Open enrollment for CalPERS health plans runs Sept. 15 through Oct. 10, and coverage changes made during that period will take effect Jan. 1, 2026, CalPERS presenters said.

The information session, led by Vanessa Albritton of CalPERS with presentations from Rob Jarzombek and Melissa Rucker, covered plan options, an upcoming pharmacy benefits manager change, updates to the Value‑Based Insurance Design (VBID) credits for PERS Gold plans, Medicare enrollment guidance, and tools members can use to compare coverage and premiums.

Why it matters: Hundreds of thousands of active and retired California public employees and their dependents use CalPERS health plans; changes to pharmacy administration, service areas and VBID rules affect members’ costs, where they can get care and how quickly prescriptions are filled.

Officials announced administrative decisions and operational changes. Rob Jarzombek, chief of the Health Plan Research and Administration Division, said, “CVS Caremark is replacing OptumRx as the pharmacy benefits manager for many of our health plans starting 01/01/2026.” CalPERS is also working with SilverScript (a CVS affiliate) to administer pharmacy benefits for affected Medicare plans, and staff said letters have been mailed to impacted members and a webinar on the PBM transition is scheduled for Sept. 18.

Vanessa Albritton detailed service‑area and VBID changes. She said, “Blue Shield Access Plus will replace Trio here. Monterey County members currently enrolled in Trio will be automatically enrolled in Blue Shield Access Plus unless they make a change during open enrollment.” On VBID, Albritton summarized the credit structure: “Each qualifying activity is worth $100, and members can earn up to $500 in credits per year,” and she added that some dependents “other than a spouse or domestic partner automatically receive all 5 credits at the start of the year,” with a combined family cap of $1,000.

CalPERS staff clarified how VBID credits will be applied in 2026: credits will no longer be applied automatically in all cases and members must take required steps—such as completing screenings, participating in care‑management intake or getting second opinions—to earn credits. Members should track credits via Included Health’s deductible tracker on the Included Health website or mobile app, officials said.

On plan types and benefits, Jarzombek reviewed differences between PERS Gold and PERS Platinum basic PPOs: PERS Gold’s service area is California only and typically has lower premiums with higher out‑of‑pocket costs (an in‑network coinsurance split described as 80/20 in the presentation); PERS Platinum offers nationwide and international coverage with higher premiums but lower member cost‑shares (presenters described a 90/10 in‑network split). Jarzombek said members can find detailed benefit breakdowns in each plan’s evidence of coverage and the CalPERS health benefits summary.

Melissa Rucker, assistant chief of the Health Account Management Division, reviewed Medicare options and enrollment timing. She responded to the common question of whether a member must enroll in Medicare while still working: “If you’re working past the age of 65 and you’re covered by a CalPERS plan or another employer group health plan, you are not required to enroll in Medicare,” Rucker said, adding guidance on when retirees should apply to avoid coverage gaps. She also explained the “combination plan” that results when at least one family member is on Medicare and at least one is not: “All members of your family must be enrolled in plans with the same health carrier,” she said.

Staff addressed frequently raised operational questions: provider contract terminations generally are not treated as qualifying events to change plans outside open enrollment, CalPERS said; members in an ongoing course of treatment can request “continuity of care” from the new plan; and moving, retirement and Medicare eligibility are qualifying events that allow plan changes within 60 days of the event. Richard Ramsey, who answered enrollment questions, described the paperwork for adding a disabled dependent older than 26 (the HPD‑34 disabled dependent questionnaire and medical report) and reiterated that parents are not eligible dependents for employer‑sponsored coverage.

On the pharmacy transition, staff said pharmacy access should remain similar for most members, but some formulary and copay differences may occur. Jarzombek said transition plans include automatic transfers of approved prior authorizations and that members will be notified if action is required. He also noted that mail‑order will remain available and that for basic members the 90‑day retail option will be restored when possible; previously mail order had been mandatory for basic members under the former PBM.

Resources and next steps: CalPERS emphasized tools members can use during open enrollment, including myCalPERS (for personalized plan statements and the Search Health Plans tool), the health benefits summary, the Medicare Enrollment Guide, plan evidence of coverage documents, and a dedicated webpage for the PBM transition (www.calpers.ca.gov/cvs). Officials said they mailed letters to members affected by the PBM switch, those facing premium increases of 9% or more, and Monterey County members affected by the service‑area change. A PBM webinar with CVS is scheduled for Sept. 18 at 10 a.m. Pacific; questions and answers from this session will be posted online the following week.

The presentation closed with an invitation to use the posted materials, contact plan carriers or CalPERS member services for plan‑specific questions, and a request that attendees complete a short feedback survey.

Ending: CalPERS staff urged members to review their myCalPERS account for custom plan statements and to use the open enrollment window Sept. 15–Oct. 10 to make changes that will take effect Jan. 1, 2026.