MEDICAL INSURANCE

 

City employees may choose from six different medical plans or enroll in cash-in-lieu.

 

1. Kaiser Permanente HMO
Member Services: 800-464-4000

my.kp.org/ca/cityofla


Kaiser Member Advocate
(323) 219-6704
LACity.Advocate@kp.org


Kaiser Permanente Mobile App


Cash-in-Lieu: Cash benefit paid to employee in-lieu of enrollment into one of the City’s health plans.

 
 
 
 
 
 
 

2. BlueShield Trio (HMO)
Member Services: 855-201-2086 – Open 7 a.m. - 7 p.m. PST, Monday through Friday 3. BlueShield (PPO)
Member Services: 855-201-2086 – Open 7 a.m. - 7 p.m. PST, Monday through Friday 4. BlueShield (HDHP PPO)
Member Services: 855-201-2086 – Open 7 a.m. - 7 p.m. PST, Monday through Friday

KeepingLAwell.com/BlueShield

BlueShield Member Advocate
Go to KeepingLAwell.com/contacts for contact information and availability of Member Advocates

 
 

5. United HealthCare Signature Value (SV) (HMO)

Member Services: 800-980-5216

Open 7 a.m. - 11 p.m. CST, Monday through Friday

6. United HealthCare SV Harmony (HMO)

Member Services: 800-980-5216

Open 7 a.m. - 11 p.m. CST, Monday through Friday

Go to KeepingLAwell.com/UHC to "search for a provider"

Information on this Page

Information on Other Pages

Medical Plan Comparison

Understanding HMOs , PPOs and HDHP PPOs

Health Maintenance Organizations (HMOs) provide medical care through a network of doctors, hospitals, and other health care 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. Each of your dependents can select their own PCP. Changes to PCP designations are allowed but usually restricted to a minimum time period; usually once every 30 days.

Medical coverage with an HMO plan is typically restricted to a specific distance from a home or work address. As City employees, your medical coverage options discussed in this guide are available to all City of Los Angeles work addresses. (See the Residence/Worksite Proximity to Service Providers section of this guide for more information). If you select HMO coverage and you reside outside of the Los Angeles City 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 and willing to travel into the Los Angeles area every time you seek care.

Preferred Provider Organizations (PPOs) allow you to see any doctor you like, whenever you like, but with varying differences in the amount of money you will be required to spend. You use in-network providers for a higher level of reimbursed benefit coverage, or go to a licensed out-of-network provider and receive a lower level of reimbursed benefit coverage. In-network options typically include a nationwide network of doctors, hospitals, and other health care providers that have agreed to offer quality medical care and services at rates specified in their contract with the insurance carrier.

PPOs allow you to see any doctor you like, whenever you like. This includes specialists; with no referral required.

The LAwell PPO plan has a deductible. You must pay the full cost of medical services rendered each calendar year until the annual deductible amount is met, then the full benefits of insurance will begin. The PPO plan also uses co-insurance, meaning that the insurance benefit will only pay a percentage of the total cost.

High Deductible Health Plans (HDHPs) require you to pay out of pocket for the services you initially seek in each calendar year before the full benefits of the insurance begin. This amount which you will need to expend for covered medical services before insurance benefits begin, commonly referred to as a deductible’ will be different depending on where you seek care (in network vs out-of-network) and if you are enrolled as an individual or have dependents covered.

To offset the high cost of a HDHP, federal law requires that a Health Savings Account (HSA) be provided alongside any HDHP. A HSA allows for pre-tax contributions to be made into the account. The balance in the HSA can be used to pay directly or be reimbursed for qualified medical expenses. See the Health Savings Account (HSA) section of this guide for more information.

In a HDHP PPO, the same attributes for PPO noted above apply. The LAwell HDHP plan offering for 2026 is a HDHP PPO plan.

The following table highlights some differences between the City’s HMO and PPO healthcare options.





