Anthem Blue Cross: Plan II

This is a traditional indemnity plan available to all eligible, retired LACERA members and their eligible dependents. Both Medicare-eligible and non-Medicare-eligible members can join this plan. 

Plan II Features

• 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 90 percent for a Preferred Provider Option (PPO) hospital (non-Medicare members only) or 80 percent for a non-PPO hospital for a semi-private room.
• Deductibles: individual $500; family $1500
• Annual maximum out-of-pocket expenses (for most services): $2,500, including the deductible. (Does not include amounts over allowable charges.)
• 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.
• This plan offers more comprehensive hospitalization benefits than Anthem Blue Cross I. Anthem Blue Cross II offers a hospital PPO that provides reduced hospital fees to participants who are admitted as inpatients.
• 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)