medical PLans

All Points Benefits (APB) Medical


LAPRA offers you and your family three medical options:


All three plans provide coverage for preventive care, office visits, hospitalization, surgery and prescription drugs. The plans differ in co-payments, coinsurance, out-of-pocket costs, and provider choice. Plan highlights and monthly premiums may be found in your Enrollment Guide.


Kaiser HMO


Kaiser HMO benefits are payable only when you use Kaiser providers and facilities. You must select a primary care physician to manage your health care, including referrals to specialists. You may self-refer to another Kaiser physician for routine and preventive care, well baby visits or OB/Gyn care. If you’d like a second opinion, you can ask to see another Kaiser physician. You may change your Kaiser physician at any time for any reason.

With the Kaiser HMO, there are no deductibles and no claim forms. You pay a $15 co-pay for most services. The annual out-of-pocket maximum is $1,500 per person and $3,000 per family. Worldwide emergency benefits are available when you travel away from home. This plan is only available to California residents.

 

Effective July 1, 2017



Benefit Feature
Kaiser HMO
(California Residents Only)
Providers
HMO Providers Only
Calendar Year Deductible
N/A
Calendar Year Out-of-Pocket Max (excludes co-pays for infertility benefits)
$1,500 per person, $3,000 per family
Lifetime Max
Unlimited
Office Visit
$15 co-pay
Hospitalization
100%
Emergency Room
$150 co-pay (waived if admitted)
Urgent Care
$15 co-pay
Maternity Care
Doctor visits: 100%
Facility charges: 100%
Well Baby/ Child Care
(up to age 2)
100%
Routine Physical
100%
Diagnostic X-ray & Lab Tests 100%
Body Scans
Not Covered
Physical & Occupational Therapy and Chiropractic Services (additional services may be authorized)
$15 co-pay
(Chiropractic up to 40 visits per year)
Acupuncture
$15 co-pay
Mental Health/Chemical Dependency
• Outpatient

• Inpatient

$15 co-pay individual therapy/
$7 co-pay group therapy
100%

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When You Need a Prescription


When you enroll in the Kaiser HMO, you automatically receive prescription drug coverage as shown in the table below.

To save money, request that your doctor write your prescriptions for “generic” drugs whenever possible. Generic drugs are often the therapeutic equivalent of their brand-name counterparts, but cost significantly less. Also, women's generic prescription contraceptives are covered with a $0 co-pay to comply with requirements of the Affordable Care Act.




Prescription Drugs
Kaiser HMO
(California Residents Only)

Retail Pharmacy
• Generic
1
• Brand
• Injectables
• Retail Supply


$15 co-pay
$30 co-pay
n/a
Up to 30 days

Mail Order
• Generic
1
• Brand
• Injectables
• Mail Order Supply

1-30 day supply / 31-100 day supply
$15 co-pay / $30 co-pay
$30 co-pay / $60 co-pay
n/a
Up to 100 days


1 $0 co-pay for women's prescription contraceptives.

 

 



Los Angeles Protective League Employee Assistance Program

All members and their families are encouraged to utilize the Los Angeles Police Protective League's Employee Assistance Program (EAP) prior to accessing your selected medical plan. The EAP provides 10 sessions covered at no cost to the family.

Premium Rates


Your cost for Medical is based on your selected plan and coverage category as well as the amount of the City of Los Angeles subsidy. The table below reflects the member cost per pay period effective July 1, 2017.



Kaiser HMO Premium Rates
Cost Per Pay-Period
Single
$0.00
2-Party
$0.00
Family
$0.00


This brief description of benefits is provided for your convenience and is subject to all terms, conditions, limitations and exclusions of the Kaiser HMO contract. Please refer to your plan’s Evidence of Coverage for details on your benefits.


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