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Members eligible for Medicare must enroll in Medicare to the full extent of their eligibility.

Prudent Buyer is for members whose primary residence is within the State of California. Blue Card program is for members who reside outside California and who are not covered by Medicare. Fee-for-Service plan is for members who reside outside of California and are covered by Medicare.

Under the Blue Cross PPO Prudent Buyer, Blue Card and Fee-For-Service Plans, you have the greatest choice of healthcare professionals because you may receive healthcare services from any licensed healthcare professional for your covered services. Under the Prudent Buyer and Blue Card plans, you may choose between a Blue Cross PPO provider and a non-PPO provider (a provider who does not belong to the Blue Cross PPO network). However, you may receive significant cost reductions if you visit Blue Cross PPO network healthcare professionals for covered services. When you use a non-PPO provider, you may be required to pay for the service at the time services are rendered and to submit your own claim forms to Blue Cross.

Medicare Part D

In 2003, the Federal Government voted to expand Medicare coverage to include Pharmacy coverage known as Medicare Part D. This benefit became effective January 1, 2006. As a Member of LAPRA, you and your covered dependents already have pharmacy benefits provided by LAPRA through Blue Cross and Kaiser that are much better than those that are available through Medicare Part D. Consequently, the Federal Government has encouraged plans, such as ours, to continue to provide pharmacy coverage. If you or any of your covered dependents are eligible for, and enroll in, Medicare Part D through a plan other than the LAPRA Blue Cross or Kaiser plans, your premium costs may be higher.

Medicare Definitions

Part A: Pays for inpatient hospital, skilled nursing facility, and some home health care. For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2008 = $1,024) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

Part B: Covers Medicare eligible physician services, outpatient hospital services, certain home health services, and durable medical equipment.

Part D: This is the prescription drug benefit that became available to Medicare Part A and/or Part B beneficiaries beginning January 1, 2006. Eligible individuals include all retirees and dependents eligible for Medicare Part A or enrolled in Part B.

Blue Cross Plans - Retiree Rates Effective July 1, 2008

Note: City Subsidy varies and is determined by retirement date, age and years of service.

Note: If you or any of your covered dependents are eligible for, and enroll in, Medicare Part D through a plan other than the LAPRA Blue Cross plans, your premium costs may be higher. You are eligible to enroll in Medicare Part D through the LAPRA Blue Cross plans if you are enrolled in Medicare Parts A and/or B.

PPO PLAN NON-MEDICARE MONTHLY RATES (CALIFORNIA RESIDENTS)

BLUE CARD PLAN RATES (Non-Medicare Residents Living Outside California Rates)

PPO PLAN BENEFIT OVERVIEW - EFFECTIVE 7/1/08

HOSPITAL SERVICES

PHYSICIAN SERVICES

HEALTH MAINTENANCE

CHEMICAL DEPENDENCY AND SUBSTANCE ABUSE

MENTAL OR NERVOUS DISORDER

OTHER COVERED EXPENSES

1 Par (or In-Network) refers to Participating Blue Cross Provider. For Outside California, it is a Blue Cross/Blue Shield Provider. There is substantial savings when you use a Par Provider. Subject to the deductible.

2 Non-Par (or Out-of-Network) is a Non-Participating Provider. Out-of-Pocket benefits are higher when you choose to use a Non-Par Provider. Subject to the deductible.

3 Visit or day limits do not apply to certain mental health care described in the Evidence of Coverage.

4 Participating Blue Cross Pharmacy: When a generic equivalent is available, you will pay the brand co-pay plus the difference of prescription drug covered expense between the generic and the brand name drug.

5 The 20% co-pay does not apply to insulin. The standard co-pays of $15 Generic and $25 Brand Names apply to insulin

6 Professional services that may be available from Blue Cross PPO providers, but would usually be available from providers whose specialties are not represented in the Blue Cross PPO network, are payable at the higher reimbursement level of the plan.

7 For those who have assigned medicare Part D coverage to Blue Cross: After a member has incured $3,600 in out-of-pocket expenses, the member will pay $2.00 for generic drugs and $5.00 for brand drugs.

Note: Covered services for the treatment of severe mental disorders will not be subject to any limitations applicable to mental or nervous disorders. Such services will be subject to all other terms, conditions, limitations and exclusions, includ