Kaiser Permanente

There are two LACERA-administered Kaiser Permanente plans, a group model Health Maintenance Organization (HMO) plan and a Medicare Advantage Prescription Drug Plan HMO (MAPD HMO).

Group Model HMO

The Kaiser Permanente HMO is a group model plan, meaning that the HMO owns and operates the facility, and the physicians are HMO employees. The Kaiser HMO is available to all eligible retired LACERA members and their eligible dependents, based on service area availability.

Features of this plan are:

• Medical care must be received from a Kaiser physician at a Kaiser facility, except for a life-threatening emergency authorized by Kaiser.
• No deductibles or annual benefit maximum amounts, except for skilled nursing care and mental health
• No claim forms
• Copayments are required for certain services
• Continued enrollment if you are covered under Kaiser and move out of California to a state where a LACERA-administered Kaiser plan is also available, providing you contact LACERA and complete an enrollment form. Current service areas are Hawaii, Georgia, Colorado (Denver area only), Oregon, and Washington.

Senior Advantage MAPD HMO

The Kaiser Senior Advantage Medicare Advantage Prescription Drug Plan (MAPD) HMO is available to all eligible retired LACERA members and their eligible dependents, based on service area availability, who are enrolled in both Medicare Parts A and B.

A Medicare Advantage Prescription Drug Plan is an HMO that has a contract with the federal government (Medicare) to provide healthcare services to those with Medicare Part A and B coverage. Medicare, in turn, pays the HMO a monthly fee for each member. These plans are for members and/or eligible dependents enrolled in both Medicare Part A and Part B. These plans include Medicare Part D (prescription drug benefit) that are creditable, meaning equal to or better than the standard individual Part D plans. Members should not enroll in non-LACERA Part D plans as this is included in the benefits.

Combined coverage: If you have Medicare Parts A and B and enroll in the Kaiser Senior Advantage MAPD plan, your non-Medicare eligible family members must enroll in the Kaiser Basic plan. See more about combined coverage on the Parts A and B page.

Features of this plan are:

• All medical care must be received from a Kaiser physician at a Kaiser facility, except for a life-threatening emergency authorized by Kaiser.
• No deductibles or annual benefit maximum amounts, except for skilled nursing care and mental health
• No restrictions on coverage for pre-existing conditions
• No claim forms
• Small copayments for office visits
• Health classes are available to develop healthy lifestyles
• Medicare Part B premiums reimbursed by the County on a tax-free basis
• Continued enrollment if you move out of California into another state that has Kaiser plans
• Silver&Fit® Exercise and Health Aging Program

Evidence of Coverage

For full details of the services, coverage, and costs of care provided by your specific medical plan, review your latest Evidence of Coverage below. 

In State

To view or download plan details click the link(s) below.

Kaiser Permanente Traditional Plan EOC – Southern California
Kaiser Permanente Traditional Plan SOB – Southern California

Kaiser Permanente Traditional Plan EOC – Northern California
Kaiser Permanente Traditional Plan SOB – Northern California

Kaiser Permanente Senior Advantage with Part D SOB – Southern California
Kaiser Permanente Senior Advantage with Part D SOB – Northern California

Kaiser Permanente Senior Advantage – Meals Benefit
Kaiser Permanente Senior Advantage – OTC Benefit
Kaiser Permanente Senior Advantage – Silver & Fit Benefit
Kaiser Permanente Senior Advantage – Transportation Benefit

Out of State

To view or download plan details click the link(s) below.
Note:  Benefits differ by region

Kaiser Permanente Traditional HMO Plan SOB – Colorado 
Kaiser Permanente Senior Advantage (HMO) with Part D SOB  – Colorado 
Kaiser Permanente Senior Advantage Silver Sneakers Benefit 
  
Kaiser Permanente Traditional HMO Plan EOB – Georgia 
Kaiser Permanente Senior Advantage (HMO) with Part D SOB – Georgia

Kaiser Permanente Traditional HMO Plan SOB – Hawaii 
Kaiser Permanente Senior Advantage (HMO) with Part D SOB – Hawaii 
Kaiser Permanente Senior Advantage Silver and Fit Benefit - Hawaii 
  
Kaiser Permanente Traditional HMO Plan SOB  – Oregon 
Kaiser Permanente Senior Advantage (HMO) with Part D SOB – Oregon 
  
Kaiser Permanente Traditional HMO Plan EOC – Washington 
Kaiser Permanente Senior Advantage (HMO) with Part D SOB – Washington 
Kaiser Permanente Senior Advantage Silver and Fit Benefit - Washington 
Kaiser Permanente Senior Advantage Transportation Benefit – Washington