MEDICAL INSURANCE

City employees may choose from five different plans: (1) Kaiser Permanente (HMO): doctors/providers only available through Kaiser facilities, which are regionally located in nine states (2) Anthem Narrow Network (Select HMO): doctors/providers available throughout Southern California and other areas (3) Anthem Full Network (CA Care HMO): doctors/providers available throughout California (4) Anthem Vivity (LA & Orange Counties HMO): doctors/providers available throughout select locations in Los Angeles and Orange Counties (5) Anthem Preferred Provider Organization (PPO): doctors/providers available nationally
(6) Cash-in-Lieu: Cash benefit paid to employee in-lieu of enrollment into one of the City’s health plans.

Plan Coverage Comparison

Understanding HMOs and PPOs

HMOs – 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.

Note: 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

PPOs – 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 tables highlight the differences between the City’s healthcare options. For more information and to obtain a copy of the complete terms of coverage, please visit anthem.com/ca/cityofla or kp.org/plandocuments.

     
    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.
  

	Kaiser Permanente HMO	Anthem Plan
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.

2024 HMO Benefit Highlights

	Kaiser Permanente HMO	Anthem Narrow Network (Select HMO) Anthem Full Network (CACare HMO)
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.}

2024 PPO Benefit Highlights

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 HMO Benefit Highlights

	Kaiser Permanente HMO	Anthem Narrow Network (Select HMO) Anthem Full Network (CACare HMO)
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.}

2023 PPO Benefit Highlights

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.}

2022 HMO Benefit Highlights

	Kaiser Permanente HMO	Anthem Narrow Network (Select HMO) Anthem Full Network (CACare HMO)
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, 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.}

2022 PPO Benefit Highlights

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.}

Your Costs

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.

For 2024, the City’s maximum monthly subsidy is an amount equal to the Kaiser Permanente HMO family premium ($2,017.40 per month) for full-time employees and the Kaiser Permanente HMO employee-only rate ($775.92 per month) for half-time employees, subject to any premium sharing requirements as provided for by the employee’s MOU.

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.

There are two MOU contribution structures:

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.

There are four coverage level options available for enrollment:

Employee Only (Single Party – Employee)
Employee & Spouse/Domestic Partner (DP)* (Two Party – Employee and another adult legal spouse or legal DP)
Employee + Child(ren)* (Two+ Party – The Employee and any legal child and/or disabled child dependents in the household)
Employee + Family* (Three+ Party – The Employee and all legal dependents)

_{* Eligibility of dependents is subject to LAwell program rules. For more information visit our page Dependent eligibility. 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. Visit Domestic Partnership for futher details.}

2024 Full-Time Employee Costs for "LAwell Plan" Medical Coverage

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 for "LAwell Plan" Medical Coverage

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	$755.93
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	$741.81
Employee + Family	$387.96	$627.16	$1,105.12
Anthem Full Network (CACare) HMO
Employee Only	$387.96	$163.33	$551.29
Employee + Spouse/DP	$387.96	$827.87	$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 & 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 Full-time Employee Costs for "LAwell Pay Plan" Medical Coverage

Coverage Level	City Pays...	Full-Time Employee Pays…	Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only	$349.17	$38.40	$387.96
Employee & Spouse/DP	$768.17	$85.35	$853.52
Employee + Child(ren)	$698.34	$77.59	$775.93
Employee + Family	$907.84	$100.87	$1,008.70
Anthem Narrow Network (Select) HMO
Employee Only	$351.37	$39.04	$390.40
Employee + Spouse/DP	$773.04	$85.90	$858.93
Employee + Child(ren)	$667.64	$74.18	$741.81
Employee + Family	$907.84	$107.29	$1,015.12
Anthem Full Network (CACare) HMO
Employee Only	$351.37	$199.93	$551.29
Employee + Spouse/DP	$773.04	$439.80	$1,212.83
Employee + Child(ren)	$667.64	$379.82	$1,047.45
Employee + Family	$907.84	$525.54	$1,433.37
Anthem Vivity (LA & Orange Counties) HMO
Employee Only	$294.96	$32.78	$327.73
Employee + Spouse/DP	$648.93	$72.10	$721.03
Employee + Child(ren)	$560.44	$62.27	$622.70
Employee + Family	$766.91	$85.21	$852.12
Anthem PPO
Employee Only	$584.16	$64.90	$649.06
Employee + Spouse/DP	$907.84	$520.09	$1,427.92
Employee + Child(ren)	$907.84	$325.36	$1,233.19
Employee + Family*	$907.84	$779.71	$1,687.54

