2018/2019 Open Enrollment Bulletin

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1 2018/2019 Open Enrollment Bulletin Open Enrollment for Your LAPRA Benefits is Here Open Enrollment is your once-a-year opportunity to evaluate your health care needs and make any changes to your medical or dental coverage, and add or remove dependents. For 2018/2019, you will continue to have the same plans and coverage options that you have today. However, with health care costs continuing to rise, we are making a few changes to our medical plans beginning July 1, The changes are highlighted on page 2 of this Bulletin. Take some time to learn what the changes are and how they might impact your enrollment decision and your out-of-pocket medical costs for the upcoming plan year (July 1, 2018 June 30, 2019). There are no changes for 2018/2019 to the Kaiser HMO, vision or dental plans. If you have questions about the medical plan changes or Open Enrollment, more information is available on the LAPRA website at You can also call a LAPRA Benefits Representative at or or benefits@lapra.org. MAKE YOUR ELECTIONS MAY 1 31, 2018 Your choices take effect July 1, 2018 Complete Your Enrollment in 4 Easy Steps 1) Read this Bulletin for 2018/2019 plan highlights and information about your enrollment options, key dates and deadlines. 2) Review your personalized Statement of Current Elections to see your current enrollment elections and covered dependents. If you have life insurance through LAPRA or RB&I, your statement will show your beneficiary designations on file at LAPRA. 3) Access the Benefits Enrollment Guide available at for details about the medical, vision and dental plans. 4) Enroll or make changes to your benefits between May 1 and May 31. See page 6 for enrollment instructions. Not Making Any Changes? If you are not making any changes to your LAPRA medical or dental coverage and you have no changes to your covered dependents, no action is required during Open Enrollment. Your current medical and dental coverage will continue. 1

2 Medical Plan Changes for 2018/2019 Here s a look at the changes to our medical plans for 2018/2019 noted in red. There are no changes to the Kaiser HMO. Prudent Buyer PPO Changes Benefit Feature Current New (07/01/2018) Providers PPO Network Non-Network PPO Network Non-Network 1 Deductible $300 per person $600 per family $500 per person $1,000 per family $350 per person $700 per family $750 per person $1,500 per family Out-of-Pocket Max $2,000 per person $6,000 per family (not to exceed $2,000 for any one person) $3,000 per person $9,000 per family (not to exceed $3,000 for any one person) $2,000 per person $6,000 per family (not to exceed $2,000 for any one person) $4,000 per person $12,000 per family (not to exceed $4,000 for any one person) 1) Benefits are based on the Anthem standard charge. You are responsible for any difference between the amount charged and the Anthem standard charge, plus any deductible and/or coinsurance amount. CaliforniaCare Plus HMO Changes (CA Residents Only) Benefit Feature Current New (07/01/2018) Providers HMO Network HMO Network Office visit for PCP, maternity care, physical and occupational therapy, chiropractic services, acupuncture and outpatient mental health/ chemical dependency $15 co-pay $20 co-pay PPO and HMO Prescription Drug Changes Benefit Feature Current New (07/01/2018) Prescription Drugs 1 Retail Non-formulary Specialty Drugs Non-maintenance drugs Non-maintenance drugs $40 co-pay 20% (max co-pay: $150) 2 $80 co-pay 20% (max co-pay: $300) 2 Mail Order Non-formulary Specialty Drugs $40 co-pay 20% (max co-pay: $150) 2 $80 co-pay 20% (max co-pay: $300) 2 1) If a generic drug is available and a brand-name drug is dispensed, you must pay the difference between the generic and brand name drug, plus the co-pay. 2) Beginning 07/01/2018, all specialty drugs (including injectables) are covered as shown above except insulin (regular co-pays apply). 2018/2019 Medical Plan Costs Per Pay Period Below is the member cost per pay period for each medical plan and coverage tier. Costs noted in red indicate a change from the current year. Coverage Tier Prudent Buyer PPO CaliforniaCare Plus HMO Kaiser HMO (CA Residents Only) Single $0.00 $0.00 $0.00 Two Party $2.50 $0.00 $0.00 Family $48.50 $50.90 $0.00 2

3 LAPRA Vision Plan There are no changes to the vision plan for 2018/2019. If you are enrolled in the Prudent Buyer PPO or the CaliforniaCare Plus HMO, you automatically receive vision coverage through Vision Service Plan (VSP). You may use any vision provider for vision care; however, when you use a VSP Choice provider, you ll save money on exams and eyewear and there are no claim forms. Below is an overview of the key benefits provided through the LAPRA vision plan. Access the Benefits Enrollment Guide on the LAPRA website at for more information. LAPRA 2018/2019 Vision Plan At-a-Glance Benefit Feature Coverage from VSP Choice Network Provider Non-VSP Choice Network Provider Reimbursement Amounts 1 Eye Exam $20 co-pay $45 reimbursement Frames Plan pays up to $115 (20% discount on out-of-pocket expense above $115) $47 reimbursement Lenses Single vision lens Lined bifocal lens Lined trifocal lens Plan pays Plan pays Plan pays $45 reimbursement $65 reimbursement $85 reimbursement Contact Lenses & Fitting Exam (in lieu of lenses and frames) $120 allowance $105 reimbursement 1 You must submit claim forms when you use non-vsp Choice Network providers. Vision Benefits for Kaiser HMO Members If you enroll in the Kaiser HMO, vision care is provided through Kaiser. There is no charge for eye exams to determine the need for vision correction. In addition, members receive a $350 allowance for medically necessary eyewear every 24 months. There are no changes to vision coverage through Kaiser for 2018/2019. Wellness Program Update Healthy Lifestyles is changing to the LAPRA Wellness Program starting July 1, is discontinuing its contract with the wellness vendor, so LAPRA will be contracting directly with the wellness vendor to continue this popular program. All of the features of the Healthy Lifestyles program (including the free gym membership) will continue under the LAPRA Wellness Program. You can continue using your current Healthy Lifestyles ID card until you receive a new LAPRA Wellness Program ID card after July 1. Have Questions About Open Enrollment or Your LAPRA Benefits? Call a LAPRA Benefits Representative at or or benefits@lapra.org. 3