 Kaiser Permanente HMO UnitedHealthcare Blue Shield
UHC SV Harmony HMO UHC SV HMO BlueShield Trio HMO HDHP PPO PPO
In-network care You may visit any Kaiser Permanente facility; a primary care physician (PCP) is recommended but not required through Kaiser’s unique internal system of care.

Plan generally pays 100% of services after co-pay		 You may visit the doctor’s office(s) of your Primary Care
Physician (PCP); you must designate a PCP or have one
auto assigned to you before seeking care; you must see this physician for all your care and they must refer you to
someone else when you need specialty care.
Each member of your family can have their own PCP.
You can change your PCP at routine internals, usually once
every 30 days.

Plan generally pays 100% of services after co-pay		 You may visit any network provider of your choice; no primary care physician or specialist referrals required.
Plan generally pays 90% of services after co-pay
Out-of-network care Not covered unless you need care for a serious medical emergency or urgent care outside of your HMO’s network service area. In those cases, limited services are allowed under specific situations, see “Care While Traveling” You may visit any licensed provider you choose, and no primary care physician or specialist referrals are required.
Plan generally pays 70% of services; additional limitations/restrictions apply.

2026 Medical Plan Services Highlights



Type of Care
 HMO Plans
BlueShield Trio HMO Kaiser Permanente HMO UnitedHealthcare
SV Harmony HMO Signature Value (SV) HMO
In-Network Only

Calendar Year Deductible 		$0/person;
$0/family		 $0/person;
$0/family		 $0/person;
$0/family

Calendar Year
Out-of-Pocket Limit		 $500/person;
$1,500/family		 $1,500/person;
$3,000/family		 $500/person;
$1,500/family
Routine Office Visits Primary
Care Physicians/Specialist
(including pediatric visits)		 Plan pays 100% after $15 Copay
Preventive Care Plan pays 100% ($0 Copay)
Urgent Care Plan pays 100% after $15 Copay
Telehealth/Virtual Visits Plan pays 100% ($0 Copay)
Maternity Care
(Preventative Care Visit)		 Plan pays 100% ($0 Copay)
Pregnancy Plan pays 100% ($0 Copay)

Inpatient Hospitalization 		Plan pays 100% ($0 Copay) Plan pays 100% after $15 Copay Plan pays 100% ($0 Copay)

Outpatient Surgery		 Plan pays 100% ($0 Copay)
Diagnostic Lab Work, X-rays,
and Advanced imaging
(CT, MRI, etc.)		 Plan pays 100% after $100 Copay
Emergency Room Care for True Emergencies
ER Room Copay (may be waived if
admitted)		 Plan pays 100% ($0 Copay)

Hearing Aid Benefit		 Plan pays 100% ($0 Copay)² hearing aids per member per 24 months $2,000 Allowance each ear every 36 months Plan pays 100%  ($0 Copay)¹ pair every 24 months $5,000 annual benefit maximum per calendar year.

  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.

  3. The Evidence of Coverage for each medical plan provides the coverage detail and will prevail over any discrepancy or conflict with information written in this guide. View the Evidence of Coverage for each plan on the City website for each insurance provider.




Type of Care
 BlueShield PPO BlueShield HDHP PPO
In-Network Out-of-Network In-Network Out-of-Network

Calendar Year Deductible 		$750/person;
$1,500/family		 $1,250/person;
$2,500/family		 $2,200/person;
$4,400/family		 $4,000/person;
$8,000/family

Calendar Year
Out-of-Pocket Limit		 $2,000/person; $4,000/family in-network and out-of-network combined $4,600/person;
$9,4200/family		 $10,000/person;
$20,000/family
Routine Office Visits Primary
Care Physicians/Specialist
(including pediatric visits)		 Plan pays 100% after $30 copay Plan Pays 70% ($0 Copay)² Plan pays 90% ($0 Copay) Plan Pays 70% ($0 Copay)²
Preventive Care Plan pays 100% ($0 Copay) Plan pays 100% ($0 Copay)
Urgent Care   Plan pays 100% after $30   
  copay		 Plan Pays 90% ($0 Copay)
Telehealth/Virtual Visits NOT COVERED NOT COVERED
Maternity Care
(Preventative Care Visit)		 Plan pays 90% ($0 Copay) Plan Pays 70% ($0 Copay)² Plan pays 90% ($0 Copay) Plan Pays 70% ($0 Copay)²
Pregnancy Plan pays 100% ($0 Copay) Plan pays 100% ($0 Copay)

