medical PLans


LAPRA offers you and your family three medical options:


 

All four 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 2019-2020 Benefits Guide for Retired Members and the 2019-2020 Retiree Medical and Dental Premium Rates Booklet.


ANTHEM BLUE CROSS HMO MEDICARE ADVANTAGE WITH PRESCRIPTION DRUG PLAN


If you and your eligible dependents are entitled to Medicare Part A and enrolled in Medicare Part B, and you live in the defined service area, you can choose the Anthem HMO Medicare Advantage with Prescription Drug Plan which includes all of Original Medicare and Part D coverages, and provides additional benefits for you. Below is an overview of the key benefits of the plan. For more information, call LAPRA at 213-674-3701 or 888-252-7721 to request an Anthem Blue Cross HMO Medicare Advantage with Prescription Drug Plan enrollment packet. reason.

The Anthem Blue Cross HMO Medicare Advantage Plan is available only to individuals who live in the HMO Medicare Advantage geographic service area. To remain a member of this plan, you must continue to reside in the HMO Medicare Advantage geographic service area. The service area includes these counties in California: Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Orange, Placer, Riverside, Sacramento, San Benito, San Bernardino, San Diego, San Francisco, Santa Clara, Solano, Sonoma, Stanislaus, Tulare, Ventura, Yolo.

 

Effective July 1, 2019



Benefit Feature
Anthem Blue Cross HMO Medicare Advantage with Prescription Drug Plan
(Eligible Retirees & Dependents Only)
Providers
HMO Providers Only1
Calendar Year Deductible
N/A
Calendar Year Out-of-Pocket Max (includes prescription drug co-pays)
Medidcal & Prescription Drug Charges: $0 out-of-pocket max2
Office Visit
$0 co-pay for Medicare-approved services
Hospitalization
$0 co-pay for Medicare-approved hospital stays
Emergency Room
$0 co-pay for Medicare-covered emergency room visit
Urgent Care
$0 co-pay for Medicare-coverted unrgently needed care visit
Routine Physical
$0 co-pay for an annual physical exam
Diagnostic X-ray & Lab Tests $0 co-pay for Medicare-covered X-ray visit and/or simple diagnostic test
$0 co-pay for Medicare-aproved complex diagnostic test and/or radiology visit
Body Scans
Not Covered
Physical & Occupational Therapy and Chiropractic Services (additional services may be authorized)
$0 co-pay for Medicare-approved physicial, occupational and speech language therapy visits
(Chiropractic up to 40 visits per year)
Chiropractic Services $ co-pay per visit
Acupuncture
$ co-pay per visit

Mental Health/Chemical Dependency
• Outpatient
• Inpatient



$0 co-pay for each Medicare-covered outpatient visit

$0 co-pay per admission

1 Your primary care physician can refer you to a specialist when necessary and must approve all care you receive except in the event of an emergency.

2 The drug portion of the plan is Part D which carries a true out-of-pocket limit of $4,850. Once you meet that true out-of-pocket limit, you pay alower drug co-pay for the remainder of the year

 

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When You Need a Prescription


When you enroll in the Anthem Blue Cross HMO Medicare Advantage with Prescription Drugs Plan, 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 Drugs1
Anthem Blue Cross HMO Medicare Advantage with Prescription Drug Plan
(Eligible Retirees & Dependents Only)

Retail Pharmacy
• Generic

• Preferred Brand
• Non-Preferred Brand and Non-Formulary Drugs
• Specialty Drugs (generic and brand)
• Diabetic Supplies (insulin, syringes, pen needles and alcohol swabs)


$5 co-pay
$20 co-pay
$40 co-pay

 

20% coinsurance ($150 max-co-pay)

$5 co-pay)

 

Mail Order
•Generic
• Preferred Brand
• Non-Preferred Brand and Non-Formulary Drugs
• Specialty Drugs (generic and brand)
• Diabetic Supplies (insulin, syringes, pen needles and alcohol swabs)

90-day supply
$10 co-pay
$40 co-pay
$80 co-pay

 


20% coinsurance ($300 max co-pay)

$10 co-pay

 


1 Co-pays shown for prescription drugs is your payment responsibility until the amount paid by you and the Coverage Gap Discount Program for covered Part D prescriptions reaches your True Out-of-Pocket limit of $4,850.

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Premium Rates


Click on a link below for the 2018-2019 or 2019-2020 retiree medical and dental premium rates. Your cost is the monthly premium rate minus the Pension Department subsidy, based on your retirement date, age and years of service.

The Anthem Blue Cross HMO Medicare Advantage rates reflect the options available to retirees meet the eligiblity requirements to participate in this plan. The Federal Medicare Agency, the Centers for Medicare and Medicaid Services (CMS), establishes eligibility requirements that impact members' cost and condition of enrollment. It is important to note that you must purchase and assign your Medicare benefits to Anthem Blue Cross or be reclassified into an unknown or unassigned category which will significantly affect your cost as indicated below.

 

  







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

 


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