Some CalPERS Members Are at Risk For Surprise Medical Bills

The Sacramento Bee reported on May 31, 2019 that about 250,000 CalPERS members may be at risk for surprise medical bills not covered by their health insurance plans. The members affected are those who have PERSCare, PERSChoice, or PERSSelect as their primary health insurance. All CalPERS members enrolled in HMO plans are not affected, and CalPERS retirees who have Medicare as their primary insurance are not affected even if they have PERSCare, PERSChoice, or PERSSelect supplement to Medicare insurance plans.

While most retirees are not affected, some are; namely, those retirees who still have PERSCare, PERSChoice, or PERSSelect as their primary health insurance because they are under 65 and not yet eligible for Medicare; and, those retirees who have one or more dependents who have one of these plans as their primary insurance. For example, a CalPERS retiree who is enrolled in Medicare may have a spouse who is under 65 for whom PERSCare, PERSChoice, or PERSSelect is their primary insurance.

The surprise bills usually are generated when the insured person is treated by an out-of-network provider in an emergency situation. If the out-of-network provider does not agree to accept the PERSCare, PERSChoice, or PERSSelect payment as payment in full for the service provided then the person receiving treatment may receive a bill for the difference - so-called "balance-billing."

The Sacramento Bee article also reports that a bill to protect consumers from "balance-billing" is working its way through the California Legislature. The bill recently passed the Assembly, but remains to be passed by the State Senate, and to be signed by Governor Newsom.