Inpatient Hospitalization 		Plan pays 90% ($0 Copay) Plan Pays 70% ($0 Copay) up to $1,500/day² Plan pays 90% ($0 Copay) Plan Pays 70% ($0 Copay) up to $1,500/day²

Outpatient Surgery		 Plan Pays 70% ($0 Copay) up to $350/day² Plan Pays 70% ($0 Copay) up to $350/day²
Diagnostic Lab Work, X-rays,
and Advanced imaging
(CT, MRI, etc.)		 Plan Pays 70% ($0 Copay)² Plan Pays 70% ($0 Copay)²
Emergency Room Care for True Emergencies
ER Room Copay (may be waived if
admitted)		 Plan pays 90% after $100 Copay
  Emergency Medical   
  Transportation 		Plan pays 90% ($0 Copay)

Hearing Aid Benefit		 Plan Pays 80% ($0 Copay) 2 hearing aids per member per 24 months²

  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.

  3. The Evidence of Coverage for each medical plan provides the coverage detail and will prevail over any discrepancy or conflict with information written in this guide. View the Evidence of Coverage for each plan on the City website for each insurance provider.

2025 Medical Plan Services Highlights
Kaiser Permanente HMO
Anthem Narrow Network
(Select HMO)
Anthem Full Network
(CACare HMO)
Anthem Vivity HMO
(LA & Orange Counties)

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.



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 charges2after 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.

2024 Medical Plan Services Highlights
Kaiser Permanente HMO
Anthem Narrow Network
(Select HMO)
Anthem Full Network
(CACare HMO)
Anthem Vivity HMO
(LA & Orange Counties)

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.



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 Medical Plan Services Highlights
Kaiser Permanente HMO
Anthem Narrow Network
(Select HMO)
Anthem Full Network
(CACare HMO)
Anthem Vivity HMO
(LA & Orange Counties)

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.


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.
 

Accessing Care & Services

Anthem HMOs

Member Advocate

Member Advocates from our healthcare providers provide personal, one-on-one assistance. The Anthem Member Advocate contact information is as follows:
Phone: (213) 200-2987, Monday - Friday 8 a.m. - 4 p.m.

Finding an Anthem Primary Care Physician or 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:

  • Visit 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
  • Contact the Anthem member advocate.

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

Anthem Sydney Mobile App

Download the Anthem Sydney Mobile App.

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.

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.

Anthem PPO

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.

Anthem Health Plan Member Advocate

Member Advocates from our healthcare providers provide personal, one-on-one assistance. The Anthem Member Advocate contact information is as follows:
Phone: (213) 200-2987, Monday - Friday 8 a.m. - 4 p.m.
Email: Lorena.Gomez@anthem.com

Anthem PPO member services: 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.

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

Anthem Sydney Mobile App

Download the Anthem Sydney Mobile App.

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. 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.

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.

To find an LGBTQIA network provider:

  • Contact the Anthem member advocate.

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:

BlueShield HMO Trio

Member Advocate

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

Finding a BlueShield Trio HMO Primary Care Physician or network provider

A PCP designation is required to see a doctor. Members and their dependents may choose their own PCP or medical group, and they do not have to enroll with the same PCP or medical group. New members will automatically be assigned a PCP if they do not provide the National Provider Identifier (NPI) during enrollment, but may change their PCP assignment by calling the Customer Service number. Members are typically allowed to change their PCP designation no more than once a month.

