MEDICAL INSURANCE

 

City employees may choose from five different medical plans or enroll in cash-in-lieu.

 

1. Kaiser Permanente HMO
Member Services: 800-464-4000

my.kp.org/ca/cityofla


Kaiser Member Advocate
(323) 219-6704
LACity.Advocate@kp.org


Kaiser Permanente Mobile App


Cash-in-Lieu: Cash benefit paid to employee in-lieu of enrollment into one of the City’s health plans.

 

2. Anthem Narrow Network (Select HMO)
Member Services: 844-348-6111 3. Anthem Full Network (CA Care HMO)
Member Services: 844-348-6111 4. Anthem Vivity HMO (LA & Orange Counties)
Member Services: 844-348-6110
5. Anthem PPO
Member Services: 833-597-2362

anthem.com/ca/cityofla

Anthem Member Advocate
(213) 200-2987
Lorena.Gomez@anthem.com


Anthem Sydney Health Mobile App

 

Information on this Page

Information on Other Pages

Medical Plan Comparison

Understanding HMOs and PPOs

Health Maintenance Organizations (HMOs) provide healthcare through a network of doctors, hospitals, and other healthcare providers. With an HMO plan, you must access covered services through a network of physicians and facilities as directed by your Primary Care Physician (PCP), except for emergencies. LAwell provides coverage where most City employees live; to enroll, a member must reside/work within the region served by the HMO.

Health coverage with an HMO plan is typically restricted to a specific distance from a home or work address. As City employees, your health coverage options discussed in this guide are available to City of Los Angeles work addresses. If you select HMO coverage and you reside outside of City of Los Angeles limits, be sure that you and your dependents are able to receive PCP services in or near your area of residence or that you are capable of and willing to travel into the Los Angeles area each time you seek care. To review PCP availability in other areas, review the “Finding Network Providers” section of the provider you are interested in.

Preferred Provider Organizations (PPOs) are nationwide networks of doctors, hospitals, and other healthcare providers that have agreed to offer quality medical care and services at discounted rates. Members may access services both within and outside of a network. They can use in-network providers for a higher level of reimbursed coverage, or go to a licensed out-of-network provider and receive a lower level of reimbursed coverage.


The following table highlights some differences between the City’s HMO and PPO healthcare options.




 Kaiser Permanente HMO Anthem Plan
Narrow Network
(Select HMO)
Full Network
(CACare HMO)		 Vivity
(LA & Orange Counties HMO)
 PPO
In-network care You may visit any Kaiser Permanente facility; a primary care physician is recommended but not required. You designate a primary care physician; you must see this physician first when you need specialty care. You may visit a network provider of your choice; no primary care physician or specialist referrals required.
Out-of-network care Not covered unless you need care for a serious medical emergency outside of your HMO’s network service area. You may visit any licensed provider you choose, and no primary care physician or specialist referrals are required. However, you will receive a lower level of benefits for out-of-network care.

2025 Medical Plan Services Highlights
Kaiser Permanente HMO
Anthem Narrow Network
(Select HMO)
Anthem Full Network
(CACare HMO)
Anthem Vivity HMO
(LA & Orange Counties)

Calendar Year Deductible
$0
$0

Calendar Year
Out-of-Pocket Limit
$1,500/person; $3,000/family
$500/person; $1,500/family

Routine Office Visits
(including pediatric visits)		 Plan pays 100% after $15 copay/visit2
Plan pays 100% after $15 copay/visit2

Virtual Visits
Plan pays 100%
Plan pays 100% after $15 copay/visit2

Preventive Care1
Plan pays 100%
Plan pays 100%

Maternity Care
(Office Visits) & Pregnancy
Plan pays 100%
Plan pays 100%

Inpatient Hospitalization
Plan pays 100%
Plan pays 100%

Outpatient Surgery
Plan pays 100% after $15 copay/procedure
Plan pays 100%

Diagnostic Lab Work and X-rays
Plan pays 100% at a Kaiser facility
Plan pays 100%

Emergency Room Care for True Emergencies (severe chest pains, breathing difficulties, severe bleeding, poisoning etc.)
Plan pays 100% after $100 copay/ visit; copay waived if admitted
Plan pays 100% after $100 copay/visit; copay waived if admitted

Hearing Aid Benefit
Plan pays up to $2,000 for one device per ear every 36 months; covers all visits for fitting, counseling, adjustment, cleaning, and inspection
Plan pays for one hearing aid per ear every 24 months

  1. Preventive care coverage includes preventive services rated A or B by the U.S. Preventive Services Task Force and federal regulations. Go to the website for your health plan or call your health plan if you have questions about coverage.

  2. Copay varies by office visit type. See the Evidence of Coverage for more details.



Anthem PPO


In-Network
Out-of-Network

Calendar Year Deductible
$750/person; $1,500/family
$1,250/person; $2,500/family

Calendar Year
Out-of-Pocket Limit
$2,000/person; $4,000/family, in-network and out-of-network combined

Routine Office Visits
(including pediatric visits)
Plan pays 100% after $30 copay/visit with no deductible; 90% after deductible for any procedures as part of visit


Plan pays 100% for Well-Baby & Well-Child Care
Plan pays 70% of allowed charges2 after deductible

Online Doctor Visits
Plan pays 100% after $30 copay
N/A

Preventive Care1
Plan pays 100%, no deductible
Plan pays 70% of allowed charges2 after deductible

Maternity Care
(Office Visits) & Pregnancy
Prenatal and postnatal office visits for services mandated by the Affordable Care Act (ACA):
Plan pays 100%; no copay, no deductible.
Other prenatal/postnatal office visits: Plan pays 100% after $30 copay/visit with no deductible.
Other services: Plan pays 90% after deductible
Plan pays 70% of allowed charges2 after deductible

Inpatient Hospitalization


Plan pays 90% after deductible; prior authorization needed3
Plan pays 70% of allowed charges2 after deductible, up to $1,500 per day maximum allowed charges.
You are responsible for all charges in excess of $1,500 per day. Prior authorization is needed3.

