premiums for out‑of‑state members but much higher member out‑of‑pocket exposure. Staff recommended Option 3: retain the current service area and plan design.

Trustee discussion and public comment: Dozens of out‑of‑state employees and affected family members called or spoke in person during public comment, saying the lack of a lower‑cost in‑state equivalent (pre‑2022 PERS Choice) had produced steep premium burdens. Several public commenters described monthly family premiums exceeding $1,000 and urged the board to adopt Option 1. Trustee Lorena Ortega and others pressed staff for a roadmap and possible bargaining or legislative approaches to address the subgroup of a few hundred active state employees required to live out of state; staff said collective bargaining and discussions with CalHR or statute changes could be pursued but that creating a plan solely for a small subgroup is prohibited by the enabling statute (PEMHCA) and would be legally complicated.

Final vote on out‑of‑state expansion: After extended discussion and public comment the committee moved to adopt staff’s recommendation (Option 3 — no expansion). The vote was taken by roll call: Kevin Pockey (aye), Malia Cohen (no), David Miller (aye), Lorena Ortega (aye), Jose Luis Pacheco (aye), Theresa Taylor (no), Yvonne Walker (aye), Melissa Willette (abstain). The motion passed (outcome: approved to retain status quo); the transcript records the roll‑call votes above.

What the decision means: Staff said that adding a nationwide Gold option without offsetting changes would likely shift membership and raise in‑state premiums, destabilizing the PPO pool. Trustees and staff also noted other paths remain — bargaining‑negotiated subsidies for specific employee groups or legislative changes — and the committee requested staff return with additional research and creative options at the June public meeting.

Votes at a glance:
- Motion: Approve staff recommendation to modify VBID credits for 2026. Mover: Trustee Jose Luis Pacheco; second: Theresa Taylor. Outcome: approved (majority voice vote; exact tally not specified in transcript). Notes: Implementation steps to follow if approved.
- Motion: Adopt staff recommendation not to expand PERS Gold service area (Option 3). Mover: President Theresa Taylor; second: (recorded as second). Outcome: approved by roll call (yes: Kevin Pockey, David Miller, Lorena Ortega, Jose Luis Pacheco, Yvonne Walker; no: Malia Cohen, Theresa Taylor; abstain: Melissa Willette). Notes: Committee directed staff to explore legislative/bargaining options and report back in June.

Ending: Committee chair Ramon Rubalcaba thanked callers and directed staff to continue exploring out‑of‑state remedies, including statute and subsidy pathways, while maintaining the system’s fiscal stability.","mediaType","Video","parentTitle","CalPERS Board Meeting | Tuesday, March 18, 2025","oneSentenceSummary","The CalPERS Pension and Health Benefits Committee on March 2025 approved updates to the PERS Gold value‑based insurance design for 2026 but voted against expanding the PERS Gold service area to all states, following extensive public comment from out‑of‑state employees.","taxTitle","California Public Employees Retirement System, Agencies under Office of the Governor, Executive, California","taxId",70079,"location","California","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6124027,"Open enrollment shows lower plan switching; CalPERS outlines 2025 COLA mechanics",962,11998000,12960000,"/Search/View?dp=1&key=2686672-a62ced09ddddb4eac65ddeb35b2c762e&start=11998&end=12960","https://assets.pipeline.soar.com/2686672-a62ced09ddddb4eac65ddeb35b2c762e/thumbnail_11998000.jpg","/articles/6124027/California/Open-enrollment-shows-lower-plan-switching-CalPERS-outlines-2025-COLA-mechanics","https://secure.pipeline.soar.com/6124027-2493b9e2050d91d456b93ee9ff1d51a0/orig.mp4?Expires=1770541963&Signature=E9gpxTWq-LgLXuTt8yZEErJYb~HJOznYw3gJdIXe8lCt-LG3pw0cOWpflRRg9i1qmGvhRQRUQHOoMoNE8L1ddsg4UrOZ1G3IMAEpjH1ftYLvNydU1EddUmzuahjcg~DppveSqyN8DomFDE9rstHYjv8voWeGuFPVwk6l5HHHIDzrS3u13LDmwxqC2WeGB~bCI-EFZgC~Idvw0E2kYv29aPd30WBchUHNOWx4fftcITv5QUS6W~5w6qySDxfwQoTo0u1pljwoZtZx1yMud7RdwQ3rIs3RxrYYLRiNyz-SvAbwLgFAqR54FMEJYCC7RpDNgccWIGasJJcXdYcZgOsu9g__&Key-Pair-Id=KUT5TJCACFTXG","CalPERS reported lower plan switching in the recent open enrollment and provided the annual retiree cost‑of‑living adjustment (COLA) overview to trustees.