To find a PCP/network provider:

Prescription Drug Coverage

Fill prescriptions at any retail pharmacy that participates in the Blue Shield network. Use of non-participating pharmacies is not covered unless associated with a covered emergency service. To find a participating pharmacy, or To find the Blue Shield drug formulary, go to KeepingLAwell.com/BlueShield

Telemedicine

Access care for general medical or mental health services at (800) 835-2362.
General medical is available 24 hours a day, 7 days a week by phone or secure online video at blueshieldca.com/teladoc. Mental Heath services are available 7a.m. to 9 p.m., 7 days a week by scheduled appointment only. Consultations must be scheduled online and cannot be requested by phone.

Fertility Treatment (IVF)

Starting January 1, 2026, California Law (SB 729) requires health plans to offer certain fertility services, including diagnosis and treatment of infertility. The benefit structure for this newly covered benefit is under regulatory review and will require approval from the Department of Managed Health Care (DMHC) before covered services/treatment will be able to commence. Approval from the DMHC before January 2026 is not guaranteed. Please check back to review the policy documents (Evidence of Coverage) on the microsite of each plan for updated information regarding IVF services.

LGBTQIA Health Care Providers

Blue Shield can offer care that is personalized 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..

Acupuncture & Chiropractic Care

The 60 visit maximum is for acupuncture and chiropractic services combined. Benefits are available for Medically Necessary acupuncture and chiropractic services for the treatment of musculoskeletal and related disorders with visit limits per your summary of benefits. Contact ASH Plans at (800) 678- 9133.

BlueShield PPO and HDHP (In & Out-Network) PPO

Member Advocate

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

Finding a BlueShield PPO & HDHP PPO Primary Care Physician or network provider

Not Applicable. Members in the BlueShield PPO and BlueShield HDHP PPO Plans may visit any licensed provider, in or out of network; primary care  physician or specialist referrals are not required. However, you will receive a lower level of benefits for out-of-network care.

To find a PCP/network provider:

Prescription Drug Coverage

Fill prescriptions at any retail pharmacy that participates in the Blue Shield network. Use of non-participating pharmacies is not covered unless associated with a covered emergency service. To find a participating pharmacy, or To find the Blue Shield drug formulary, go to KeepingLAwell.com/BlueShield

Telemedicine

Access care for general medical or mental health services at (800) 835-2362.
General medical is available 24 hours a day, 7 days a week by phone or secure online video at blueshieldca.com/teladoc. Mental Heath services are available 7a.m. to 9 p.m., 7 days a week. Teladoc is available In Network only."

Fertility Treatment (IVF)

Starting January 1, 2026, California Law (SB 729) requires health plans to offer certain fertility services, including diagnosis and treatment of infertility. The benefit structure for this newly covered benefit is under regulatory review and will require approval from the Department of Managed Health Care (DMHC) before covered services/treatment will be able to commence. Approval from the DMHC before January 2026 is not guaranteed. Please check back to review the policy documents (Evidence of Coverage) on the microsite of each plan for updated information regarding IVF services.

LGBTQIA Health Care Providers

Blue Shield can offer care that is personalized 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..

Acupuncture & Chiropractic Care

Blue Shield PPO plans include coverage for chiropractor and acupuncture services with some limitations on the number of visits. Please reference your benefit summaries for details. You can visit any participating provider without a referral. Call the number or your ID cards or visits blueshieldca.com to search for a provider. Out-of-Network providers are available at a higher member cost share.

Kaiser Permanente HMO

Member Advocate

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

Phone: (323) 219-6704, Monday - Friday 8 a.m. - 4 p.m.
Email: LACity.Advocate@kp.org

Finding a Kaiser Primary Care Physician or 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.

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.

Find a Kaiser pharmacy, visit my.kp.org/ca/cityofla.

Kaiser Permanente Mobile App

Download the Kaiser Permanente Mobile App.

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

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 contact the Kaiser member advocate. 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 contact the Kaiser member advocate.

