Summary of 2025 Wellwise Non-Medicare Retiree PPO Health Plan Document

This document is a health plan summary for the County of Orange's Wellwise Non-Medicare Retiree PPO (Preferred Provider Organization) plan, which is a component of the County's broader pharmacy benefit management and claims administration procurement. The Wellwise Non-Medicare Retiree PPO provides comprehensive health coverage for non-Medicare eligible retirees and their dependents, with prescription drug benefits that will be administered under the new PBM contract beginning January 1, 2026. The plan is part of a three-year contract with two optional one-year renewal terms, with the selected pharmacy benefit manager required to coordinate closely with Blue Shield of California and Alight Solutions for claims processing, eligibility management, and administrative functions.

The Wellwise Non-Medicare Retiree PPO plan document outlines detailed benefit structures, copayments, coinsurance percentages, deductibles, and out-of-pocket maximums across various medical services and prescription drug coverage tiers. The plan includes network pharmacy services, mail-order pharmacy options, and formulary-based drug coverage with specified cost-sharing amounts. The current pharmacy claims administration is managed by OptumRx in a carve-out arrangement with Blue Shield of California. The RFP solicitation was posted January 7, 2025, with proposals due February 13, 2025, and vendor presentations scheduled for March 27, 2025. While no specific budget was disclosed in available documents, the comprehensive nature of the contract covering multiple health plans for County employees and retirees across diverse populations suggests significant contract value.