We have renamed the Benefits Program from “My Flex” to “LAwell” to better demonstrate the ultimate purpose of all of our employee benefits: to support our employees’ and their families’ current and future health and wellbeing.
As a new hire, you will receive your LAwell Benefits Enrollment package 2-4 weeks after your first paycheck IF you are working a minimum number of qualifying hours (at least 40 hours per pay period for Full Time employees) and you are a contributing member to LACERS.
Once an offer is made, you have 60 days to make an election.
Want to learn more? View our New Hire benefit flyer
Form 1095-C provides information about a health insurance offer made to an employee by their employer. All employees who receive LAwell health coverage will get a 1095-C tax form.
For more information about the Affordable Care Act (ACA), please visit the Internal Revenue Service website at https://www.irs.gov/affordable-care-act.
For general assistance with your benefits, contact the LAwell Benefits Request Line at 1-800-778-2133, Monday to Friday 8:00 am to 5:00 pm.
For administrative issues you may contact your Employee Benefits Division Member Services Representative according to your last name:
Mayra Martinez (A-F): (213) 978-1615
Tameekah Ford (G-I, K-M): (213) 978-1600
Vincent Pacheco (N-V): (213) 978-1640
Maria Lopez (J, W-Z): (213) 978-1584
Member Advocates from our Health and Dental providers provide personal, one-on-one assistance out of our office in City Hall, 200 N. Spring Street, Room 867 with the following drop-in schedule:
Anthem Blue Cross
If you are eligible for LAwell benefits, you can also cover:
or a Domestic Partner (DP)
and/or a Child:
Special Situation Child Rule: If your child is also a LAwell eligible City employee, he/she must enroll into his/her own LAwell coverage and cannot be covered as your dependent.
Your dependent child's coverage will end on the last day of the month in which your child turns age 26. A COBRA notice will be provided to your child within 45 days of coverage termination.
Disabled Child coverage: Children with disabilities can remain your covered dependent after turning age 26 only if your LAwell health plan has certified the dependents disability.
Grandchild coverage: Coverage for grandchildren will end when the parent child reaches age 19 or age 26 if a full-time student.
The following are examples of individuals who are not considered eligible dependents:
NOTE: If your eligible dependent becomes ineligible (Example: Divorce, loss of custody, etc), you must drop coverage for the ineligible dependent within 30 days of the date he or she loses eligibility.
A Life Event Change can be marriage, beginning or ending a domestic partnership, birth, adoption, divorce, death, addition or loss of an eligible dependent, or a loss or gain of spouse/domestic partner health coverage. You must report a Life Event Change within 30 days of its occurrence and submit documentation within 60 days in order for the change to take effect.
Adding a Dependent Child
What Benefits You Can Change
When You Can Enroll and Make Benefit Changes
How To Enroll and Make Benefit Changes
• Retired employees and employees who transfer to DWP: Last day of the month
• Terminated/Resigned employees: effective date of termination
• Employees on leave: effective date of leave, unless on direct bill
• Dependent children: the last day of the month in which they turn age 26.
Your benefits may continue while you are on certain leave-from-work statuses, but still employed. However, you will be required to pay for all, or a portion, of the premiums for these benefits. Not all benefits may be eligible to continue. Read pages 50-53 of the 2019 CHOOSEwell guide for more information.
A primary care physician (PCP) is your main doctor. Always try to go to your PCP first for health concerns or questions.
Your PCP coordinates any other care you need, such as a visit to a specialist or a hospital stay. You may need to contact your PCP to get an OK (prior authorization) before you get certain services.
Most PCPs are family or general practitioners, internists or pediatricians. These types of doctors have gone to school to learn about all areas of health. That way, they can get a strong, overall picture of your health.
You may need to contact your Primary Care Physician (PCP) to get an OK (preapproval) before you get certain services. Your PCP will work with you to decide if you need to see a specialist. If so, your PCP will refer you to a specialist in your medical group.
You can go to http://www.anthem.com/ca/cityofla and use our online Find a Doctor tool to find available physicians. If you already know the PCP you want, you can call our Member Services team at the number on your member ID card. Let us know who you want to choose as your new PCP and we’ll take it from there.
Kaiser Permanente members are not required to select a PCP before coverage starts and will not be automatically assigned a PCP. Kaiser members can receive urgent care or emergency care services without choosing a PCP. Kaiser members may elect to choose a PCP before MEDICAL COVERAGE & CASH-IN-LIEU or while making a regular doctor’s appointment.
If it is an emergency, call 9-1-1 or go to the nearest hospital - you don’t need an OK from us or your PCP. But be careful not to use the emergency room unless it really is an emergency.
You can also log into www.anthem.com/ca/cityofla and use the Find a Doctor tool to look for an urgent care center. You can usually walk in without an appointment needed. And they can handle lots of urgent health issues like a flu or cold, allergies, prescribing medication, even small fractures and X-rays.
