CalPERS officials said open enrollment for 2026 health coverage will run Sept. 15 through Oct. 10, and any changes made during that period will take effect Jan. 1, 2026. Vanessa Albritton, a presenter for CalPERS, gave an overview of enrollment windows, plan types and resources available to active and retired state, CSU, public agency and school members.

The open-enrollment window matters because it is the only routine period—absent qualifying life events—when eligible members may newly enroll, change plans, add or remove dependents, or cancel coverage, Albritton said. She advised members to review their myCalPERS account for personalized plan statements and to check plan premiums before deciding whether to make a change.

CalPERS emphasized several items of note for 2026. The Value-Based Insurance Design (VBID) program continues and lets members lower their inpatient deductible by completing qualifying healthy-activity credits worth $100 each, up to $500 per subscriber; dependents other than a spouse or domestic partner receive all five credits at the start of the year. Family credits are capped at $1,000. Albritton said some activities are tracked via claims, while others can be self‑reported through Included Health and the program’s mobile app.

Rob Jarzombek, chief of the Health Plan Research and Administration Division, announced that CVS Caremark will replace OptumRx as the pharmacy benefits manager (PBM) for many CalPERS plans effective Jan. 1, 2026. “CVS Caremark is replacing OptumRx as the pharmacy benefits manager for many of our health plans starting 01/01/2026,” Jarzombek said. He said pharmacy access should remain similar for most members, but some formulary tier changes and co‑pay adjustments are possible; CalPERS will publish formularies and tiering on a dedicated CVS website during open enrollment.

Jarzombek said prior authorizations approved under OptumRx will be transferred automatically where appropriate and that plans are in place to allow members to fill prescriptions affected by formulary changes during the transition. He added that mail‑order prescriptions will continue, that 90‑day supplies will be available again at network retail pharmacies for many basic plan drugs, and that the mandatory mail‑order requirement under OptumRx will become optional under CVS for basic members. CalPERS is hosting a PBM webinar on Sept. 18 to review the transition and answer member questions.

Albritton and staff reviewed plan changes and plan types. They described three common plan architectures offered to members: HMOs (network-limited, typically smaller copays and no deductible), PPOs (PERS Gold and PERS Platinum, with deductibles and coinsurance; Gold is California‑only while Platinum offers nationwide/international coverage), and an EPO available in some rural Northern California counties. Monterey County members currently enrolled in Blue Shield Trio will be automatically moved to Blue Shield Access+ unless they select a different plan during open enrollment, Albritton said.

On differences between the PERS Gold and PERS Platinum basic PPOs, Jarzombek summarized that Gold generally has lower monthly premiums but higher member cost sharing (an 80/20 in‑network coinsurance split) and is limited to California; Platinum carries a higher premium but typically lower out‑of‑pocket cost sharing (90/10 in network) and broader geographic coverage. He and staff repeatedly advised members to consult each plan’s Evidence of Coverage and the CalPERS health benefits summary for precise deductible and coinsurance amounts.

Melissa Rucker, assistant chief of the Health Account Management Division, reviewed Medicare options and enrollment timing for members approaching age 65 or retirement. She said Medicare Advantage HMOs and PPOs require plan‑area residency and Medicare approval; supplement‑to‑Medicare plans (CalPERS supplemental plans) provide coverage across all 58 California counties and still rely on providers that accept Medicare. Rucker said CalPERS must receive members’ Medicare information to transition coverage automatically; otherwise the member will receive notices requesting action.

Richard Ramsey addressed enrollment and eligibility rules and forms. He said contract terminations between providers and plans are not treated as qualifying events for plan changes because such negotiations commonly occur year‑round; members may request continuity-of-care plans if mid‑course treatment is affected. For disabled dependents over age 26, Ramsey identified the required paperwork: the Disabled Dependent Member Questionnaire and Medical Report (form HPD‑34) and an authorization for release of protected health information (form BDS‑35), with instructions that the doctor must send the completed HPD‑34 directly to CalPERS.

Medical continuity, preexisting‑condition protections and vaccines were also addressed. A CalPERS medical staff speaker answered that CalPERS will continue to provide and cover the latest COVID‑19 vaccine for any CalPERS members aged 6 months and older who want it, with no cost sharing, despite recent FDA guidance that limited a specific vaccine’s authorization to certain groups; the speaker said CalPERS instructed carriers and pharmacy partners to cover vaccines for members per CalPERS guidance. Staff also stated there were no changes to seasonal influenza or RSV vaccine recommendations.

CalPERS highlighted online resources and communications: the myCalPERS account (custom statements, search tools to check provider networks and premiums), a centralized open‑enrollment resources page, evidence‑of‑coverage documents, the health benefits summary, and a Spanish version of the open‑enrollment newsletter. CalPERS said it mailed letters to members affected by the PBM transition, those with a premium increase of 9% or more, and Monterey County members in the plan moving from Trio to Access+; it also mailed a letter introducing SilverScript branding to Medicare members who will be affected.

Discussion vs. direction vs. decision: the webinar provided information and answers to presubmitted questions; it did not contain formal votes or regulatory decisions. The only automatic enrollment action noted was the service‑area switch in Monterey County (Blue Shield Trio → Blue Shield Access+), which staff said will occur for affected members unless they opt for a different plan during open enrollment. Staff directed members to resources and scheduled a PBM webinar; no board motions or legislative actions occurred in the session.

Members seeking more information were directed to calpers.ca.gov, the dedicated CVS transition page (calpers.ca.gov/cvs), the Medicare Enrollment Guide (calpers.ca.gov/meg), and the VBID page (calpers.ca.gov/vbid). CalPERS said webinar Q&As would be posted online the following week and invited attendees to a short feedback survey.