[{"_1":2,"_100":-5,"_101":-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],{"_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",6197450,"mediaKeyId","3853183-5d3a843d777d7ce3c2a3e748c23c7a4c","parentId",3853183,"title","CalPERS previews 2026 health premiums, flags Monterey and Harmony network changes; pharmacy benefit vendor negotiations continue","audioSeconds",679,"startMs",14027000,"endMs",14706000,"viewUrl","/Search/View?dp=1&key=3853183-5d3a843d777d7ce3c2a3e748c23c7a4c&start=14027&end=14706","thumbnailUrl","https://assets.pipeline.soar.com/3853183-5d3a843d777d7ce3c2a3e748c23c7a4c/thumbnail_14027000.jpg","articleUrl","/articles/6197450/California/CalPERS-previews-2026-health-premiums-flags-Monterey-and-Harmony-network-changes-pharmacy-benefit-vendor-negotiations-continue","mediaUrl","https://secure.pipeline.soar.com/6197450-ae3fc7eb0a95aa54ed95e4c9893b766f/orig.mp4?Expires=1771026481&Signature=e7qOWVwzWy6JbudTdqP2BiC5dmUxz82lm0X07UhCpy6OzCSCoakyzWvHw7dJfqxNb0NCbVjz1EPtIAJbxTg5ReheUOh~3PWWBRXoe4VO33005F1O2~9wcFx96BfkV-mrEK2WLDizMCjVLNZZsTTbcdOsuqsaF4P6Z~OqsRqQkcWI~y~NhyRscTEw9kyCNxC85FP1VV~7ANCQn~4Dm7~~fJDA~YP~nK31XDu44wrv6Kyw8MC1mi1AUycA0VdYgzfDLMAOmyIyv8pJbs3Lup0~0G4TdIOwuLB2AcapnUHmIh7EXqfnJ1TsAwOXbwogx0~rb8kCC~no9I2YLUTzrBpvfA__&Key-Pair-Id=KUT5TJCACFTXG","author","California Public Employees Retirement System","date","2025-06-17T21:57:08Z","article","CalPERS staff on June 17 presented preliminary 2026 premium projections for basic and Medicare health plans, recommended a change to how one narrow‑network plan is offered in Monterey County and proposed postponing another plan’s expansion to reduce premium volatility. Staff also updated trustees on ongoing negotiations for a new pharmacy benefit manager (PBM) contract intended to include financial guarantees tied to cost trend and clinical quality.

Rob George Zombeck, health plan actuary, said preliminary results show average increases of about 6.5% for basic HMOs and roughly 12% for basic PPOs; the combined CalPERS premium increase was preliminarily 8.21%, an improvement from last year. For Medicare, the weighted average across Medicare Advantage and Medigap products was higher for certain plans, driven in part by changes in CMS subsidy methodology and rising pharmacy costs. George Zombeck and Don Moulds described several drivers: medical and pharmacy trends, plan‑level claims experience, higher utilization of specialty drugs and Inflation Reduction Act changes to Medicare subsidies that have uneven effects across plans.

Two narrow‑network issues drew staff recommendations. First, Blue Shield’s Trio plan has grown and is affected by high costs in Monterey County; staff recommended replacing Trio with Blue Shield’s broader Access+ plan in Monterey to protect Trio’s statewide sustainability and avoid Trio’s premium being driven above comparable Access+ levels. Staff said the change would preserve a low‑cost statewide option but acknowledged some current Trio members in Monterey could see higher premiums; Blue Shield has begun regulatory discussions with the Department of Managed Health Care. Second, UnitedHealthcare’s Harmony narrow‑network plan expanded rapidly, particularly into Northern California counties, producing membership increases that contributed to premium volatility. Staff recommended delaying Harmony’s four‑county Northern California expansion for one year so the plan can stabilize.

Several trustees complimented staff on negotiation outcomes and the work required to moderate premium increases. Public commenters from rural California urged CalPERS to preserve access for members who rely on multi‑state or cross‑border providers — several agencies asked CalPERS to consider extending rural county designations or to allow wider PPO network options for border communities.

On the pharmacy benefit, Julia Logan, CalPERS health team, briefed trustees on negotiations with multiple PBMs following a nationwide market scan and vendor discussions. CalPERS seeks a new five‑year contract that improves affordability, strengthens clinical oversight and increases transparency. Key negotiation goals include a pharmacy cost‑trend guarantee (putting substantial dollars at risk for exceeding agreed trend thresholds), quality guarantees tied to the CalPERS Quality Alignment Measure set and enhanced audit and transparency rights. Staff said the finalists have agreed in principle to clinical guarantees and enhanced contract protections but that several contractual items remain under negotiation; a final PBM recommendation is expected at the July board off‑site. Staff warned members of potential disruption tied to any PBM transition and described mitigation steps, including transition planning, targeted outreach and CMS protections for first fills to Medicare members.

Why this matters: Health premiums are a major cost for members and employers; PBM terms affect pharmacy spending — a significant share of total health costs. Network decisions affect member access, particularly in high cost counties and rural border areas.

