FAQs - HEALTHCARE
- Do all LACERA plan members qualify for retiree healthcare benefits?
You are eligible to enroll in the LACERA-administered Healthcare Benefits Program if you are a member of LACERA and retire from the County of Los Angeles or outside District.* Even if you did not have medical coverage under an employee healthcare program while you were an active County employee, you are eligible to participate in the program.
*Includes Little Lake Cemetery District, Local Agency Formation Commission, South Coast Air Quality Management District, and Los Angeles County Office of Education.
- I'm going to retire soon and I would like information about the healthcare plans available to retired members.
You may find a list of the current LACERA-Administered Retiree Healthcare providers on our Contact Insurance Company page. If you want additional information about the plans check out our Healthcare Plans page and look in the left-hand navigation bar.
- When I retire, how much of my healthcare premium will be subsidized by the County?
The general rule is that if you have 10 years of retirement service credit, the County contributes 40 percent of your healthcare plan premium, or 40 percent of the benchmark plan rate (Anthem Blue Cross Plans I and II), whichever is less. For each year of retirement service credit beyond 10 years, the County contributes an additional 4 percent per year, up to a maximum of 100 percent for a member with 25 years of service credit.
The County contribution can never exceed the premium of the benchmark plan. If the premium for the plan and coverage option you have chosen exceeds the benchmark premium, you are required to pay the difference, even if you have 25 or more years of service. If you have 25 or more years of service and your plan premium is less than the benchmark rate, the County contributes 100 percent of your plan premium only, not the benchmark plan rate.
- I am getting ready to retire. How do I enroll in a LACERA-administered healthcare plan?
If you visit LACERA's Member Service Center to apply for retirement, a LACERA Retirement Benefits Specialist will meet with you and assist you in preparing your retirement paperwork. The specialist will provide you with enrollment forms for LACERA-administered retiree medical and dental/vision insurance.
Once you retire, you will receive a retiree healthcare packet in the mail containing important information regarding your retirement healthcare options. A postcard on which you can request enrollment forms and specific information about any LACERA-administered health plan is also included. It is important you complete and return the postcard to us.
The enrollment process involves two steps:
- Read your LACERA Exploring Your Healthcare Benefits booklet regarding all the various medical options. Fill out the card enclosed to request specific information and enrollment forms for the plans you have selected.
- Within ten working days you will receive an envelope containing the information you requested. Please note: you must select a healthcare plan within 60 days of your retirement date.
- What happens if I enroll after 60 days of my retirement date?
LACERA coverage is coordinated to begin on the first day of the month after active County health coverage ends. For this to occur, your enrollment form must be received by LACERA within 60 days from the date of your retirement or within 60 days from the date your name appears on the Board of Retirement agenda. If you enroll after the 60-day deadline, you must complete a waiting period from the date your enrollment form is received by LACERA to enroll. A six-month waiting period applies for late enrollment on LACERA-adminstered health plans; a one-year waiting period applies on dental/vision plans.
- Are there exceptions to the six-month waiting period?
Yes. Exceptions include:
- You move out of your HMO service area.
- You're currently enrolled in Anthem Blue Cross of California and you move out of the Prudent Buyer network area.
- You change from Anthem Blue Cross Plan I, Anthem Blue Cross Plan II, Anthem Blue Cross Prudent Buyer Plan, Kaiser Permanente, UnitedHealthcare, or CIGNA Network Model Plan to Kaiser Senior Advantage, UnitedHealthcare Medicare Advantage, SCAN, or Anthem Blue Cross III.
- You change from Anthem Blue Cross I to Anthem Blue Cross II.
- You change from any LACERA-administered medical plan to SCAN.
- Who qualifies as a dependent on my LACERA-administered retiree health insurance?
- Your spouse (unless legally separated)
- Your registered domestic partner, provided you both filed a California Declaration of Domestic Partnership
- You or your spouse’s natural or legally adopted children or stepchildren, up to age 26
- Your dependent children over 19 who are incapable of self-support due to a physical or mental handicap and meet specific requirements. (For details, call Retiree Healthcare at 800-786-6464 and press 1.)
- I'm a retiree. How do I enroll my new partner on my medical insurance?
To add your new spouse or domestic partner you must fill out a Change/Cancellation Form and send it to LACERA within 30 days from your date of marriage or domestic partnership registration. You must also provide an original marriage certificate or Certificate of Registered Domestic Partnership, which will be copied and returned to you. If LACERA receives the required items by the 15th of the month, coverage begins on the first day of the month following the date of the qualifying event. If any dependent is added later than 30 days from the date that he/she becomes an eligible family member, late enrollment rules apply.
- What happens to my LACERA-administered medical insurance plan when I turn 65?
Generally, three months prior to your 65th birthday, you will receive a "Turning 65" letter from LACERA. The letter, which provides valuable information to help you make a decision regarding medical insurance, will ask whether you are eligible for Medicare Parts A and B and if you wish to enroll in one of the following LACERA-administered plans:
Medicare Supplement Plan
- Anthem Blue Cross III
Medicare Advantage Prescription Drug Plans
- Kaiser Senior Advantage
- SCAN Health Plan
- United Health Medicare Advantage
- Cigna-HealthSpring Preferred with Rx (available in Maricopa County and Apache Junction, Pinal County, AZ)
- How does the Medicare Part B Premium reimbursement work?