United Healthcare: SV Harmony HMO and Signature Value (SV) HMO

Member Advocate

Access covered services through the UnitedHealthcare network of physicians and facilities as directed by your PCP, except for emergencies:

Finding a United Healthcare Primary Care Physician or network provider

A PCP designation is required to see a doctor. Members and their dependents may choose their own PCP or medical group, and they do not have to enroll with the same PCP or medical group. New members will automatically be assigned a PCP if they do not provide the National Provider Identifier (NPI) during enrollment, but may change their PCP assignment by calling the Customer Service number. Members are typically allowed to change their PCP designation no more than once a month.

To find a PCP/network provider:

  • Go to KeepingLAwell.com/UHC to "search for a provider"
  • Call (800) 980-5216 – Available 7 a.m. - 11 p.m. CST, Monday through Friday
  • Contact the City’s dedicated member advocate.

Prescription Drug Coverage

UnitedHealthcare uses Optum pharmacy services for retail and mail order. Fill prescriptions at any retail pharmacy that participates in the OptumRx network. Use of non-participating pharmacies is typically not covered unless associated with a covered emergency service. To find a participating pharmacy,or To find the Optum RX drug formulary, go to KeepingLAwell.com/UHC

Telemedicine

Access to Telemedicine is covered as a regular routing office visit with a $15 Copay. To visit, go to KeepingLAwell.com/UHC

Fertility Treatment (IVF)

Starting January 1, 2026, California Law (SB 729) requires health plans to offer certain fertility services, including diagnosis and treatment of infertility. The benefit structure for this newly covered benefit is under regulatory review and will require approval from the Department of Managed Health Care (DMHC) before covered services/treatment will be able to commence. Approval from the DMHC before January 2026 is not guaranteed. Please check back to review the policy documents (Evidence of Coverage) on the microsite of each plan for updated information regarding IVF services.

LGBTQIA Health Care Providers

UnitedHealthcare provides personalized care based on your medical necessity

Acupuncture & Chiropractic Care

Benefits are available with a $15 Copay and with a limit of 60 visits annually (combined maximum benefit)

Your Medical Plan Premium Costs

City Subsidy

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.

The amount of premium you are responsible for depends on four factors:

- Your employment status for 2026 (full-time or half-time)

  • The 2025 maximum monthly City subsidy for full-time employees is $2,240.52 per month. This is an amount equal to the 2026 Kaiser Permanente HMO family premium.

  • The 2026 maximum monthly City subsidy for half-time employees is $861.74 per month. This is an amount equal to the 2025 Kaiser Permanente HMO employee-only rate.

*Subject to any premium sharing requirements as provided for by the employee’s MOU.

- Your employment status for 2025 (full-time or half-time)

  • The 2025 maximum monthly City subsidy for full-time employees is $2,119.50 per month. This is an amount equal to the 2025 Kaiser Permanente HMO family premium.

  • The 2025 maximum monthly City subsidy for half-time employees is $815.20 per month. This is an amount equal to the 2025 Kaiser Permanente HMO employee-only rate.

*Subject to any premium sharing requirements as provided for by the employee’s MOU.

1. The Memorandum of Understanding (MOU) contribution structure that applies to you - the LAwell Pay or the LAwell Pay Plan.

  • 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.

    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.

2. The specific medical plan you choose.

3. The coverage level you choose. This is the number of dependents* you cover, if any. There are four coverage level options available for enrollment.

  • Employee Only: Single Party – Employee Only

  • Employee & Spouse/Domestic Partner (DP): Two Party – Employee and another adult legal spouse or legal DP

  • Employee + Child(ren): Two+ Party – Employee and any legal child and/or disabled child dependents

  • Employee + Family: Three+ Party – Employee and all legal dependents

    *Eligibility of dependents is subject to LAwell program rules. 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. Find more information on our Dependent Eligibility page.