Outpatient Surgery


Plan pays 90% after deductible
Plan pays 70% of allowed charges2 after deductible, up to $350 per day maximum allowed charges. You are responsible for all charges in excess of $350 per day.

Diagnostic Lab Work and X-rays
Plan pays 90% after deductible
Plan pays 70% of allowed charges2 after deductible

Emergency Room Care for True Emergencies (severe chest pains, breathing difficulties, severe bleeding, poisoning, etc.)
Plan pays 90% after $100 copay/visit; copay waived if admitted and regular hospitalization benefits apply
Plan pays 90% after $100 copay/visit; copay waived if admitted and regular hospitalization benefits apply

Hearing Aid Benefit
Plan pays 80% after deductible for one hearing aid per ear every 24 months
Plan pays 80% of allowed charges2after deductible for one hearing aid per ear every 24 months

  1. Preventive care coverage includes preventive services rated A or B by the U.S. Preventive Services Task Force and federal regulations.
    Go to the website for your health plan or call your health plan if you have questions about coverage.

  2. When members use non-preferred providers, they must pay the applicable copay and coinsurance plus any amount that exceeds Anthem Blue Cross’s allowable amount.
    Charges above the allowable amount do not count toward the calendar year deductible or out-of-pocket limit.

  3. You or your doctor must contact Anthem for preauthorization and approval at a non-participating provider before a hospital stay or you will be responsible for a penalty of $250.

2024 Medical Plan Services Highlights
Kaiser Permanente HMO
Anthem Narrow Network
(Select HMO)
Anthem Full Network
(CACare HMO)
Anthem Vivity HMO
(LA & Orange Counties)

Calendar Year Deductible
$0
$0

Calendar Year
Out-of-Pocket Limit
$1,500/person; $3,000/family
$500/person; $1,500/family

Routine Office Visits
(including pediatric visits)		 Plan pays 100% after $15 copay/visit2
Plan pays 100% after $15 copay/visit2

Virtual Visits
Plan pays 100%
Plan pays 100% after $15 copay/visit2

Preventive Care1
Plan pays 100%
Plan pays 100%

Maternity Care
(Office Visits) & Pregnancy
Plan pays 100%
Plan pays 100%

Inpatient Hospitalization
Plan pays 100%
Plan pays 100%

Outpatient Surgery
Plan pays 100% after $15 copay/procedure
Plan pays 100%

Diagnostic Lab Work and X-rays
Plan pays 100% at a Kaiser facility
Plan pays 100%

Emergency Room Care for True Emergencies (severe chest pains, breathing difficulties, severe bleeding, poisoning etc.)
Plan pays 100% after $100 copay/ visit; copay waived if admitted
Plan pays 100% after $100 copay/visit; copay waived if admitted

Hearing Aid Benefit
Plan pays up to $2,000 for one device per ear every 36 months; covers all visits for fitting, counseling, adjustment, cleaning, and inspection
Plan pays for one hearing aid per ear every 24 months

  1. Preventive care coverage includes preventive services rated A or B by the U.S. Preventive Services Task Force and federal regulations. Go to the website for your health plan or call your health plan if you have questions about coverage.

  2. Copay varies by office visit type. See the Evidence of Coverage for more details.



Anthem PPO


In-Network
Out-of-Network

Calendar Year Deductible
$750/person; $1,500/family
$1,250/person; $2,500/family

Calendar Year
Out-of-Pocket Limit
$2,000/person; $4,000/family, in-network and out-of-network combined

Routine Office Visits
(including pediatric visits)
Plan pays 100% after $30 copay/visit with no deductible; 90% after deductible for any procedures as part of visit


Plan pays 100% for Well-Baby & Well-Child Care
Plan pays 70% of allowed charges2 after deductible

Online Doctor Visits
Plan pays 100% after $30 copay
N/A

Preventive Care1
Plan pays 100%, no deductible
Plan pays 70% of allowed charges2 after deductible

Maternity Care
(Office Visits) & Pregnancy
Prenatal and postnatal office visits for services mandated by the Affordable Care Act (ACA):
Plan pays 100%; no copay, no deductible.
Other prenatal/postnatal office visits: Plan pays 100% after $30 copay/visit with no deductible.
Other services: Plan pays 90% after deductible
Plan pays 70% of allowed charges2 after deductible

Inpatient Hospitalization


Plan pays 90% after deductible; prior authorization needed3
Plan pays 70% of allowed charges2 after deductible, up to $1,500 per day maximum allowed charges.
You are responsible for all charges in excess of $1,500 per day. Prior authorization is needed3.

Outpatient Surgery


Plan pays 90% after deductible
Plan pays 70% of allowed charges2 after deductible, up to $350 per day maximum allowed charges. You are responsible for all charges in excess of $350 per day.

Diagnostic Lab Work and X-rays
Plan pays 90% after deductible
Plan pays 70% of allowed charges2 after deductible

Emergency Room Care for True Emergencies (severe chest pains, breathing difficulties, severe bleeding, poisoning, etc.)
Plan pays 90% after $100 copay/visit; copay waived if admitted and regular hospitalization benefits apply
Plan pays 90% after $100 copay/visit; copay waived if admitted and regular hospitalization benefits apply

Hearing Aid Benefit
Plan pays 80% after deductible for one hearing aid per ear every 24 months
Plan pays 80% of allowed charges2 after deductible for one hearing aid per ear every 24 months

  1. Preventive care coverage includes preventive services rated A or B by the U.S. Preventive Services Task Force and federal regulations.
    Go to the website for your health plan or call your health plan if you have questions about coverage.

