Moving outside of your plan’s service area can impact your LACERA-administered health plan’s rates and coverage levels. Insurance requirements vary from state to state, and there may be specific state provisions that result in differences in plan benefits. For example, some wellness programs and routine checkups for adults are available in California but not in other states.
If you move outside California or out of your healthcare plan’s service area, you may find:
- Your current health plan is not available. HMO plans are available in defined geographic areas.
- Your benefits may be reduced if the provider is not in-network. For example, Anthem Prudent Buyer is a California-based, preferred provider network.
Before you move or disenroll from your current healthcare plan, contact us (contact info provided below) so that we can explain the impacts and help understand your coverage options.
Out-of-Area Benefits Chart
- Anthem Blue Cross Plans I and II
- Plan pays 80% of covered expenses after the deductible has been met, although deductibles and hospital benefits differ between Plan I and Plan II. You are covered anywhere in the U.S. as well as in many foreign countries.
- Anthem Blue Cross Plans I and II cover cancer screenings (mammogram, cervical cancer screening, prostate screening, etc.) as regular benefits where medically appropriate and as listed in the Evidence of Coverage (EOC).
- Anthem Blue Cross Plan III (Medicare Supplement Plan)
- Plan pays 20% of covered eligible Medicare expenses after Medicare pays.
- Anthem Blue Cross Plan III provides benefits for routine checkups as secondary to Medicare when covered and paid by Medicare.
- To maximize your benefit, you should choose a physician who accepts assignment of benefits from Medicare. If the provider does not accept assignment, you must pay the difference between the provider charges and your plan’s coverage.
- You are covered anywhere in the U.S. by hospitals or providers who accept Medicare assignment or provide Medicare-eligible services. You are covered in foreign countries for emergencies only.
- Anthem Blue Cross Prudent Buyer Plan
- Plan pays 70% of covered expenses outside of the area (80% in the event of an emergency situation) for any physician in any state. You are covered in foreign countries for emergencies only.
- SCAN Health Plan
- The LACERA-administered SCAN Health Plan serves retirees/survivors and their eligible dependents with Medicare Parts A & B entitlements in the following Service Area by Counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, Ventura, Santa Clara, Sonoma, Napa, San Francisco and Stanislaus.
- You will need to change to another plan if you move to an area not covered by a SCAN Health Plan ZIP code service area.
- SCAN Desert Health Plan - Arizona
This plan is available to retirees/survivors and their eligible dependents with Medicare Parts A & B entitlements in the following Counties in Arizona: Maricopa, Pima, Pinal.
- SCAN Health Plan - Nevada
This plan is available to retirees/survivors and their eligible dependents with Medicare Parts A & B entitlements in the following Counties in Nevada: Clark and Nye.
- Cigna Network Model Plan/Cigna-HealthSpring Preferred Rx (available only in Maricopa, Apache Junction and Pinal County Arizona)
- You will need to change to another plan if you move outside California or Arizona.
- Kaiser Permanente/Kaiser Permanente Senior Advantage
- The LACERA-administered Kaiser out-of-state plans are: Kaiser-Colorado, Kaiser-Georgia, Kaiser-Hawaii, and Kaiser-Oregon. You will need to change to another plan if you move to an area not covered by a Kaiser Permanente ZIP code service area.
- You will need to change to another plan if you move outside California or outside the UnitedHealthcare service area ZIP code.
- UnitedHealthcare Medicare Advantage (HMO)
- You must first notify LACERA. You will need to switch to another plan if you move outside California.
If you move permanently to a foreign country, in most cases the medical plans available to you are the Anthem Blue Cross Plans I and II. Anthem Blue Cross does not preauthorize any medical services provided in foreign countries. You must pay first and then send the bills, proof of medical necessity, and your payment information, along with an Anthem Blue Cross Foreign Claim Form, to Anthem Blue Cross of California for reimbursement. Contact Anthem Blue Cross to obtain their foreign claim form.