What’s next: Staff will continue negotiations with carriers and PBM finalists, finalize premiums and submit final rate recommendations to the board in July, and continue member outreach about any network or PBM changes.","mediaType","Video","parentTitle","CalPERS Board of Administration | Tuesday, June 17, 2025","oneSentenceSummary","CalPERS staff presented preliminary 2026 basic and Medicare premiums and recommended pausing a narrow‑network expansion to limit volatility; staff also summarized ongoing pharmacy benefit manager negotiations intended to include cost‑trend and quality guarantees.","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},6197455,"CalPERS pension committee approves intent to award long‑term care TPA contract to Illumifin, cites $16.8M projected savings",162,7431000,7593000,"/Search/View?dp=1&key=3853183-5d3a843d777d7ce3c2a3e748c23c7a4c&start=7431&end=7593","https://assets.pipeline.soar.com/3853183-5d3a843d777d7ce3c2a3e748c23c7a4c/thumbnail_7431000.jpg","/articles/6197455/California/CalPERS-pension-committee-approves-intent-to-award-longterm-care-TPA-contract-to-Illumifin-cites-168M-projected-savings","https://secure.pipeline.soar.com/6197455-cb7bb7752de6b1575e6ad3c6668170b2/orig.mp4?Expires=1771026481&Signature=ed-F1feIYYQQJ5YCMZkQsXOuvtjU~TQzp8Oxp6tt9ciBxSQDI2ps23rmqySgnoj7K6~snSmm8fTvD8ZpxrIcYraue2boepFgpYsq-d9QE~Bfuagptv13IyVvJPGnNHopX4rH4jwrEajVoQgSy-lPQgVaGEnyRMheo2K1d3AvvCcEatmUliF18mW1D1D~XdRPoKnkFAGatSJg8pA6gUB48I7XPpoXsGp5Dy1cJnG14IG1LMjLEDwg-iczK3SOY3u5UJCBxjeg5KuW8XoFBaUGC6y0DDFlGU7VxR3fLOyU~zDQrg377dnuAXHZ290WEtl7wM2vqFt81DHxKoTNN7Cd1A__&Key-Pair-Id=KUT5TJCACFTXG","The California Public Employees’ Retirement System Pension & Health Benefits Committee on June 17 approved an intent to award a five‑year contract to Illumifin to serve as third‑party administrator (TPA) for CalPERS’ long‑term care insurance program, subject to final negotiations and satisfaction of requirements.

Staff presented results of an August 2024 request for proposals that produced three finalists: Illumifin (the incumbent), Well Cove (also listed as CHCS in the process) and Davies Life & Health. Jared Chinnberry, CalPERS staff, said the selection combined technical scoring, interview performance and fee proposals. Illumifin scored highest on total points and proposed the lowest overall administrative fees over the five‑year period; staff reported projected net program savings of $16.8 million (a 25% reduction compared with the current contract) after negotiating a July 1, 2026 start date (earlier than the originally planned January 2027) and fee reductions.

Chinnberry summarized the evaluation: Illumifin’s national scale (more than 1.9 million long‑term care policies, according to staff), in‑house software for electronic visit verification and fraud detection, and proposed data platform enhancements gave it an edge. Staff said Illumifin’s proposal would lower administrative service fees, including per‑member‑per‑month (PMPM) charges and claimed a 23% fee reduction from the initial Illumifin bid; the negotiated start date added roughly $2 million in additional savings compared with a January 2027 start.

Trustees discussed the evaluation and congratulated staff on the negotiation results. President Theresa Taylor said it was “a really good win” for the long‑term care program and thanked staff for their work. Trustee David Miller seconded a motion approving the intent to award; the committee then conducted a roll call vote. Votes recorded in the transcript were all “aye”: Kevin Pauke; Malia Cohen; David Miller; Nicole Griffith (for Reyna Ortega); Jose Luis Pacheco; Theresa Taylor; Yvonne Walker; Melissa Willette. The motion carried and staff announced the award to the incumbent Illumifin, with an effective contract period of 07/01/2026–06/30/2031, pending final negotiations and contract execution.

Why this matters: The long‑term care program covers roughly 77,000 policyholders; administrative fees are an ongoing cost that directly affect program sustainability and premium pressures. Staff said the recommended contract reduces administrative fees materially and is intended to improve data and fraud‑detection capabilities while ensuring continuity of service.