4 LAPRA Dental Plans There are no changes to the dental plans for 2018/2019. Below is an overview of the key benefits provided through the LAPRA dental plans. Access the Benefits Enrollment Guide on the LAPRA website at for more information. LAPRA 2018/2019 Dental Plans At-a-Glance Benefit Feature PPO Dental Plan HMO Dental Plan (CA Residents Only) Providers PPO Network Non-Network 1 HMO Dental Providers Only Deductible None $25 per person $50 per family (waived for Preventive & Diagnostic) None Maximum $2,000 per person (excluding Orthodontia) None Preventive & Diagnostic Cleanings Exams/X-rays Sealants (3 per year) (3 per year) No charge No charge $10 co-pay per tooth Basic Extractions/Fillings Root Canal Oral Surgery 90% 90% 90% 80% 80% 80% No charge $0 to $180 co-pay per tooth $0 to $200 co-pay per tooth Major Crowns & Bridges Dentures Implants $100 to $200 co-pay per tooth $150 to $200 co-pay per tooth N/A Orthodontia (including adults and children) 50% 50% $1,750 co-pay (child or adult) (Services exceeding a 24-month treatment period will require additional co-pays.) Orthodontia Lifetime Maximum $1,750 per person (Includes $300 for pre-orthodontic visit and treatment plan) N/A 1 For non-network providers, benefits are based on the customary and reasonable charge. You are responsible for any difference between the amount charged and the customary and reasonable charge, plus any deductible and/or coinsurance amount. 2018/2019 Dental Plan Costs Per Pay Period Below is the member cost per pay period for each dental plan and coverage tier. Coverage Tier PPO Dental Plan HMO Dental Plan (CA Residents Only) Single $0.00 $0.00 Two Party $13.50 $11.50 Family $16.00 $

5 Is Your Life Insurance Beneficiary Information Up-to-Date? If you have life insurance, it s important to review your beneficiary designations from time-to-time to ensure any benefits go to those you want to protect. Failure to update beneficiaries leads to delays, taxes or legal battles over life insurance benefits. Eventually someone gets the proceeds from your life insurance, but it may not be the people you would have chosen. If you have life insurance through LAPRA or RB&I, your Statement of Current Elections will show your beneficiary designations on file at LAPRA. If information about your beneficiaries is outdated, incorrect or incomplete, download a Change of Beneficiary Form from the LAPRA website at and submit to LAPRA by: benefits@lapra.org Fax: Regular mail to: LAPRA 600 North Grand Ave Los Angeles, CA If you have questions about your life insurance benefits or beneficiary designations, or would like a Change of Beneficiary Form sent to you, benefits@lapra.org or call LAPRA at or Benefits Information Available Online The 2018/2019 Benefits Enrollment Guide is available on the LAPRA website. Go to and click on the Open Enrollment link. In addition, legally required notices and disclosures including Summary Annual Reports (SARs), Summaries of Benefits and Coverage (SBCs), Evidence of Coverage (EOCs) and a variety of other disclosures are available on the LAPRA website. Go to and click on the Tools & Resources link. You can also benefits@lapra.org or call LAPRA at or to request a printed copy of the Benefits Enrollment Guide or any notice or legal disclosure be mailed to you at no charge. 5

6 How to Enroll or Make Changes to Your Benefits To enroll or make changes to your medical or dental coverage or add or drop coverage for dependents, follow the steps below. STEP 1 STEP 2 Use the Online Forms Retrieval Tool You can access the forms you need to enroll or make changes to your coverage or to add or drop coverage for your dependents by answering a few questions using the online forms retrieval tool. 1) Go to 2) Click on the Access Forms button to begin. 3) Follow the onscreen instructions and answer the questions presented. Based on your answers, you will be presented with one or more forms in PDF format that will need to be completed, signed and returned to LAPRA. Submit Your Forms to LAPRA by May 31, 2018 You have three options to submit your forms: 1) benefits@lapra.org 2) Fax: ) Regular mail to: LAPRA 600 North Grand Ave Los Angeles, CA If you mail your forms via regular mail, the envelope must be postmarked on or before May 31, ) Complete the form(s) on your computer, then print the form(s) and sign/date each form as required. You can also print out blank forms and fill out each form by hand. Have Questions or Need Help Accessing the Enrollment Forms? If you are unable to access the Online Forms Retrieval Tool on the LAPRA website, contact a LAPRA Benefits Representative for assistance by benefits@lapra.org or by calling or A Representative will explain your options and mail (or ) any required forms to you that need to be completed and returned to LAPRA. Forms must be completed and returned to LAPRA as shown in step 2 above. The information contained in this Bulletin is designed to provide you with an overview of certain aspects of your 2018/2019 medical, vision and dental options through the Los Angeles Police Relief Association, Inc. (LAPRA). This Bulletin does not include all program rules and details, including limitations and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be any inconsistencies between this Bulletin and the legal plan documents, the legal plan documents and insurance contracts are the final authority. 6