Anthem Blue Cross: Plan I

Anthem Blue Cross Plan I is a traditional indemnity plan available to eligible, retired LACERA members and their dependents. Both Medicare-eligible and non-Medicare-eligible members can join this plan.

Plan I Features

Indemnity plans require an annual deductible out-of-pocket amount before you are entitled to coverage by your medical plan. Please note, hospital benefits under this plan are very limited.

• You may see any physician you choose, and the plan pays 80 percent after the deductible has been met. Hospital room and board is covered at $75 a day.
• Deductibles: $100 (individual or family)
• There are no annual benefit maximum amounts, except for outpatient mental health, acupuncture and the diabetes instruction program.
• Lifetime Maximum Benefits: $1,000,000. If you meet the lifetime maximum, you will need to move out of Anthem Blue Cross and into a LACERA-administered plan that is available in your area. LACERA's Retiree Healthcare Division will coordinate the transition. If there are no other plans available, you will be disenrolled.
• The plan has very limited hospital room and board benefits—an important consideration if you or your eligible dependents do not have Medicare Part A (hospital benefits).
• Utilization Review: This program provides a pre-admission review to determine medical necessity and length of stay on all hospital admissions and lets you know ahead of time if a procedure is covered under your plan.
• Coordination with Medicare
• “Centers of Medical Excellence”: a unique program that consists of facilities that provide case management and high-quality care for specific medical conditions and transplants.
• Prescription Benefit Manager: CVS/Caremark (retail and mail-order prescription drug benefits)
• Accordant Disease Management Program
• Pharmacy advisor counseling (for adults managing conditions like diabetes, high blood pressure, and heart disease)