The County of Los Angeles reimburses members and/ or their eligible dependents for their Medicare Part B premiums (standard rate only) on a tax-free basis, provided they meet the following eligibility requirements:*
- Enrolled in the LACERA-administered Medicare Supplement Plan (Anthem Blue Cross Plan III) or a LACERA-administered Medicare Advantage Prescription Drug Plan (MA-PD), such as Cigna-HealthSpring Preferred with Rx (available in Maricopa County and Apache Junction, Pinal County, AZ), Kaiser Senior Advantage, United Healthcare Medicare Advantage, or SCAN
- Pay their own Medicare Part B premiums
- Not receiving Medicare Part B Premium reimbursement from another agency, such as another employer or state.
Each month after you have paid the Medicare Part B Premium, LACERA will include the reimbursement on your monthly retirement check.
*This reimbursement program is subject to annual review by the Board of Supervisors.
- How would losing my Medicare Part B eligibility due to non-payment of my Medicare Part B premium or requesting to disenroll from Medicare Part B affect my enrollment in a LACERA-administered Medicare HMO or Medicare Supplement Plan?
If you lose your Medicare Part B eligibility status, you will be disenrolled from your LACERA-administered Medicare HMO of Medicare Supplement Plan. To be enrolled, you must be currently enrolled in both Medicare Part A and B. If you re-enroll in Medicare Part B, you must contact LACERA immediately in order to coordinate your re-enrollment into the LACERA-administered Medicare HMO or Medicare Supplement Plan. Re-enrollment in Medicare Part B will not automatically re-enroll you in these plans.
- How can I switch my LACERA-administered medical plan?
You must complete a Medical and Dental/Vision Change Form. The form is available on the Brochures & Forms page. Or you can call LACERA's Retiree Healthcare Division at 800-786-6464 and press 1 to request a form or receive more information.
Generally, a one-year waiting period from LACERA's receipt of your signed Dental/Vision Change form applies when switching LACERA-administered dental/vision plans. Coverage is continuous and no evidence of insurability is required.
NOTE: The waiting period is waived if you move out of your HMO's designated service area. See the Out of State Move page for more information.
- Where do I get a Change Form for the LACERA-Administered Healthcare Plans?
Medical and Dental/Vision Change Forms are available on the Brochures & Forms page. Or call LACERA at 800-786-6464 and press 1 to request a form or get more information.
- I'm a retiree and I have a question about healthcare. How can I find the answer?
Visit our Retiree Healthcare section for enrollment information, plan phone numbers and web sites, and more about the LACERA-administered healthcare program, including medical and dental/vision plans. Our Brochures & Forms page includes printed materials and forms. If you cannot find the answer to your question by using these online resources, call us at 800-786-6464 and press 1 to speak with a Healthcare Benefits Specialist.
- Where can I find out more about Medicare and Social Security?
For questions about Medicare or Social Security contact the Centers for Medicare and Medicaid Services (CMS): 800-633-4227; medicare.gov or the Social Security Administration (SSA): 800-772-1213; ssa.gov.
- I am a retiree. Will healthcare coverage extend to my eligible survivors when I die?
If a retired member dies while covered by a LACERA-administered health plan, the eligible survivors may continue coverage. Following are the administrative rules:
- When an eligible survivor notifies LACERA of a member's death, we will mail an information packet to the survivor. LACERA must be notified within 30 days of the event; otherwise Late Enrollment rules apply.
- Late Enrollment rules include a six-month wait for medical and a one-year wait for dental/vision coverage, from the date LACERA receives the enrollment form. Benefits for eligible dependents are continuous, provided they were covered under the deceased member's plan.
- If a survivor is not eligible for continuing healthcare benefits, but has been continuously covered under your plan, LACERA will mail the survivor a COBRA packet with information on continuing healthcare coverage.
- If a survivor is eligible for continuing healthcare benefits, but was not continuously covered under your plan, late enrollment rules will apply.
- If a survivor is covered under a LACERA-administered healthcare plan and remarries, the survivor's eligible new dependents can be added to the plan, provided LACERA is notified within 30 days of the date of acquisition (i.e. marriage, birth, adoption, etc.). However, when the eligible survivor dies, the dependents will no longer be eligible for continued coverage through LACERA, except for a limited period of time through COBRA.
- If your eligible survivors are required to pay premiums for coverage, they will be notified accordingly.
- My wife is a retired LACERA member. Would I still be eligible for health insurance coverage if she predeceases me?
Yes, an eligible surviving spouse or domestic partner of a retired member qualifies for the same health benefits they received while the member was alive.
- Does LACERA still have annual Retiree Health Fairs?
No. In lieu of the annual health fair, we now have a retiree health improvement program entitled Staying Healthy Together: Focus on Wellness which provides health information via three sources: 1) Newsletters, 2) Web, and 3) Workshops. With this program, we can provide information on staying healthy to all our retired members. Every six months, the program will focus on a new health-related topic. Your quarterly Spotlight newsletter includes informative Staying Healthy Together articles for you to read. You can also visit Staying Healthy Together to access links to health-related web sites and find information on upcoming workshops.
- When I enroll in a LACERA-administered Medicare HMO plan, why can't I list a P.O. Box address as my permanent residence address on the Universal Enrollment Form for the Medicare Advantage Prescription Drug Plan?
Medicare/CMS regulations require that you provide your street address and not a P.O. Box address when you enroll in a LACERA-administered Medicare HMO plan. If you list a P.O. Box address as your permanent address, your enrollment form will be rejected by the insurance carriers, which may affect your enrollment.