2024 Half-Time Employee Costs for "LAwell Pay Plan" Medical Coverage

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 & Orange Counties) HMO
Employee Only	$294.96	$32.87	$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 for "LAwell Plan" Medical Coverage

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 Half-Time Employee Costs for "LAwell Plan" Medical Coverage

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 Full-time Employee Costs for "LAwell Pay Plan" Medical Coverage

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 for "LAwell Pay Plan" Medical Coverage

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

2022 Full-Time Employee Costs for "LAwell Plan" Medical Coverage

Coverage Level	City Pays…	Full-Time Employee Pays…	Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only	$326.87	$0.00	$326.87
Employee & Spouse/DP	$719.12	$0.00	$719.12
Employee + Child(ren)	$653.74	$0.00	$653.74
Employee + Family	$849.86	$0.00	$849.86
Anthem Narrow Network (Select) HMO
Employee Only	$320.32	$0.00	$320.32
Employee & Spouse/DP	$704.74	$0.00	$704.74
Employee + Child(ren)	$608.65	$0.00	$608.65
Employee + Family	$832.89	$0.00	$832.89
Anthem Full Network (CACare) HMO
Employee Only	$320.32	$132.01	$452.33
Employee + Spouse/DP	$704.74	$290.37	$995.11
Employee + Child(ren)	$608.65	$250.76	$859.41
Employee + Family	$832.89	$343.17	$1,176.06
Anthem Vivity (LA & Orange Counties) HMO
Employee Only	$268.90	$0.00	$268.90
Employee + Spouse/DP	$591.60	$0.00	$591.60
Employee + Child(ren)	$510.92	$0.00	$510.92
Employee + Family	$699.15	$0.00	$699.15
Anthem PPO
Employee Only	$532.54	$0.00	$532.54
Employee + Spouse/DP	$849.86	$321.73	$1,171.59
Employee + Child(ren)	$849.86	$161.95	$1,011.81
Employee + Family*	$849.86	$534.74	$1,384.60

2022 Half-Time Employee Costs for "LAwell Plan" Medical Coverage

Coverage Level	City Pays…	Half-Time Employee Pays…	Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only	$326.87	$0.00	$326.87
Employee & Spouse/DP	$326.87	$392.25	$719.12
Employee + Child(ren)	$326.87	$326.87	$653.74
Employee + Family	$326.87	$522.99	$849.86
Anthem Narrow Network (Select) HMO
Employee Only	$320.32	$0.00	$320.32
Employee & Spouse/DP	$326.87	$377.87	$704.74
Employee + Child(ren)	$326.87	$281.78	$608.65
Employee + Family	$326.87	$506.02	$832.89
Anthem Full Network (CACare) HMO
Employee Only	$320.32	$132.01	$452.33
Employee + Spouse/DP	$326.87	$668.24	$995.11
Employee + Child(ren)	$326.87	$532.54	$859.41
Employee + Family	$326.87	$849.19	$1,176.06
Anthem Vivity (LA & Orange Counties) HMO
Employee Only	$268.90	$0.00	$268.90
Employee + Spouse/DP	$326.87	$264.73	$591.60
Employee + Child(ren)	$326.87	$184.05	$510.92
Employee + Family	$326.87	$372.28	$699.15
Anthem PPO
Employee Only	$326.87	$205.67	$532.54
Employee + Spouse/DP	$326.87	$844.72	$1,171.59
Employee + Child(ren)	$326.87	$684.94	$1,011.81
Employee + Family*	$326.87	$1,057.73	$1,384.60