  2. When members use non-preferred providers, they must pay the applicable copay and coinsurance plus any amount that exceeds Anthem Blue Cross’s allowable amount.
    Charges above the allowable amount do not count toward the calendar year deductible or out-of-pocket limit.

  3. You or your doctor must contact Anthem for preauthorization and approval at a non-participating provider before a hospital stay or you will be responsible for a penalty of $250.


2023 Medical Plan Services Highlights
Kaiser Permanente HMO
Anthem Narrow Network
(Select HMO)
Anthem Full Network
(CACare HMO)
Anthem Vivity HMO
(LA & Orange Counties)

Calendar Year Deductible
$0
$0

Calendar Year
Out-of-Pocket Limit
$1,500/person; $3,000/family
$500/person; $1,500/family

Routine Office Visits
(including pediatric visits)		 Plan pays 100% after $15 copay/visit2
Plan pays 100% after $15 copay/visit2

Virtual Visits
Plan pays 100%
Plan pays 100% after $15 copay/visit2

Preventive Care1
Plan pays 100%
Plan pays 100%

Maternity Care
(Office Visits) & Pregnancy
Plan pays 100%
Plan pays 100%

Inpatient Hospitalization
Plan pays 100%
Plan pays 100%

Outpatient Surgery
Plan pays 100% after $15 copay/procedure
Plan pays 100%

Diagnostic Lab Work and X-rays
Plan pays 100% at a Kaiser facility
Plan pays 100%

Emergency Room Care for True Emergencies (severe chest pains, breathing difficulties, severe bleeding, poisoning etc.)
Plan pays 100% after $100 copay/ visit; copay waived if admitted
Plan pays 100% after $100 copay/visit; copay waived if admitted

Hearing Aid Benefit
Plan pays up to $2,000 for one device per ear every 36 months; covers all visits for fitting, counseling, adjustment, cleaning, and inspection
Plan pays for one hearing aid per ear every 24 months
1 Preventive care coverage includes preventive services rated A or B by the U.S. Preventive Services Task Force and federal regulations. Go to the website for your health plan or call your health plan if you have questions about coverage.

2 Copay varies by office visit type. See the Evidence of Coverage for more details.


Anthem PPO


In-Network
Out-of-Network

Calendar Year Deductible
$750/person; $1,500/family
$1,250/person; $2,500/family

Calendar Year
Out-of-Pocket Limit
$2,000/person; $4,000/family, in-network and out-of-network combined

Routine Office Visits
(including pediatric visits)
Plan pays 100% after $30 copay/visit with no deductible; 90% after deductible for any procedures as part of visit


Plan pays 100% for Well-Baby & Well-Child Care
Plan pays 70% of allowed charges2 after deductible

Online Doctor Visits
Plan pays 100% after $30 copay
N/A

Preventive Care1
Plan pays 100%, no deductible
Plan pays 70% of allowed charges2 after deductible

Maternity Care
(Office Visits) & Pregnancy
Prenatal and postnatal office visits for services mandated by the Affordable Care Act (ACA):
Plan pays 100%; no copay, no deductible.
Other prenatal/postnatal office visits: Plan pays 100% after $30 copay/visit with no deductible.
Other services: Plan pays 90% after deductible
Plan pays 70% of allowed charges2 after deductible

Inpatient Hospitalization


Plan pays 90% after deductible; prior authorization needed3
Plan pays 70% of allowed charges2 after deductible, up to $1,500 per day maximum allowed charges.
You are responsible for all charges in excess of $1,500 per day. Prior authorization is needed.3

Outpatient Surgery


Plan pays 90% after deductible
Plan pays 70% of allowed charges2 after deductible, up to $350 per day maximum allowed charges. You are responsible for all charges in excess of $350 per day.

Diagnostic Lab Work and X-rays
Plan pays 90% after deductible
Plan pays 70% of allowed charges2 after deductible

Emergency Room Care for True Emergencies (severe chest pains, breathing difficulties, severe bleeding, poisoning, etc.)
Plan pays 90% after $100 copay/visit; copay waived if admitted and regular hospitalization benefits apply
Plan pays 90% after $100 copay/visit; copay waived if admitted and regular hospitalization benefits apply

Hearing Aid Benefit
Plan pays 80% after deductible for one hearing aid per ear every 24 months
Plan pays 80% of allowed charges2 after deductible for one hearing aid per ear every 24 months


1 Preventive care coverage includes preventive services rated A or B by the U.S. Preventive Services Task Force and federal regulations. Go to the website for your health plan or call your health plan if you have questions about coverage.

2 When members use non-preferred providers, they must pay the applicable copay and coinsurance plus any amount that exceeds Anthem Blue Cross’s allowable amount. Charges above the allowable amount do not count toward the calendar year deductible or out-of-pocket limit.

3 You or your doctor must contact Anthem for preauthorization and approval at a non-participating provider before a hospital stay or you will be responsible for a penalty of $250.
 

Accessing Care & Services

Kaiser Permanente HMO

Member Advocate

Member Advocates from our healthcare providers provide personal, one-on-one assistance. The Kaiser Member Advocate contact information is as follows:

Phone: (323) 219-6704, Monday - Friday 8 a.m. - 4 p.m.
Email: LACity.Advocate@kp.org

Finding a Kaiser Primary Care Physician or network provider

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 or while making a regular doctor’s appointment.