Open enrollment results: Rob Gerzombek reported an overall transfer rate of 3.9% for the latest open enrollment, down from 5.6% the prior year. The basic plans saw about a 4.5% transfer rate (roughly 55,000 members changed plans); Medicare members transferred at about 1.7% (≈5,900). The largest net gains in basic plans were Blue Shield Access+ (a net gain of ~6,200 members, +5%), UHC Alliance (≈2,800 members, +3.75%) and UHC Harmony (≈2,600 members, nearly +34%). Major losses included Kaiser (≈6,200 member decline), PERS Platinum (≈4,100 loss) and Anthem Select (≈3,100 loss), driven in part by relative premium moves.

CalPERS also noted basic plan expansions in 2025: UHC Harmony expanded into Contra Costa, Solano and Napa counties; Blue Shield Trio expanded into Contra Costa and partial Shasta zip codes; Kaiser expanded into additional zip codes in Monterey County. Staff said these expansions had mixed initial membership results but were part of broader access work.

Retiree COLA and PPPA: Kimberly Pulido explained the 2025 COLA framework. For calendar year 2024 the Consumer Price Index for All Urban Consumers (CPI‑U) rose 2.95%; COLA increases are payable in May and are limited to the lesser of CPI‑U change or an employer‑contracted COLA provision. Nearly 96% of retirees are under a 2% COLA contract; other contracts can include 3%, 4% or 5%. A small subset of very long‑retired members may be eligible for a purchasing power protection allowance (PPPA) to preserve a minimum purchasing‑power threshold (75% for state and school members; 80% for public agency members). Pulido said the PPPA population is small (roughly 16,000 members) and COLA adjustments will appear on May 1 warrants.

Trustees had no additional questions on these informational items; staff said they will continue posting member‑facing materials and survey results to their website and report follow‑up metrics as available.","CalPERS reported a lower open‑enrollment transfer rate for 2025 and reviewed the May retiree cost‑of‑living adjustment (COLA) mechanics and the purchasing power protection allowance (PPPA).",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6124032,"CalPERS steps up annual benefit verification, reports millions recovered in overpayments",300,3480000,3780000,"/Search/View?dp=1&key=2686672-a62ced09ddddb4eac65ddeb35b2c762e&start=3480&end=3780","https://assets.pipeline.soar.com/2686672-a62ced09ddddb4eac65ddeb35b2c762e/thumbnail_3480000.jpg","/articles/6124032/California/CalPERS-steps-up-annual-benefit-verification-reports-millions-recovered-in-overpayments","https://secure.pipeline.soar.com/6124032-08d81cb7693a7cf9ba614d6cea23c808/orig.mp4?Expires=1770541963&Signature=CLCvKf1AOgxTOL8HiN-8wl3o0rA~Ho236UGR6enwF2~Ug3bpjitz~OEO27GUcx0fPvdwK6iPlVru90nRBgHjDjIM5Z6LfAysMFy7HJG1GP3oS8bUG5GyP2wDkHq66JuTMQAT1DZIvO~4HLqZt77QMQRuFhzN9oI8ccFEEBkQKno3wJN~FZ-d69WoKi76px2MvJto8xemtMon2KsfJmoE1a~83rB~8e~C6-bxy8q6e-syajF1jPlEHhLOuY4gEBwC41ytlNxvnZv2E6bkvlTv39dz8uVw4QjI92ZRfgZiC0EC9JETADIoOs~dfgPEtBFXENcne4wIxx7lo~xEKUiuLQ__&Key-Pair-Id=KUT5TJCACFTXG","CalPERS staff said the agency is moving from a biennial to an annual benefit verification cycle for high‑risk retirees to reduce overpayments tied to unreported deaths and payroll data errors.

Kim Malm, a CalPERS team member, told trustees that the 2025 benefit‑verification cycle will begin March 27 and CalPERS will mail certification requests to about 10,000 retirees who meet risk thresholds (including age, benefit amount and time since last contact). The certification may be notarized or supported by a letter from a health‑care provider, care facility or bank; if a required certification is not returned, staff said the agency will hold the retiree’s August 1 benefit payment if the roll closes on July 18.

Collections and results: Malm summarized recent results from CalPERS’ combined efforts, including a death‑verification vendor and a contract with a collections firm. In 2024, a benefit‑verification mailing of about 8,700 letters produced reports of more than 200 deaths across California and 24 other states, which generated roughly $2.2 million in identified overpayments and $1.7 million collected to date. CalPERS began using SoCure as a death‑verification vendor in July 2024; SoCure has reported about 460 deaths to date, corresponding to approximately $4.1 million in overpayments with about $3.3 million collected. Combined, CalPERS said the death‑verification and benefit‑verification efforts identified nearly 700 deaths and about $6 million in overpayments, with roughly $5 million collected in the past year.