 

2026 Full-Time Employee Costs

Coverage Level City Pays… Full-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Blue Shield Trio HMO
Employee Only $428.83 $0.00 $428.83
Employee & Spouse/DP $943.48 $0.00 $943.48
Employee + Child(ren) $814.84 $0.00 $814.84
Employee + Family $1,115.05 $0.00 $1,115.05
Kaiser HMO
Employee Only $430.87 $0.00 $430.87
Employee & Spouse/DP $947.92 $0.00 $947.92
Employee + Child(ren) $861.74 $0.00 $861.74
Employee + Family $1,120.26 $0.00 $1,120.26
UHC SV Harmony HMO
Employee Only $456.50 $0.00 $456.50
Employee + Spouse/DP $1,004.34 $0.00 $1,004.34
Employee + Child(ren) $867.41 $0.00 $867.41
Employee + Family $1,120.26 $66.73 $1,186.99
UHC SV HMO
Employee Only $790.06 $0.00 $790.06
Employee + Spouse/DP $1,106.08 $0.00 $1,106.08
Employee + Child(ren) $1,027.08 $0.00 $1,027.08
Employee + Family $1,120.26 $64.83 $1,185.09
BlueShield PPO
Employee Only $711.65 $0.00 $711.65
Employee + Spouse/DP $1,120.26 $445.35 $1,565.61
Employee + Child(ren) $1,120.26 $231.85 $1,352.11
Employee + Family* $1,120.26 $730.01 $1,850.27
BlueShield HDHP PPO
Employee Only $531.32 $0.00 $531.32
Employee + Spouse/DP $1,120.26 $45.24 $1,165.50
Employee + Child(ren) $1,006.95 $0.00 $1,006.95
Employee + Family* $1,120.26 $256.64 $1,376.90

2026 Half-Time Employee Costs


Coverage Level City Pays… Half-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Blue Shield Trio HMO
Employee Only $428.83 $0.00 $428.83
Employee & Spouse/DP $430.87 $512.61 $943.48
Employee + Child(ren) $430.87 $383.97 $814.84
Employee + Family $430.87 $684.18 $1,115.05
Kaiser HMO
Employee Only $428.83 $0.00 $430.87
Employee & Spouse/DP $430.87 $517.05 $947.92
Employee + Child(ren) $430.87 $430.87 $861.74
Employee + Family $430.87 $689.39 $1,120.26
UHC SV Harmony HMO
Employee Only $430.87 $25.63 $456.50
Employee + Spouse/DP $430.87 $573.47 $1,004.34
Employee + Child(ren) $430.87 $436.54 $867.41
Employee + Family $430.87 $756.12 $1,186.99
UHC SV HMO
Employee Only $430.87 $359.19 $790.06
Employee + Spouse/DP $430.87 $675.21 $1,106.08
Employee + Child(ren) $430.87 $596.21 $1,027.08
Employee + Family $430.87 $754.22 $1,185.09
BlueShield PPO
Employee Only $430.87 $280.78 $711.65
Employee + Spouse/DP $430.87 $1,134.74 $1,565.61
Employee + Child(ren) $430.87 $921.24 $1,352.11
Employee + Family* $430.87 $1,419.40 $1,850.27
BlueShield HDHP PPO
Employee Only $430.87 $100.45 $531.32
Employee + Spouse/DP $430.87 $734.63 $1,165.50
Employee + Child(ren) $430.87 $576.08 $1,006.95
Employee + Family* $430.87 $946.03 $1,376.90