Go to my.kp.org/ca/cityofla, choose Find a Doctor, then choose Southern California or call 800-464-4000 – Open 24 hours a day, 7 days a week

Prescription Drug Coverage

Prescription benefits are part of the Kaiser Permanente HMO medical plan. You must fill prescriptions at a Kaiser pharmacy. To have a prescription filled, simply show your member ID card and pay a copayment when you go to a participating Kaiser pharmacy. You do not have to submit claim forms. Prescriptions from non-participating pharmacies are not covered unless they are associated with covered emergency services.

Find a Kaiser pharmacy, visit my.kp.org/ca/cityofla.

Kaiser Permanente Mobile App

Download the Kaiser Permanente Mobile App.

Telemedicine

Kaiser provides phone and video appointments at no additional cost to you. An e-visit from the comfort of your home will allow you to get quick guidance from a Kaiser Permanente provider, including some prescriptions and 24/7 self-care advice. For more convenient ways to get care, visit kp.org/getcare.

LGBTQIA Health Care Providers

Providers Kaiser can offer care that is personalized and most relevant to your sexual orientation, gender identity, or gender expression. You and your provider can decide what information to add to your medical record that will best meet your care needs. For assistance in finding an LGBTQIA provider, use the network provider link above, or contact the Kaiser member advocate. For further information about transgender or nonbinary health care, please call the Transgender Care line at 323-857-3818 to speak to a nurse case coordinator. This line is available from 7:30 a.m. to 5:00 p.m.

Acupuncture & Chiropractic Care

Physician-referred acupuncture is covered at a $15 per visit copay. Kaiser Permanente HMO does not cover chiropractic care, but member discounts on these services are available. For more information, go to kp.org/healthyroads, call 877-335-2746, or contact the Kaiser member advocate.

Anthem HMOs

Member Advocate

Member Advocates from our healthcare providers provide personal, one-on-one assistance. The Anthem Member Advocate contact information is as follows:
Phone: (213) 200-2987, Monday - Friday 8 a.m. - 4 p.m.
Email: Lorena.Gomez@anthem.com

Finding an Anthem Primary Care Physician or network provider

Members in an Anthem HMO Plan will choose a Primary Care Physician (PCP) or medical group. You and your family members do not have to enroll with the same PCP or medical group, but a PCP designation is required to see a doctor. If you enroll in an Anthem plan for the first time, you and your family will be automatically assigned a PCP. You may call the Anthem Blue Cross Customer Service number on the back of your ID card to change your PCP assignment. Anthem members are typically allowed to change their PCP designation no more than once a month.

To find a PCP/network provider:

  • Visit anthem.com/ca/cityofla, choose Find Care, then identify your plan, or
  • Call Anthem (Narrow or Full) at 844-348-6111, Monday through Friday, 8 a.m. to 8 p.m, or
  • Call Anthem Vivity at 844-348-6110, Monday through Friday, 8 a.m. to 8 p.m or
  • Contact the Anthem member advocate.

Prescription Drug Coverage

Prescription benefits are part of the Anthem HMO medical plans. You must fill prescriptions at any retail pharmacy that participates in the Anthem pharmacy network. Prescriptions from non-participating pharmacies are also covered, but your cost share may be significantly higher. To have a prescription filled, simply show your member ID card and pay a copayment when you go to a participating Anthem pharmacy. You do not have to submit claim forms.

To find a participating pharmacy, go to anthem.com/ca/cityofla and select Drug Lists (Formularies) at the bottom of the page, then select Anthem National Drug List.

If an Anthem member requests a brand-name drug and a generic equivalent is available, the member is responsible for paying the generic drug copayment plus the difference in cost between the brand-name drug and its generic drug equivalent. Some examples of expenses the prescription drug program does not cover include:

  • Most over-the-counter drugs (except insulin), even if prescribed by your doctor
  • Vitamins, except those requiring a prescription, like prenatal vitamins
  • Any drug available through prescription but not medically necessary for treating an illness or injury
  • Non FDA-approved drugs, or drugs determined to used for experimental or investigative indications

Anthem Sydney Mobile App

Download the Anthem Sydney Mobile App.

Telemedicine

Anthem offers LiveHealth Online providing online video visits with a doctor 24/7 through a smartphone, tablet, or computer with a webcam; no appointment is needed. Anthem also offers the Sydney Care mobile app ( App Store or Google Play), which members can download at no cost. Members will be able to connect directly to a board-certified doctor via text or secure two-way video via the Sydney Care app who can then recommend care options.

LGBTQIA Health Care Providers

Anthem can offer care that is personalized and most relevant to your sexual orientation, gender identity, or gender expression. You and your provider can decide what information to add to your medical record that will best meet your care needs. For assistance in finding an LGBTQIA provider, use the network provider link above, or visit the Anthem onsite member advocate at City Hall.

Acupuncture & Chiropractic Care

Anthem plans include coverage for chiropractic care and acupuncture, with some limitations on the number of visits covered each year. You can visit any participating chiropractor from the network without a referral from your primary care physician. Simply call a participating provider to schedule an initial exam.

Anthem PPO

Members in the Anthem PPO Plan may visit any licensed provider, in or out of network; no primary care physician or specialist referrals are required. However, you will receive a lower level of benefits for out-of-network care.

Anthem Health Plan Member Advocate

Member Advocates from our healthcare providers provide personal, one-on-one assistance. The Anthem Member Advocate contact information is as follows:
Phone: (213) 200-2987, Monday - Friday 8 a.m. - 4 p.m.
Email: Lorena.Gomez@anthem.com

Anthem PPO member services: 833-597-2362.

Prescription Drug Coverage

Prescription benefits are part of the Anthem PPO medical plan. You must fill prescriptions at any retail pharmacy that participates in the Anthem pharmacy network. Prescriptions from non-participating pharmacies are also covered, but your cost share may be significantly higher. To have a prescription filled, simply show your member ID card and pay a copayment when you go to a participating Anthem pharmacy. You do not have to submit claim forms.

