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Lifetime Maximum Benefit Will Increase in July 2025 for the LACERA-Administered Anthem Blue Cross Group Health Plans

Published on 12.12.2024 in Announcements
Light blue background with medical symbol.

After extensive collaboration with the County, LACERA has enhanced the coverage of our Anthem Blue Cross I, II, and Prudent Buyer healthcare plans. Effective July 1, 2025 (the start of the new plan year), the lifetime maximum benefit (LMB) for these plans will increase from $1 million to $1.5 million.

The LMB applies only to the Anthem Blue Cross I, II, and Prudent Buyer indemnity/preferred provider organization (PPO) plans. LACERA’s other plan options—group health maintenance organizations (HMOs), Medicare Supplement (Anthem Blue Cross Plan III), and Medicare Advantage Prescription Drug plans (MAPDs)—do not have a lifetime benefit maximum.

The Change in the LMB Could Open Up Your Healthcare Plan Options

When you retired, the LMB may have been an important factor when choosing coverage for yourself and your eligible family members. Since a single major illness could put a member close to their lifetime benefit maximum, this significant increase in the LMB ensures indemnity plans are viable over a much longer time period.

If you would like to review or reconsider your healthcare options, you can review the plan types, benefits, and the carrier plans that LACERA offers on our Healthcare Plans page or watch our Intro to Retiree Healthcare and Medicare Enrollment video.

How to Change Plans

If the upcoming change in the LMB makes an indemnity/PPO plan a more desirable option for you, you can request to change your plan any time, since LACERA does not have an open enrollment period. However, there is a mandatory six-month waiting period (applicable exceptions to the six-month waiting period will apply). The waiting period begins the month following the date LACERA receives your enrollment change form(s). So, for example, if you submit your change forms in January 2025, your waiting period starts in February 2025, and your new plan goes into effect in August 2025 after the six-month waiting period is complete. Your current healthcare insurer will remain the same until the August transition.

Visit the Manage Your Enrollment page for more information about changing plans or click on Retiree Healthcare Forms and Publications to access a medical change enrollment form. We recommend viewing the instructions and sample forms when filling out and submitting your form.

If you need assistance, you can contact the Retiree Healthcare Division at 800-786-6464 or sign in to your My LACERA account and click on the Messages button (above the blue navigation bar) to correspond with us.

Our Ongoing Commitment

The County and LACERA will be regularly reviewing the annual experience study of these health plans. This ongoing evaluation will allow us to make necessary adjustments to the LMB, with the final goal of eliminating the cap altogether. This is all part of fulfilling our mission of producing, protecting, and providing your promised benefits and ensuring you receive the medical care that you need and deserve.

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