2022 Full-time Employee Costs for "LAwell Pay Plan" Medical Coverage

Coverage Level	City Pays...	Full-Time Employee Pays…	Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only	$294.19	$32.69	$326.87
Employee & Spouse/DP	$647.21	$71.91	$719.12
Employee + Child(ren)	$588.37	$65.37	$653.74
Employee + Family	$764.88	$84.98	$849.86
Anthem Narrow Network (Select) HMO
Employee Only	$288.30	$32.03	$320.32
Employee + Spouse/DP	$634.27	$70.48	$704.74
Employee + Child(ren)	$547.79	$60.86	$608.65
Employee + Family	$749.60	$83.29	$832.89
Anthem Full Network (CACare) HMO
Employee Only	$288.30	$164.04	$452.33
Employee + Spouse/DP	$634.27	$360.85	$995.11
Employee + Child(ren)	$547.79	$311.62	$859.41
Employee + Family	$749.60	$426.46	$1,176.06
Anthem Vivity (LA & Orange Counties) HMO
Employee Only	$242.01	$26.89	$268.90
Employee + Spouse/DP	$532.45	$59.16	$591.60
Employee + Child(ren)	$459.84	$51.09	$510.92
Employee + Family	$629.24	$69.92	$699.15
Anthem PPO
Employee Only	$479.29	$53.25	$532.54
Employee + Spouse/DP	$764.88	$406.71	$1,171.59
Employee + Child(ren)	$764.88	$246.93	$1,011.81
Employee + Family*	$764.88	$619.72	$1,384.60

2022 Half-Time Employee Costs for "LAwell Pay Plan" Medical Coverage

Coverage Level	City Pays...	Half-Time Employee Pays…	Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only	$294.19	$32.69	$326.87
Employee & Spouse/DP	$294.19	$424.93	$719.12
Employee + Child(ren)	$294.19	$359.56	$653.74
Employee + Family	$294.19	$555.68	$849.86
Anthem Narrow Network (Select) HMO
Employee Only	$288.30	$32.03	$320.32
Employee + Spouse/DP	$294.19	$410.56	$704.74
Employee + Child(ren)	$294.19	$314.47	$608.65
Employee + Family	$294.19	$538.71	$832.89
Anthem Full Network (CACare) HMO
Employee Only	$288.30	$164.04	$452.33
Employee + Spouse/DP	$294.19	$700.93	$995.11
Employee + Child(ren)	$294.19	$565.23	$859.41
Employee + Family	$294.19	$881.88	$1,176.06
Anthem Vivity (LA & Orange Counties) HMO
Employee Only	$242.01	$26.89	$268.90
Employee + Spouse/DP	$294.19	$297.42	$591.60
Employee + Child(ren)	$294.19	$216.74	$510.92
Employee + Family	$294.19	$404.97	$699.15
Anthem PPO
Employee Only	$294.19	$238.36	$532.54
Employee + Spouse/DP	$294.19	$877.41	$1,171.59
Employee + Child(ren)	$294.19	$717.63	$1,011.81
Employee + Family*	$294.19	$1,090.42	$1,384.61

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.

Coverage Eligible for Cash-in-Lieu

The eligible medical coverage options include:

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

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

To continue your current Cash-in-Lieu election, nothing is required. Cash-in-Lieu will continue until you notify us of a qualifying life event change.

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

Select Cash-in-Lieu.
Complete the Cash-In-Lieu Affidavit , providing required supporting documentation of your eligible medical coverage, by the December 8, 2023 deadline. 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 for 2024.

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

Additional First-Time Enrollment Rules

If you enroll during Open Enrollment for 2024, participation is effective January 1, 2024, and your current LAwell medical coverage will terminate December 31, 2023. Your first “Cash-in-Lieu” payment will be reflected in your gross wages on the paycheck you receive on January 10, 2024, for the pay period ending December 30, 2023.

