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HEALTHCARE


KAISER/SENIOR ADVANTAGE

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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Medicare Parts A and B. An MA-PD Plan is an HMO that has a contract with the federal government to provide healthcare 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.