To find a participating pharmacy, go to anthem.com/ca/cityofla and select Drug Lists (Formularies) at the bottom of the page, then select Anthem National Drug List.

If an Anthem member requests a brand-name drug and a generic equivalent is available, the member is responsible for paying the generic drug copayment plus the difference in cost between the brand-name drug and its generic drug equivalent. Some examples of expenses the prescription drug program does not cover include:

  • Most over-the-counter drugs (except insulin), even if prescribed by your doctor

  • Vitamins, except those requiring a prescription, like prenatal vitamins

  • Any drug available through prescription but not medically necessary for treating an illness or injury

  • Non FDA-approved drugs, or drugs determined to used for experimental or investigative indications

Anthem Sydney Mobile App

Download the Anthem Sydney Mobile App.

Telemedicine

Anthem offers LiveHealth Online providing online video visits with a doctor 24/7 through a smartphone, tablet, or computer with a webcam; no appointment is needed. Lastly, Anthem also offers the Sydney Care mobile app ( App Store or Google Play), which members can download at no cost. Members will be able to connect directly to a board-certified doctor via text or secure two-way video via the Sydney Care app who can then recommend care options.

LGBTQIA Health Care Providers

Anthem can offer care that is personalized and most relevant to your sexual orientation, gender identity, or gender expression. You and your provider can decide what information to add to your medical record that will best meet your care needs.

To find an LGBTQIA network provider:

  • Contact the Anthem member advocate.

Acupuncture & Chiropractic Care

Anthem plans include coverage for chiropractic care and acupuncture, with some limitations on the number of visits covered each year. You can visit any participating chiropractor from the network without a referral from your primary care physician. Simply call a participating provider to schedule an initial exam.

To find a network provider:

  • Contact the Anthem member advocate.

Your Medical Plan Premium Costs

City Subsidy

The City is committed to supporting the healthcare needs of LAwell members and their families. Contributions to health insurance premiums represent a substantial component of your total compensation.

The amount of premium you are responsible for depends on four factors:

1. Your employment status (full-time or half-time)

  • The 2025 maximum monthly City subsidy for full-time employees is $2,119.50 per month. This is an amount equal to the 2025 Kaiser Permanente HMO family premium.

  • The 2025 maximum monthly City subsidy for half-time employees is $815.20 per month. This is an amount equal to the 2025 Kaiser Permanente HMO employee-only rate.

*Subject to any premium sharing requirements as provided for by the employee’s MOU.

2. The Memorandum of Understanding (MOU) contribution structure that applies to you - the LAwell Play or the LAwell Pay Plan.

  • LAwell Plan: Pays up to the City’s maximum subsidy without additional premium cost-sharing. Covered MOUs include 00, 01, 02, 03, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 26, 27, 28, 29, 30, 31, 32, 34, 36, 37, 38, 39, 40, 61, 63, 64, and 65.

  • LAwell Pay Plan: As of January 1, 2023, no MOUs are included in the LAwell Pay Plan, subject to change without notice.

    If you have questions regarding your health plan contributions, please refer to your applicable MOU, or to Los Angeles Administrative Code Section 4.307 for non-represented employees.

3. The specific medical plan you choose.

4. The coverage level you choose. This is the number of dependents* you cover, if any. There are four coverage level options available for enrollment.

  • Employee Only: Single Party – Employee Only

  • Employee & Spouse/Domestic Partner (DP): Two Party – Employee and another adult legal spouse or legal DP

  • Employee + Child(ren): Two+ Party – Employee and any legal child and/or disabled child dependents

  • Employee + Family: Three+ Party – Employee and all legal dependents

    *Eligibility of dependents is subject to LAwell program rules. Domestic partnerships are not recognized under federal tax law, and enrollment of domestic partner dependents may result in different taxable income treatment of the employee. Find more information on our Dependent Eligibility page.

 

2025 Full-Time Employee Costs

2025 LAwell Plan Costs

Coverage Level City Pays… Full-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $407.60 $0.00 $407.60
Employee & Spouse/DP $896.71 $0.00 $896.71
Employee + Child(ren) $815.19 $0.00 $815.19
Employee + Family $1,059.75 $0.00 $1,059.75
Anthem Narrow Network (Select) HMO
Employee Only $436.86 $0.00 $436.86
Employee & Spouse/DP $961.14 $0.00 $961.14
Employee + Child(ren) $830.09 $0.00 $830.09
Employee + Family $1,059.75 $76.17 $1,135.92
Anthem Full Network (CACare) HMO
Employee Only $436.86 $180.03 $616.89
Employee + Spouse/DP $961.14 $396.02 $1,357.16
Employee + Child(ren) $830.09 $342.01 $1,172.10
Employee + Family $1,059.75 $544.19 $1,603.94
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $366.73 $0.00 $366.73
Employee + Spouse/DP $806.83 $0.00 $806.83
Employee + Child(ren) $696.80 $0.00 $696.80
Employee + Family $953.52 $0.00 $953.52
Anthem PPO
Employee Only $726.30 $0.00 $726.30
Employee + Spouse/DP $1,059.75 $538.09 $1,597.84
Employee + Child(ren) $1,059.75 $320.19 $1,379.94
Employee + Family* $1,059.75 $828.61 $1,888.36


