LAPRA 2018/19 Benefits Guide for Retired Members

4 Medical LAPRA offers you and your family three medical options: • Anthem Blue Cross Prudent Buyer PPO • Anthem Blue Cross CaliforniaCare Plus HMO • Kaiser HMO 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. Anthem Blue Cross Prudent Buyer PPO Plan The Anthem Blue Cross Prudent Buyer Plan is a Preferred Provider Organization (PPO) that gives you the option to see any provider (participating providers or non-participating providers) whenever you need care. If saving health care dollars is important to you, you will want to stay in-network by using only PPO doctors and hospitals. The Prudent Buyer PPO network is the largest provider network in California. PPO Network Providers PPO network providers are doctors, hospitals, pharmacies, labs, etc. that participate in the Anthem Blue Cross Prudent Buyer PPO network and have agreed to provide services at pre-negotiated reduced rates. When you use PPO network providers, you receive the highest level of benefits at the lowest possible cost. You are not required to choose a primary care physician and you can see doctors and specialists within the network without a referral. PPO providers file all claims for you. How It Works After the applicable calendar year deductible is met, the plan pays 90% of most covered services. When the deductible and other out-of-pocket expenses for covered services total the applicable calendar year out-of-pocket maximum, the plan begins to pay covered charges at the 100% level for the remainder of the year. There are separate out- of-pocket maximums for medical charges and for prescription drug expenses. As shown in the comparison charts on pages 6 and 7, deductible amounts and out-of-pocket maximums differ for individual or family coverage, and are higher for non-network providers than for network providers. IMPORTANT: If services are received from a non- participating provider, you may be billed by the provider for the difference between their charges and your plan’s maximum allowed amount. The maximum allowed amount is the total reimbursement payable under your plan for covered services you receive from providers. Need Help? Want to change doctors? Need an ID card? Call Anthem Blue Cross, at the toll free number listed on the back cover of this Guide if you want to change doctors, request a new ID card, or have your claim or benefit questions answered. For questions regarding eligibility or to request an ID card, call a LAPRA Benefits Representative at 213-674-3701 or 888-252-7721 or send an email to benefits@lapra.org . If you are new to the plan, you will receive an identification card shortly after you enroll. If you need care before your card arrives, make an appointment and explain that you are a new plan member.