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The
Kaiser
HMO (Health
Maintenance Organizations) is a group model plan. A group model plan means
that the HMO owns and operates the facility, and the physicians are HMO
employees. The Kaiser HMO is available to all retired LACERA members and
their dependents.
Features
of this plan are:
- All medical care must be received from a Kaiser physician at a Kaiser
facility, except for a life-threatening emergency authorized by Kaiser
- No
deductibles or annual benefit maximum amounts, except for skilled nursing
care and mental health
- You do not submit claim forms
- Copayments are required for certain services
- You
may continue enrollment if you move out of California into another state
that has Kaiser plans. Service areas currently are Hawaii, Georgia,
Colorado (Denver area only), Oregon and some Washington counties.*
- Health classes are available to develop healthy lifestyles
KAISER
SENIOR ADVANTAGE
The
Kaiser
Senior Advantage
is
a Medicare
Advantage-Prescription Drug Plan (MA-PD)
available
to all retired LACERA members and their dependents who are enrolled in
both
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Make
the time
to enjoy life.
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Medicare Parts A and
B. An MA-PD Plan is an HMO that has a contract with the federal government
to provide health care services to those with Medicare Part A and Part B.
If you have Medicare and enroll in Kaiser Senior Advantage, your non-Medicare
eligible family members must enroll in the Kaiser Basic plan.
Features
of this plan are:
- All medical
care must be received from a Kaiser physician at a Kaiser facility,
except for a life-threatening emergency authorized by Kaiser
- No
deductibles or annual benefit maximum amounts, except for skilled nursing
care and mental health
- No
restrictions on coverage for pre-exisitng conditions
- You
do not submit claim forms
- Small
copayments for office visits
- Health
classes are available to develop healthy lifestyles
- Your
premiums for Medicare Part B are reimbursed by the County on a tax-free
basis
- You
may continue enrollment if you move out of California into another state
that has Kaiser plans available. Service areas currently are Hawaii,
Georgia, Colorado (Denver area only), Oregon and some Washington counties.*
*Service
areas are subject to change.
Need
more information? Call
LACERA for enrollment information and benefit changes. Call the
insurance
carrier
for plan booklets, claim forms, eligibility and billing questions.
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