2025 LAwell Pay Plan Costs

Coverage Level City Pays… Full-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $366.84 $40.76 $407.60
Employee & Spouse/DP $807.04 $89.67 $896.71
Employee + Child(ren) $733.68 $81.52 $815.19
Employee + Family $953.78 $105.97 $1,059.75
Anthem Narrow Network (Select) HMO
Employee Only $393.18 $43.68 $436.86
Employee & Spouse/DP $865.03 $96.12 $961.14
Employee + Child(ren) $747.09 $83.01 $830.09
Employee + Family $953.78 $182.15 $1,135.92
Anthem Full Network (CACare) HMO
Employee Only $393.18 $223.71 $616.89
Employee + Spouse/DP $865.03 $492.14 $1,357.16
Employee + Child(ren) $747.09 $425.02 $1,172.10
Employee + Family $953.78 $650.17 $1,603.94
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $330.06 $36.68 $366.73
Employee + Spouse/DP $726.15 $80.68 $806.83
Employee + Child(ren) $627.13 $69.68 $696.80
Employee + Family $858.17 $95.35 $953.52
Anthem PPO
Employee Only $653.68 $72.63 $726.30
Employee + Spouse/DP $953.78 $644.07 $1,597.84
Employee + Child(ren) $953.78 $426.17 $1,379.94
Employee + Family* $953.78 $934.59 $1,888.36

2025 Half-Time Employee Costs

2025 LAwell Plan Costs

Coverage Level City Pays… Half-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $407.60 $0.00 $407.60
Employee & Spouse/DP $407.60 $489.11 $896.71
Employee + Child(ren) $407.60 $407.59 $815.19
Employee + Family $407.60 $652.15 $1,059.75
Anthem Narrow Network (Select) HMO
Employee Only $407.60 $29.26 $436.86
Employee & Spouse/DP $407.60 $553.54 $961.14
Employee + Child(ren) $407.60 $422.49 $830.09
Employee + Family $407.60 $728.32 $1,135.92
Anthem Full Network (CACare) HMO
Employee Only $407.60 $209.29 $616.89
Employee + Spouse/DP $407.60 $949.56 $1,357.16
Employee + Child(ren) $407.60 $764.50 $1,172.10
Employee + Family $407.60 $1,196.34 $1,603.94
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $366.73 $0.00 $366.73
Employee + Spouse/DP $407.60 $399.23 $806.83
Employee + Child(ren) $407.60 $289.20 $696.80
Employee + Family $407.60 $545.92 $953.52
Anthem PPO
Employee Only $407.60 $318.70 $726.30
Employee + Spouse/DP $407.60 $1,190.24 $1,597.84
Employee + Child(ren) $407.60 $972.34 $1,379.94
Employee + Family* $407.60 $1,480.76 $1,888.36

2025 LAwell Pay Plan Costs

Coverage Level City Pays… Half-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $366.84 $40.76 $407.60
Employee & Spouse/DP $366.84 $529.88 $896.71
Employee + Child(ren) $366.84 $448.36 $815.19
Employee + Family $366.84 $692.91 $1,059.75
Anthem Narrow Network (Select) HMO
Employee Only $366.84 $70.03 $436.86
Employee & Spouse/DP $366.84 $594.31 $961.14
Employee + Child(ren) $366.84 $463.26 $830.09
Employee + Family $366.84 $769.09 $1,135.92
Anthem Full Network (CACare) HMO
Employee Only $366.84 $250.06 $616.89
Employee + Spouse/DP $366.84 $990.33 $1,357.16
Employee + Child(ren) $366.84 $805.27 $1,172.10
Employee + Family $366.84 $1,237.11 $1,603.94
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $330.06 $36.68 $366.73
Employee + Spouse/DP $366.84 $440.00 $806.83
Employee + Child(ren) $366.84 $329.97 $696.80
Employee + Family $366.84 $586.69 $953.52
Anthem PPO
Employee Only $366.84 $359.47 $726.30
Employee + Spouse/DP $366.84 $1,231.01 $1,597.84
Employee + Child(ren) $366.84 $1,013.11 $1,379.94
Employee + Family* $366.84 $1,521.53 $1,888.36

2024 Full-Time Employee Costs

2024 LAwell Plan Costs

Coverage Level City Pays… Full-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $387.96 $0.00 $387.96
Employee & Spouse/DP $853.52 $0.00 $853.52
Employee + Child(ren) $775.93 $0.00 $775.93
Employee + Family $1,008.70 $0.00 $1,008.70
Anthem Narrow Network (Select) HMO
Employee Only $390.40 $0.00 $390.40
Employee & Spouse/DP $858.93 $0.00 $858.93
Employee + Child(ren) $741.81 $0.00 $741.81
Employee + Family $1,008.70 $6.42 $1,015.12
Anthem Full Network (CACare) HMO
Employee Only $390.40 $160.89 $551.29
Employee + Spouse/DP $858.93 $353.90 $1,212.83
Employee + Child(ren) $741.81 $305.64 $1,047.45
Employee + Family $1,008.70 $426.67 $1,433.37
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $327.73 $0.00 $327.73
Employee + Spouse/DP $721.03 $0.00 $721.03
Employee + Child(ren) $622.70 $0.00 $622.70
Employee + Family $852.12 $0.00 $852.12
Anthem PPO
Employee Only $649.06 $0.00 $649.06
Employee + Spouse/DP $1008.70 $419.22 $1,427.92
Employee + Child(ren) $1008.70 $224.49 $1,233.19
Employee + Family* $1008.70 $678.84 $1,687.54