You can also use LiveHealth Online to access non-emergency after hours care. LiveHealth Online gives you 24/7 video visit access to board-certified physicians using a mobile device or a computer with a webcam. No appointment is necessary, and you pay your regular copayment. To learn more, go to livehealthonline.com or download the LiveHealth Online mobile app from the App Store® or Google PlayTM.
Visit a Kaiser Urgent Care facility, email your doctor, or talk to member services representative. Go to my.kp.org/ca/cityofla
Doctors, hospitals, facilities (such as labs) and other professionals who provide health care services may have a contract with Anthem. If they do, they're in the Anthem network - also called in-network providers. That means they accept Anthem payment rates when Anthem members go to them for care. If they don't have a contract with Anthem, they're outside of the Anthem network - or out of network providers.
When you see network providers, you only have to pay the copays, deductibles and coinsurance required by your plan. If you get treatment from a provider outside the network, you could have to pay much more. Check your benefit summary or Evidence of Coverage for details regarding how out-of-network services are covered.
Additionally, providers in the Anthem network are responsible for getting any needed precertification (approval) for your care. They also file your claim for you and will seek payment from Anthem for covered services.
Please log into www.anthem.com/ca/cityofla and use the Find a Doctor tool to determine if a particular provider is in the network, contact Member Services at the number on your ID card, or talk with the Anthem Member Advocate at City Hall
Before traveling, contact Anthem Blue Cross Customer Service at the number listed on your member ID card for a list of participating hospitals. Always go to the closest emergency facility; request an itemized bill (in English) before leaving to file a claim for reimbursement. The BlueCross Blue Shield Global Core Service Center is available 24 hours a day, seven days a week toll free at 800-815-BLUE or by calling collect at 804-673-1177. An assistant coordinator, along with a medical professional, will arrange doctor or hospitalization needs.
Go to the nearest emergency facility and call 800-225-8883 if you receive treatment. Request an itemized bill (in English) and save your receipt to file a claim for reimbursement.
If you are covered through an HMO plan and your child is going to school outside of our service area, there may be special circumstances under which your child may be eligible for a guest membership in a medical group in the city your dependent lives in while away from home. Before you leave home, call the Member Services number on your ID card for assistance. Even without a guest membership, you can get medically necessary care (urgent care, emergency services, or follow-up care) when you are away from home.
If you are covered through the PPO plan, medically necessary care is covered for your child who is outside of our California service area through our national BlueCard network. Please visit www.anthem.com/ca/cityofla or call the Member Services number on your ID card to find a participating provider in the area your child is in.
Go to any Kaiser facility for covered care. To find a Kaiser facility, visit kp.org or call 800-464-4000. If no Kaiser facility is available, only emergency care is covered.
The DCUSA HMO plan covers braces for adults and children, and the PPO plan covers braces for children to age 26 only. Coverage is as follows:
DCUSA DHMO plan -
Children under 19 - Member copayment is $1,000 plus start up fees of $300 Children 19-26 - Your copay is $1,350 plus start up fees of $300 Adults - Your copay is $1,350 plus start up fees of $300
Delta PPO plan -
Delta pays 50% of the cost up to $1500 per lifetime per child
The maximum is the amount of money that Delta Dental will pay toward services in a calendar year per person. Once Delta has paid $1500 in a calendar year, any other costs would become your responsibility. Please note that preventive services do not apply toward this maximum.
There are many situations. But in general:
Accidental Death and Dismemberment (AD&D) insurance offers additional financial protection for an employee, or a family member, if they die in an accident, are dismembered, or lose their vision, hearing, or ability to speak.
Yes. As in previous years, both the online and phone enrollment options will be available. Look out for your Enrollment Kit to provide more information.
Review the materials in your Open Enrollment kit you receive in the mail. You can also review information on the online Enrollment Site by clicking “Enroll” on the Home page of this site.
Be sure to review:
Most of your previously elected 2018 benefit elections will automatically roll over to 2019 unless you make a change during Open Enrollment.
However - Enrollment in Dependent Care Reimbursement and Flexible Spending Accounts does not automatically roll over. Any funds in these accounts for 2018 must be used in 2018. If you wish to participate in one of these accounts for 2019, you will need to enroll again during Open Enrollment.
Employees who enroll in specific levels of Life or Disability insurance may be required to complete a Medical History Statement with the Standard Insurance Company before their elected insurance level can take effect.
Employees required to complete this form can do so online by using this link: www.standard.com/mybenefits/mhs_ho.html
Use GROUP #630363
Not sure if your election requires a Medical History Statement? Check your Confirmation Statement, or review your elections by logging into your account.
