LAPRA 2018/19 Benefits Guide for Retired Members

5 Anthem Blue Cross CaliforniaCare Plus HMO The Anthem Blue Cross CaliforniaCare Plus HMO offers comprehensive coverage for a wide range of health care services. Benefits are payable only when you use Anthem Blue Cross HMO providers and facilities.* There are no deductibles and no claim forms. You pay a $20 co-pay for most services. The calendar year out-of-pocket co-pay maximum is $1,000 per person and $3,000 per family. You must choose a primary care physician (PCP) from a Participating Medical Group or Independent Practice Association in the Anthem Blue Cross HMO network. You have the right to designate any PCP who participates in the network and who is available to accept you or your family members. For children, you may designate a pediatrician as the PCP. You do not need authorization to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. Your PCP manages all of your medical care, refers you to specialists as needed, and can help you take advantage of special wellness programs. If you do not list a PCP on your enrollment form, Anthem Blue Cross will automatically assign one to you within 30 miles from your home address. If you’re not satisfied with Anthem Blue Cross’ selection, you should call Anthem Blue Cross Customer Service at 800-289-2250 to request a medical PCP change. This plan is only available to California residents. Kaiser HMO Kaiser HMO benefits are payable only when you use Kaiser providers, facilities and pharmacies. You must select a primary care physician (PCP) to manage your health care, including referrals to specialists. You have the right to designate any PCP who participates in the network and who is available to accept you or your family members. For children, you may designate a pediatrician as the PCP. You do not need authorization to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. Kaiser will automatically assign a PCP for yourself and your enrolled family members. For information on how to change your PCP, and for a list of PCPs, contact Kaiser. 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. * Under the “Plus” benefits, you have the option to choose providers outside of the CaliforniaCare HMO network for certain outpatient services and still receive limited benefits for those services. Refer to the section titled “Your Plus Benefits” in the CaliforniaCare HMO Evidence of Coverage for details. Anthem Blue Cross Guest Membership Program Your eligible dependents living outside of California may be eligible to enroll in HMO coverage with a partner Blue Cross and Blue Shield plan under the Guest Membership Program. The program is for members who will be temporarily residing outside of California for a minimum of 90 days. Call 800-827-6422 for a list of states that participate in the program, verify provider availability and request a Guest Membership application.