2024 LAwell Pay Plan Costs

Coverage Level City Pays… Full-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $387.96 $0.00 $387.96
Employee & Spouse/DP $853.52 $0.00 $853.52
Employee + Child(ren) $775.93 $0.00 $775.93
Employee + Family $1,008.70 $0.00 $1,008.70
Anthem Narrow Network (Select) HMO
Employee Only $390.40 $0.00 $390.40
Employee & Spouse/DP $858.93 $0.00 $858.93
Employee + Child(ren) $741.81 $0.00 $741.81
Employee + Family $1,008.70 $6.42 $1,015.12
Anthem Full Network (CACare) HMO
Employee Only $390.40 $160.89 $551.29
Employee + Spouse/DP $858.93 $353.90 $1,212.83
Employee + Child(ren) $741.81 $305.64 $1,047.45
Employee + Family $1,008.70 $426.67 $1,433.37
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $327.73 $0.00 $327.73
Employee + Spouse/DP $721.03 $0.00 $721.03
Employee + Child(ren) $622.70 $0.00 $622.70
Employee + Family $852.12 $0.00 $852.12
Anthem PPO
Employee Only $649.06 $0.00 $649.06
Employee + Spouse/DP $1008.70 $419.22 $1,427.92
Employee + Child(ren) $1008.70 $224.49 $1,233.19
Employee + Family* $1008.70 $678.84 $1,687.54

2024 Half-Time Employee Costs

2024 LAwell Plan Costs

Coverage Level City Pays… Half-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $387.96 $0.00 $387.96
Employee & Spouse/DP $387.96 $465.56 $853.52
Employee + Child(ren) $387.96 $387.97 $775.93
Employee + Family $387.96 $620.74 $1,008.70
Anthem Narrow Network (Select) HMO
Employee Only $387.96 $2.44 $390.40
Employee & Spouse/DP $387.96 $470.97 $858.93
Employee + Child(ren) $387.96 $353.85 $674.99
Employee + Family $387.96 $627.16 $1,015.12
Anthem Full Network (CACare) HMO
Employee Only $387.96 $163.33 $551.29
Employee + Spouse/DP $387.96 $824.87 $1,212.83
Employee + Child(ren) $387.96 $659.49 $1,047.45
Employee + Family $387.96 $1,045.41 $1,433.37
Anthem Vivity (LA and Orange Counties) HMO
Employee Only $327.73 $0.00 $327.73
Employee + Spouse/DP $387.96 $333.07 $721.03
Employee + Child(ren) $387.96 $234.74 $622.70
Employee + Family $387.96 $464.16 $852.12
Anthem PPO
Employee Only $387.96 $261.10 $649.06
Employee + Spouse/DP $387.96 $1,039.96 $1,427.92
Employee + Child(ren) $387.96 $845.23 $1,233.19
Employee + Family* $387.96 $1,299.58 $1,687.54

2024 LAwell Pay Plan Costs

Coverage Level City Pays...
 Half-Time
Employee Pays… 		Total Cost of Coverage
Biweekly (per Pay Period)
Kaiser HMO
Employee Only $349.17 $38.80 $387.96
Employee + Spouse/DP $349.17 $504.35 $853.52
Employee + Child(ren) $349.17 $426.76 $775.93
Employee + Family $349.17 $659.54 $1,008.70
Anthem Narrow Network (Select) HMO
Employee Only $349.17 $41.24 $390.40
Employee + Spouse/DP $349.17 $509.77 $858.93
Employee + Child(ren) $349.17 $392.65 $741.81
Employee + Family $349.17 $665.96 $1,015.12
Anthem Full Network (CACare) HMO
Employee Only $349.17 $202.13 $551.29
Employee + Spouse/DP $349.17 $863.67 $1,212.83
Employee + Child(ren) $349.17 $698.29 $1,047.45
Employee + Family $349.17 $1,084.21 $1,433.37
Anthem Vivity (LA and Orange Counties) HMO
Employee Only $294.96 $32.78 $327.73
Employee + Spouse/DP $349.17 $371.87 $721.03
Employee + Child(ren) $349.17 $273.54 $622.70
Employee + Family $349.17 $502.96 $852.12
Anthem PPO
Employee Only $349.17 $299.90 $649.06
Employee + Spouse/DP $349.17 $1,078.76 $1,427.92
Employee + Child(ren) $349.17 $884.03 $1,233.19
Employee + Family* $349.17 $1,338.38 $1,687.54
 

2023 Full-Time Employee Costs

2023 LAwell Plan Costs

Coverage Level City Pays… Full-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $351.33 $0.00 $351.33
Employee & Spouse/DP $772.93 $0.00 $772.93
Employee + Child(ren) $702.66 $0.00 $702.66
Employee + Family $913.46 $0.00 $913.46
Anthem Narrow Network (Select) HMO
Employee Only $355.23 $0.00 $355.232
Employee & Spouse/DP $781.56 $0.00 $781.56
Employee + Child(ren) $674.99 $0.00 $674.99
Employee + Family $913.46 $10.22 $923.68
Anthem Full Network (CACare) HMO
Employee Only $355.23 $146.40 $501.63
Employee + Spouse/DP $781.56 $322.02 $1,103.58
Employee + Child(ren) $674.99 $278.10 $953.09
Employee + Family $913.46 $390.79 $1,304.25
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $298.21 $0.00 $298.21
Employee + Spouse/DP $656.08 $0.00 $656.08
Employee + Child(ren) $566.61 $0.00 $566.61
Employee + Family $775.36 $0.00 $775.36
Anthem PPO
Employee Only $590.59 $0.00 $590.59
Employee + Spouse/DP $913.46 $385.83 $1,299.29
Employee + Child(ren) $913.46 $208.64 $1,122.10
Employee + Family* $913.46 $622.06 $1,535.52