Operational fixes: CalPERS staff also said payroll data errors — for example, inaccurate scheduled work hours reported by employers — contributed to calculation errors that lead to benefit adjustments and potential overpayments. The actuarial office is developing tools to detect calculation errors sooner, and CalPERS’ legal office contracted with Cedar Financial to pursue debt recovery across states.

Member assistance and outreach: Staff encouraged affected members to contact the CalPERS call center or use secure messages in myCalPERS if they have questions. CalPERS also reported ongoing member education events: a March in‑person session in Visalia drew 439 attendees, virtual events drew more than 1,800 attendees, and upcoming in‑person and virtual sessions were scheduled for Burbank, Monterey, Anaheim and Redding in 2025–2026.

Trustees asked no substantive follow‑up questions during the presentation; staff said they would continue to report on the program’s outcomes.","CalPERS is moving to an annual benefit‑verification cycle for high‑risk retirees, sending 10,000 letters starting March 27, 2025, and reported recent overpayment recoveries tied to death verification and payroll data errors.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6124037,"CalPERS reports implementation issues, improving call metrics after PPO move to Blue Shield and Included Health",360,12360000,12720000,"/Search/View?dp=1&key=2686672-a62ced09ddddb4eac65ddeb35b2c762e&start=12360&end=12720","https://assets.pipeline.soar.com/2686672-a62ced09ddddb4eac65ddeb35b2c762e/thumbnail_12360000.jpg","/articles/6124037/California/CalPERS-reports-implementation-issues-improving-call-metrics-after-PPO-move-to-Blue-Shield-and-Included-Health","https://secure.pipeline.soar.com/6124037-c4008ade763f8bc42dc17703131889a7/orig.mp4?Expires=1770541963&Signature=LOHwznxYsEjADeHOxVb2UHPxh-NoPRDUdb7QAua6HKpn~9VKWsTBVsLSNDT2Z9ncz-Nx33vfR-3jsqPdRe~SWH7xMXtMn379L8Dgc6hpaGvSfq3mA0sG1Bv1EOayBS1FoIxYOb34iyTX2ax3C0PekfgOnBR9O-05Eul7DiEuuDSTq2Yrr7r413dZgwl9TcqQKLc--bSeHB8bi9xZaj7GL2Y17jGtDaDcb4ZIKoNRUTYUfs9NUyKO3CXYPKuZGBrzlrT0EholdroG36312o6Gvd5jF9YhNyM6mNvPuW4jXo7retoeSxKmrHpFhHWQzxvGw19AP7sUe7OkqK8qlHUihA__&Key-Pair-Id=KUT5TJCACFTXG","CalPERS staff told trustees that the multi‑month transition of roughly 400,000 PPO members to Blue Shield of California and Included Health produced early service gaps but is now stabilizing.

Rob Gerzombek, a CalPERS team member, said call volumes to Included Health peaked at about 6,000 calls per day in January, driven largely by members seeking clarification about primary care provider (PCP) assignments. Staff and vendor teams implemented corrective actions — expanded provider network access, additional call‑center agents, a voice mailbox option for PCP changes, improved FAQs and training, and closer quality monitoring — and metrics are improving: Included Health answered 62% of calls within 30 seconds in January–February and has a target of 90%.

CalPERS also established continuity‑of‑care protections and a limited out‑of‑network exception program for members undergoing active treatment, maternity care, scheduled surgery or other specified conditions. As of February, staff reported about 1,100 continuity‑of‑care requests with roughly 950 approvals; about 100 limited out‑of‑network exception requests were received and most were approved.

Service and use so far: Through February, Included Health said it provided over 21,000 referrals to high‑quality providers, enrolled nearly 300 members into care management (about one‑third into the maternity program) and delivered nearly 1,100 virtual primary/urgent care visits and more than 550 virtual behavioral health visits. CalPERS staff said they are monitoring call recordings, reviewing training materials, and improving the Included Health app and navigation so members can more easily find in‑network PCPs and learn about new benefits such as free lab tests and doula coverage.

Trustee questions and next steps: Trustees asked whether language support or other access issues emerged; staff reported no language‑access problems flagged. The committee requested ongoing updates on clinical quality measures and member experience scores as the partnership matures.","CalPERS staff updated trustees on early operational problems after moving PPO administration to Blue Shield and Included Health, including high call volumes and primary‑care matching issues; staff said service metrics and member navigation are improving and continuity‑of‑care safeguards were implemented.","actionData","errors"]

Article not found

CalPERS committee approves VBID updates for 2026, votes against adding PERS Gold for out‑of‑state members

Open enrollment shows lower plan switching; CalPERS outlines 2025 COLA mechanics

CalPERS steps up annual benefit verification, reports millions recovered in overpayments

CalPERS reports implementation issues, improving call metrics after PPO move to Blue Shield and Included Health