Under the ACA, individuals and their dependents are generally required to have health coverage that meet certain minimum federal coverage requirements or be potentially subject to a shared responsibility payment (i.e., tax payment), the payment of which occurs through the filing of your federal income tax return. This provision of the ACA is commonly referred to as the “individual mandate.” Most individuals and their dependents who are covered under an employer provided health coverage plan will have health coverage that meet minimum federal requirements.
Individuals who do not have access to employer provided health coverage can use the health insurance marketplace (exchanges) to buy qualifying individual health coverage or get coverage through other sources such as Medicare or Medi-Cal.
Yes, the health coverage plan offered through your employment with the City will meet the necessary federal coverage requirements under the ACA for any month that you are covered.
Certain individuals may be exempt from having health coverage that does not meet minimum federal coverage requirements. For further information on qualifying exemptions please consult a tax advisor or go to https://www.irs.gov/affordable-care-act/individuals-and-families.
No, only health coverage is required under the ACA. Most City employees are eligible for other benefits beyond health insurance. However, you are not required to have these benefits for purposes of the ACA.
You are not required to buy health coverage through the City if you are covered under your spouse’s plan. However, it is important to confirm if the health coverage provided through your spouse’s plan meet minimum federal coverage requirements.
The health coverage plan offered through your employment with the City will meet the necessary coverage requirements under the ACA for any month that you are covered.
Depending on the type of health plan in which you are enrolled, you will receive either tax forms 2018 Form 1095-B or 2018 Form 1095-C.
If you are an employee receiving health coverage through your employment with the City, you will receive a copy of 2018 Form 1095-C from the City. In addition, you will receive a copy of 2018 Form 1095-B from your health insurance issuer. These forms will be mailed to your home address no later than March 4, 2019, with copies sent to the Internal Revenue Service (IRS). The information provided in these forms can assist you in preparing your tax return but is not required. Be sure to retain the forms with your other important tax records.
In the event you and your dependents did not have health coverage for any month of 2018, you may owe a shared responsibility payment. Please consult your tax advisor.
In addition to the ACA related tax forms issued to you as part of your employment with the City, you may also receive additional forms in the event you had multiple employers required to issue ACA related tax forms to you for 2018, or if you were covered by more than one insurance carrier during 2018.
The individual shared responsibility provision requires that you and your dependents have health coverage meeting certain minimum federal requirements for the full 2018 year, unless an exemption applies. A shared responsibility payment may be required for the months in 2018 that you and your dependents did not have health coverage or qualify for an exemption.
Health Insurance Marketplace — also known as the Health Insurance Exchange — is the place where individuals without health coverage can find information about health coverage options and also purchase health care insurance. Information can also be found regarding eligibility for help with paying premiums and reducing out-of-pocket costs. Each year the marketplace has an open enrollment period.
In addition to the federally-facilitated marketplace, HealthCare.gov, there are also state-based Marketplaces. Whether you use the federally-facilitated Marketplace or a state-based Marketplace depends on the state in which you live. The California marketplace is called Covered California. To learn more, please go to http://www.coveredca.com.
If your dependent’s coverage was cancelled in 2018, you may be subject to a shared responsibility payment for any gaps in health coverage. Reenrollment of your dependent, provided eligibility requirements are met, would have to wait until the next open enrollment period or until you have an eligible life event change. However, any coverage obtained through reenrollment will not be retroactive. Please consult a tax advisor for more information on the shared responsibility payment.
Keep in mind, if you have family members who lose City coverage in the future, those family members may qualify for coverage through the health insurance marketplace. To learn more, go to http://www.coveredca.com for additional information.
Yes, the health coverage plan offered through Direct Billing will meet the necessary federal coverage requirements under the ACA for any month that you are covered.
It is important to note that if you have health coverage under Direct Billing, you must pay your health premiums by the due date on your billing notice to keep your health coverage active. It is important to understand that if you fail to pay your health premiums by the due date on your billing notice, your health coverage will be cancelled and cannot be reinstated retroactively.
You can continue your health coverage under Direct Billing by paying the full cost shown on your billing notice for up to six months. When any coverage you have through Direct Billing ends, you will need to seek other coverage if you are not eligible for a City health plan. You may want to consider coverage through the health insurance marketplace. To learn more, please go to http://www.coveredca.com.
The City is required to collect SSNs for dependents to fulfill certain reporting obligations under the ACA. Be aware that your health insurance issuer may also ask for your dependent SSN under the ACA.
Almost everyone can buy coverage through the health insurance marketplace. However, if you are eligible for health coverage through your employment with the City, the marketplace may not be the most cost-effective choice, especially since the City pays a significant portion of the premiums on health insurance offered under its sponsored plans.
If certain conditions are met, some individuals may qualify for subsidies to help them purchase health coverage through the health insurance marketplace. However, if you and your dependents are eligible for health coverage through your employment with the City, you may not qualify for a government subsidy. Please consult your tax advisor.