LAPRA - Health Plans

LAPRA offers its members three medical plans and two dental plans with different features, benefits, and rates.

Active and retired members can choose from the following plans - feel free to browse each section for more details.

The medical and dental plans provided by LAPRA to active members are subject to Section 125 of the Internal Revenue Code. As provided under Section 125, once you make a benefit election for you and, if applicable, your family, you will generally not be able to change your election until the next annual open enrollment period. Except in the limited situations described below, the benefits you choose must remain in effect throughout the plan year (July 1 - June 30)

Once you elect to enroll in or decline coverage for you, your spouse, or dependent, you may only change that election according to the following rules:

You become legally married. (See note below regarding domestic partners.)
You Acquire a new dependent. If you enroll in a medical plan a new dependent that you acquired through birth, adoption, or placement for adoption, and your spouse is eligible but not enrolled for coverage in that plan, you may also enroll your spouse in that plan.
There is a court order directing that a dependent be added to your coverage.

You become divorced, your marriage is annulled, or your spouse dies.
You lose a dependent.
Your spouse or dependent moves, and due to the move, your spouse or dependent is no longer eligible for coverage under your plan.
There is a court order directing that a dependent be removed from your coverage.

3. If you are not enrolled in a LAPRA plan, you may enroll for coverage only if:

You return from an unpaid leave of absence
You also enroll for coverage a new dependent that you have acquired through marriage, birth, adoption, or placement for adoption.
You declined coverage because you were covered under another plan (including federal COBRA continuation coverage), and you lose eligibility for coverage under that plan (or in the case of federal COBRA coverage, you exhausted such coverage).

You move, and due to the move, you are no longer eligible for coverage under your plan.
You are on an unpaid leave of absence.

All of the following apply:(i) you,your spouse, or your dependent moves,(ii) due to the move, you, your spouse , or your dependent is no longer eligible for coverage under the plan you were enrolled in, and (iii) coverage for you, your spouse, or your dependent is available under the plan in which you wish to enroll.

6. If your spouse or dependent is not enrolled in a LAPRA plan, you may add them to your coverage only If:

You had declined coverage for your spouse or dependent because your spouse or dependent was covered under another plan (including Federal COBRA continuation coverage), and your spouse or dependent lose eligibility for coverage under that plan (or in the case of federal COBRA coverage, your spouse or dependent exhausts such coverage).

7. In certain very limited circumstances, if your coverage under the LAPRA plan you have selected to reduced (for example, there is significant increase in your deductible), you may be allowed to elect coverage in another plan available through LAPRA. In addition, in certain very limited circumstances, if you experience a complete loss of coverage under a LAPRA plan (for example, an HMO is no longer available where you live, or you reach the lifetime maximum payable under your plan), you may be allowed to elect coverage under another LAPRA plan or drop coverage entirely.

Domestic Partners: Domestic partners may also be enrolled for coverage according to the applicable plan procedures. The enrollment of domestic partners who are not otherwise your dependent, however, is not governed by Section 125.

Submission of Enrollment Form for Election Change: Any request to change your election according to the rules set forth above must be made within 31 days after the event for which a change in election is permitted. The change in election will generally be effective the first day of the month following the date your enrollment form is received by LAPRA. If your enrollment for is not received within 31 days, you must wait until the next enrollment period.

If you have questions about the circumstances under which you may change your benefit elections, please contact our office.

Dependent Additions
Eligible dependents must be enrolled within 31 days after their eligibility date (marriage, birth, adoption, Court approval of guardianship, domestic partnership qualification). If you do not enroll your dependent within the 31-day period, you must wait until Open Enrollment.

Adding Spouse: If you are adding a spouse, you must complete and return the Verification of Marriage letter or a copy of your temporary marriage certificate or a copy of your certified marriage certificate. If you do not have a copy of your certified marriage certificate you will have 60 days from your spouse's effective date to submit the certificate. If you fail to submit the required certificate within the 60-day period, your spouses coverage will automatically be cancelled on the first of the month following the expiration of the 60-day period. You will then be required to wait until the next Open Enrollment period to re-enroll your spouse to submit the required certified copy of the marriage certificate.

Adding Dependent Child: If you are adding a child, you must complete and return the Verification of Birth letter or a copy of the commemorative hospital birth certificate that lists the names of both parents, a copy of the certified birth certificate or a copy of the Court approval of legal guardianship. If you do not have a required certificate you will have 60 days from your child's effective date to submit a copy of one of the certificates. If you fail to submit the required certificate within the 60-day period, your child's coverage will automatically be cancelled on the first day of the month following the expiration of the 60-day period. You will then be required to wait until the next Open Enrollment period to re-enroll your child and submit the required copy of the certified birth certificate.

Enrolling Domestic Partner
If you are adding a domestic partner, you must submit an enrollment form within 31 days of the legal and valid registration of a domestic partnership or approval of a domestic partnership application by the City of Los Angeles, which ever is applicable. Written proof of the legal registration of a domestic partnership or the written approval of the domestic partnership application by the City of Los Angeles must also be submitted.

For Active members you must call the Benefits Department of the City of Los Angeles at (213) 978-1609 to request an Affidavit of Domestic Partnership.

For Retired members you must call the Department of Fire and Police Pensions at (213) 978-4560 to request an Affidavit of Domestic Partnership.

Removal of Dependents
LAPRA does not provide coverage for divorced spouses or for children who do not qualify as dependents under the plan. You must immediately contact LAPRA to remove any dependents who no longer qualify as dependents. In order to be eligible for COBRA continuation coverage, you or the former dependent must notify LAPRA within 60 days from (1) the date of divorce or legal separation or the date your child ceases to qualify as a dependent under the plan, or (2) if later, within 60 days from the date coverage is lost due to such event.

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in a plan offered by LAPRA if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 31 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.

The Children's Health Insurance Program Reauthorization Act of 2009 adds two additional special enrollment rights. If, on or after April 1, 2009, (1) you or your dependents's Medicaid or State Children's Health Insurance Program coverage is terminated due to loss of eligibility, or (2) you or your dependent becomes eligible for a premium assistance subsidy under Medicaid or the State Children's Health Insurance Program, you may enroll yourself and/or your dependents in a plan offered by LAPRA within 60 days after such event

To request special enrollment or obtain more information, contact a LAPRA Benefits Representative at (213) 674-3701 or (888) 252-7721.

The American Recovery and Reinvestment Act of 2009 reduces the COBRA premium for individuals who, during the period beginning September 1, 2008, and ending December 31, 2009, (1) are involuntarily terminated from employment, and (2) lost coverage due to such termination. For individuals who qualify for the premium reduction, the reduced COBRA premium is 35 percent of the COBRA premium otherwise charged by LAPRA. The premium reduction is available for nine months of COBRA continuation coverage.

In compliance with the Women’s Health and Cancer Rights Act of 1998, the Plans offered under LAPRA provide for mastectomy-related services including reconstruction and surgery to achieve a symmetrical appearance, prostheses, and services in connection with physical complications at all stages of mastectomy, including lymph edemas. Benefits for these services will be provided in a manner determined in consultation with the attending physician and the patient. If you have any questions regarding these benefits, please call Blue Cross at (800) 289-2250, California Care at (800) 288-6921 or Kaiser at (800) 464-4000.