What’s next: Staff will finalize contract negotiations and proceed with implementation after board approval; the contract’s earlier start date requires vendor readiness for transition activities to begin well before January 2027.","The Pension & Health Benefits Committee voted unanimously to issue an intent to award a five‑year contract for the CalPERS long‑term care third‑party administrator to Illumifin, with a proposed effective date of July 1, 2026 and projected program savings of about $16.8 million over the contract term.",{"_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},6197460,"CalPERS Risk & Audit Committee approves 2025–26 compliance and audit plans; retirees urge extended credit monitoring after 2023 breach",1282,5198000,6480000,"/Search/View?dp=1&key=3853183-5d3a843d777d7ce3c2a3e748c23c7a4c&start=5198&end=6480","https://assets.pipeline.soar.com/3853183-5d3a843d777d7ce3c2a3e748c23c7a4c/thumbnail_5198000.jpg","/articles/6197460/California/CalPERS-Risk-Audit-Committee-approves-202526-compliance-and-audit-plans-retirees-urge-extended-credit-monitoring-after-2023-breach","https://secure.pipeline.soar.com/6197460-1ac394d2aab661ec8626a9faab952075/orig.mp4?Expires=1771026481&Signature=nkv6X7oLr8Y0MdzRgsOaU-LsPQCXeTXflGh-auC3nVVpp6qJFaHm~drh34PXjh0ALiZfM1WtrnOVf~8kmUpKBOFs2WxxJsFEowVQUxkzyA9psnLl9-wVWQqT~5fRTXN0LQI0xUN5~K8JbovwaIl0nuuLfjcwnpPCHei70zCFq8LafPc1UfTpPE65d5MxwL0k5f2pmuNR9oP-xlOLEtVhlK1aOjHzST5CiaudH-ILPQUdky0oJ1uKEFB4qGgRFmR9wVrWnD7o51ry32qQ4d8P1y3pRBqD2E2HqNpFPDXlzAvdcfx1nz~wz0FF5sJW8cRh9o2exq57WjICm2gIG233Mw__&Key-Pair-Id=KUT5TJCACFTXG","The California Public Employees’ Retirement System Risk & Audit Committee on June 17 approved the enterprise compliance risk and governance annual plan, the Office of Audit Services (OAS) audit plan, and the board’s independent auditor plan for fiscal year 2025–26.

Committee members voted by acclamation or unanimous roll call on the three agenda action items after staff presentations and brief question-and-answer exchanges. Committee members also heard multiple public comments urging the system to extend free Experian credit monitoring for retirees impacted by CalPERS’ May 2023 data breach.

Kevin Fine, CalPERS chief compliance officer, presented the enterprise compliance risk and governance (ECRG) annual plan, saying the multi‑year program will continue maturing CalPERS’ compliance work across “people, processes and technology,” expand use of a governance risk and compliance (GRC) platform, formalize regulatory change processes and enhance assurance and monitoring activities. He told trustees the RFP for the board’s next independent auditor was issued May 20, 2025, and that written responses to proposers’ questions would be posted June 20 and proposals are due July 7, 2025.

The committee voted to approve the ECRG annual plan (agenda item 5A) by acclamation during the meeting. Belize Chippoui of the Office of Audit Services then presented the OAS risk‑based internal audit plan, describing the methodology — executive and senior management interviews, board surveys, and coordination with ECRG — and described a four‑cycle employer compliance review using data analytics to select agencies. The committee approved the OAS plan (agenda item 5B) with a motion recorded by Trustee Jose Luis Pacheco and seconded by Trustee Frank Ruffino; the motion passed unanimously.

The committee also heard BDO, the board’s external auditor, outline its annual independent audit approach for CalPERS’ June 30, 2025 financial statements. Billy Kim, BDO principal, and colleagues described significant audit risk areas — management override of controls, valuation of investments and valuation of long‑term care liabilities — and described planned procedures, including confirmations with custodians, testing of journal entries and actuarial review. The committee approved BDO’s audit plan (agenda item 5C) by motion from Trustee Jose Luis Pacheco and second by Vice Chair David Miller; the motion passed unanimously.

Public comment focused heavily on the May 2023 data breach affecting roughly 769,000 retirees and inactive members. Margaret Brown, president of the Retired Public Employees Association of California (RPEA), urged CalPERS to continue Experian credit monitoring \"because the risks to our identities didn't end when the headlines faded.\" Several other RPEA representatives and retirees echoed that request, describing confusing breach notices and the lifetime risk of identity theft.

CalPERS staff acknowledged the comments and said they would evaluate options, including discussions with Experian about continued coverage and discounted rates. The committee did not take formal action on the public‑comment request; staff said the matter is under advisement.

Why this matters: The plans approved by the committee set internal audit and compliance priorities for the coming fiscal year and guide external audit work that underpins the system’s audited financial statements. The public comments underscore ongoing member concern about data security and the operational and reputational implications of vendor breaches.

What’s next: CalPERS staff said responses to the independent auditor RFP will be evaluated after the July 7 deadline, and a recommended firm is expected to come to the Board of Administration later in 2025. Staff also said they will follow up on the Experian requests and report back to the board.","The Risk & Audit Committee approved enterprise compliance and audit workplans for FY 2025–26 and heard public pleas from retired members urging CalPERS to extend Experian credit monitoring after a May 2023 data breach.","actionData","errors"]

Article not found

CalPERS previews 2026 health premiums, flags Monterey and Harmony network changes; pharmacy benefit vendor negotiations continue

CalPERS pension committee approves intent to award long‑term care TPA contract to Illumifin, cites $16.8M projected savings

CalPERS Risk & Audit Committee approves 2025–26 compliance and audit plans; retirees urge extended credit monitoring after 2023 breach