2023 LAwell Pay Plan Costs

Coverage Level City Pays...
 Full-Time
Employee Pays… 		Total Cost of Coverage
Biweekly (per Pay Period)
Kaiser HMO
Employee Only $316.20 $35.14 $351.33
Employee & Spouse/DP $695.64 $77.29 $772.93
Employee + Child(ren) $632.40 $70.26 $702.66
Employee + Family $822.12 $91.34 $913.46
Anthem Narrow Network (Select) HMO
Employee Only $319.71 $35.52 $355.23
Employee + Spouse/DP $703.41 $78.16 $781.56
Employee + Child(ren) $607.50 $67.50 $674.99
Employee + Family $822.12 $101.57 $923.68
Anthem Full Network (CACare) HMO
Employee Only $319.71 $181.92 $501.63
Employee + Spouse/DP $703.41 $400.18 $1,103.58
Employee + Child(ren) $607.50 $345.60 $953.09
Employee + Family $822.12 $482.14 $1,304.25
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $268.39 $29.82 $298.21
Employee + Spouse/DP $590.48 $65.61 $656.08
Employee + Child(ren) $509.96 $56.66 $566.61
Employee + Family $697.83 $77.54 $775.36
Anthem PPO
Employee Only $531.54 $59.06 $590.59
Employee + Spouse/DP $822.12 $477.18 $1,299.29
Employee + Child(ren) $822.12 $299.99 $1,122.10
Employee + Family* $822.12 $713.41 $1,535.52

2023 Half-Time Employee Costs

2023 LAwell Plan Costs

Coverage Level City Pays… Half-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $351.33 $0.00 $351.33
Employee & Spouse/DP $351.33 $421.60 $772.93
Employee + Child(ren) $351.33 $351.33 $702.66
Employee + Family $351.33 $562.13 $913.46
Anthem Narrow Network (Select) HMO
Employee Only $351.33 $3.90 $355.23
Employee & Spouse/DP $351.33 $430.23 $781.56
Employee + Child(ren) $351.33 $323.66 $674.99
Employee + Family $351.33 $572.35 $923.68
Anthem Full Network (CACare) HMO
Employee Only $351.33 $150.30 $501.63
Employee + Spouse/DP $351.33 $752.25 $1,103.58
Employee + Child(ren) $351.33 $601.76 $953.09
Employee + Family $351.33 $952.92 $1,304.25
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $298.21 $0.00 $298.21
Employee + Spouse/DP $351.33 $304.75 $656.08
Employee + Child(ren) $351.33 $215.28 $566.61
Employee + Family $351.33 $424.03 $775.36
Anthem PPO
Employee Only $351.33 $239.26 $590.59
Employee + Spouse/DP $351.33 $947.96 $1,299.29
Employee + Child(ren) $351.33 $770.77 $1,122.10
Employee + Family* $351.33 $1,184.19 $1,535.52

2023 LAwell Pay Plan Costs

Coverage Level City Pays...
 Half-Time
Employee Pays… 		Total Cost of Coverage
Biweekly (per Pay Period)
Kaiser HMO
Employee Only $316.20 $35.14 $351.33
Employee & Spouse/DP $316.20 $456.73 $772.93
Employee + Child(ren) $316.20 $386.47 $702.66
Employee + Family $316.20 $597.26 $913.46
Anthem Narrow Network (Select) HMO
Employee Only $316.20 $39.04 $355.23
Employee + Spouse/DP $316.20 $465.37 $781.56
Employee + Child(ren) $316.20 $358.80 $674.99
Employee + Family $316.20 $607.49 $923.68
Anthem Full Network (CACare) HMO
Employee Only $316.20 $185.44 $501.63
Employee + Spouse/DP $316.20 $787.39 $1,103.58
Employee + Child(ren) $316.20 $636.90 $953.09
Employee + Family $316.20 $988.06 $1,304.25
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $268.39 $29.82 $298.21
Employee + Spouse/DP $316.20 $339.89 $656.08
Employee + Child(ren) $316.20 $250.42 $566.61
Employee + Family $316.20 $459.17 $775.36
Anthem PPO
Employee Only $316.20 $274.40 $590.59
Employee + Spouse/DP $316.20 $983.10 $1,299.29
Employee + Child(ren) $316.20 $805.91 $1,122.10
Employee + Family* $316.20 $1,219.33 $1,535.52

Cash-in-Lieu

If you already have eligible medical coverage you may be able to waive LAwell coverage and receive a taxable payment each month.

  • Full-time employees receive an additional $50 in taxable income in their paycheck each pay day, up to $100 per month

  • Half-time employees receive $25 per paycheck, up to $50 per month.

Medical Coverage Eligible for Cash-in-Lieu

  • Dependent coverage through your spouse’s or domestic partner’s employer

  • Dependent coverage (if you’re under age 26) through your parent’s plan that qualifies as minimum essential coverage (MEC) in accordance with the individual shared responsibility provision of the Affordable Care Act (ACA)

  • Individual/Family coverage through your second employer

  • Retiree coverage through your previous employer

  • Medicare

  • Medi-Cal

  • TRICARE

Medical Coverage NOT eligible for Cash-in-Lieu

  • Coverage you and/or your spouse obtain through the Covered California Marketplace, or any other program that is not an employer-offered health plan, does not qualify as eligible coverage for the Cash-in-Lieu program.

How to Enroll in Cash-in-Lieu

If you are currently enrolled in Cash-in-Lieu, nothing is required to continue your current Cash-in-Lieu election. Cash-in-Lieu will continue until you notify the LAwell Benefits Program of a qualifying life event change.

To elect cash-in-lieu for the first-time elections:

  • Report your Cash-in-Lieu election to the LAwell Benefits Program.

  • Complete the Cash-In-Lieu Affidavit, providing required supporting documentation of your eligible medical coverage, by the deadline listed on your confirmation statement. If you do not submit a Cash-In-Lieu Affidavit by the deadline, your participation in Cash-in-Lieu will be canceled and you will be enrolled in employee-only medical coverage.

Download the Affidavit here. You will also receive a copy of the affidavit along with your confirmation statement.