Kaiser Permanente HMO

Kaiser Permanente’s City of Los Angeles Website

Finding a Primary Care Physician or Kaiser 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.

To find a PCP/network provider:

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.

To find a Kaiser pharmacy, visit kp.org.

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

Anthem Blue Cross Mon-Fri, 8am-4pm Phone: (213) 200-2987 Email: Lorena.Gomez@anthem.com

Kaiser Permanente Tue-Thurs, 8am-4pm Phone: (323) 219-6704 Email: LACity.Advocate@kp.org

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 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 visit the Kaiser onsite member advocate at City Hall. 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 visit an onsite member advocate at City Hall.

Anthem HMOs

Anthem City of Los Angeles Website

Finding a Primary Care Physician or Anthem 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:

Go to 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
Visit an onsite member advocate at City Hall

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

Onsite Member Advocates An Anthem Health Plan Member Advocate is available at Los Angeles City Hall, 200 N. Spring Street, Room 867, Los Angeles, CA 90012
8:00 AM – 4:00 PM, Monday - Friday

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. Lastly, Anthem PPO members can also access same-day vide doctor visits using the Heal mobile app. Heal is only for Anthem PPO members and is not currently available to HMO members.

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.

To find a network provider:

Go to 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
Visit an onsite member advocate at City Hall

Anthem PPO

Anthem City of Los Angeles Website

Seeing a medical provider

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.

For Anthem PPO member services call 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.

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

Health Plan Member Advocates An Anthem Health Plan Member Advocate is available at Los Angeles City Hall, 200 N. Spring Street, Room 867, Los Angeles, CA 90012
8:00 AM – 4:00 PM, Monday - Friday

Medical Services via Phone or Web 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.

To find an LGBTQIA network provider:

Go to anthem.com/ca/cityofla, choose Find Care, then identify your plan or
Call Anthem PPO at 833-597-2362 or
Visit an onsite member advocate at City Hall

To find a network provider:

Go to anthem.com/ca/cityofla, choose Find Care, then identify your plan or
Call Anthem PPO at 833-597-2362 or
Visit an onsite member advocate at City Hall

MEDICAL INSURANCE

Plan Coverage Comparison

Understanding HMOs and PPOs

2024 HMO Benefit Highlights

2024 PPO Benefit Highlights

2023 HMO Benefit Highlights

2023 PPO Benefit Highlights

2022 HMO Benefit Highlights

2022 PPO Benefit Highlights

Your Costs

2024 Full-Time Employee Costs for "LAwell Plan" Medical Coverage

2024 Half-Time Employee Costs for "LAwell Plan" Medical Coverage

2024 Full-time Employee Costs for "LAwell Pay Plan" Medical Coverage

2024 Half-Time Employee Costs for "LAwell Pay Plan" Medical Coverage

2023 Full-Time Employee Costs for "LAwell Plan" Medical Coverage

2023 Half-Time Employee Costs for "LAwell Plan" Medical Coverage

2023 Full-time Employee Costs for "LAwell Pay Plan" Medical Coverage

2023 Half-Time Employee Costs for "LAwell Pay Plan" Medical Coverage

2022 Full-Time Employee Costs for "LAwell Plan" Medical Coverage

2022 Half-Time Employee Costs for "LAwell Plan" Medical Coverage

2022 Full-time Employee Costs for "LAwell Pay Plan" Medical Coverage

2022 Half-Time Employee Costs for "LAwell Pay Plan" Medical Coverage

Cash-in-Lieu

Coverage Eligible for Cash-in-Lieu

Coverage NOT eligible for Cash-in-Lieu

How to Enroll in Cash-in-Lieu

Additional First-Time Enrollment Rules

Kaiser Permanente HMO

Anthem HMOs

Anthem PPO

CONTACT US