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 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, 2023
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% |
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 |
|
Mail Order |
1-30 day supply / 31-100
day supply |
1 $0 co-pay for women's prescription contraceptives.
Los Angeles Protective League Member Assistance Program
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, 2023.
| Kaiser HMO Premium Rates Effective July 1, 2023 | |
|---|---|
Cost Per Pay-Period |
|
Single |
$0.00 |
2-Party |
$0.00 |
Family |
$0.00 |