2025 Full-Time Employee Costs

2025 LAwell Plan Costs
Coverage Level City Pays… Full-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $407.60 $0.00 $407.60
Employee & Spouse/DP $896.71 $0.00 $896.71
Employee + Child(ren) $815.19 $0.00 $815.19
Employee + Family $1,059.75 $0.00 $1,059.75
Anthem Narrow Network (Select) HMO
Employee Only $436.86 $0.00 $436.86
Employee & Spouse/DP $961.14 $0.00 $961.14
Employee + Child(ren) $830.09 $0.00 $830.09
Employee + Family $1,059.75 $76.17 $1,135.92
Anthem Full Network (CACare) HMO
Employee Only $436.86 $180.03 $616.89
Employee + Spouse/DP $961.14 $396.02 $1,357.16
Employee + Child(ren) $830.09 $342.01 $1,172.10
Employee + Family $1,059.75 $544.19 $1,603.94
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $366.73 $0.00 $366.73
Employee + Spouse/DP $806.83 $0.00 $806.83
Employee + Child(ren) $696.80 $0.00 $696.80
Employee + Family $953.52 $0.00 $953.52
Anthem PPO
Employee Only $726.30 $0.00 $726.30
Employee + Spouse/DP $1,059.75 $538.09 $1,597.84
Employee + Child(ren) $1,059.75 $320.19 $1,379.94
Employee + Family* $1,059.75 $828.61 $1,888.36

2025 LAwell Pay Plan Costs

Coverage Level City Pays… Full-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $366.84 $40.76 $407.60
Employee & Spouse/DP $807.04 $89.67 $896.71
Employee + Child(ren) $733.68 $81.52 $815.19
Employee + Family $953.78 $105.97 $1,059.75
Anthem Narrow Network (Select) HMO
Employee Only $393.18 $43.68 $436.86
Employee & Spouse/DP $865.03 $96.12 $961.14
Employee + Child(ren) $747.09 $83.01 $830.09
Employee + Family $953.78 $182.15 $1,135.92
Anthem Full Network (CACare) HMO
Employee Only $393.18 $223.71 $616.89
Employee + Spouse/DP $865.03 $492.14 $1,357.16
Employee + Child(ren) $747.09 $425.02 $1,172.10
Employee + Family $953.78 $650.17 $1,603.94
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $330.06 $36.68 $366.73
Employee + Spouse/DP $726.15 $80.68 $806.83
Employee + Child(ren) $627.13 $69.68 $696.80
Employee + Family $858.17 $95.35 $953.52
Anthem PPO
Employee Only $653.68 $72.63 $726.30
Employee + Spouse/DP $953.78 $644.07 $1,597.84
Employee + Child(ren) $953.78 $426.17 $1,379.94
Employee + Family* $953.78 $934.59 $1,888.36

2025 Half-Time Employee Costs

2025 LAwell Plan Costs

Coverage Level City Pays… Half-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $407.60 $0.00 $407.60
Employee & Spouse/DP $407.60 $489.11 $896.71
Employee + Child(ren) $407.60 $407.59 $815.19
Employee + Family $407.60 $652.15 $1,059.75
Anthem Narrow Network (Select) HMO
Employee Only $407.60 $29.26 $436.86
Employee & Spouse/DP $407.60 $553.54 $961.14
Employee + Child(ren) $407.60 $422.49 $830.09
Employee + Family $407.60 $728.32 $1,135.92
Anthem Full Network (CACare) HMO
Employee Only $407.60 $209.29 $616.89
Employee + Spouse/DP $407.60 $949.56 $1,357.16
Employee + Child(ren) $407.60 $764.50 $1,172.10
Employee + Family $407.60 $1,196.34 $1,603.94
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $366.73 $0.00 $366.73
Employee + Spouse/DP $407.60 $399.23 $806.83
Employee + Child(ren) $407.60 $289.20 $696.80
Employee + Family $407.60 $545.92 $953.52
Anthem PPO
Employee Only $407.60 $318.70 $726.30
Employee + Spouse/DP $407.60 $1,190.24 $1,597.84
Employee + Child(ren) $407.60 $972.34 $1,379.94
Employee + Family* $407.60 $1,480.76 $1,888.36

2025 LAwell Pay Plan Costs

Coverage Level City Pays… Half-Time Employee Pays… Total Cost of Coverage Biweekly (per Pay Period)
Kaiser HMO
Employee Only $366.84 $40.76 $407.60
Employee & Spouse/DP $366.84 $529.88 $896.71
Employee + Child(ren) $366.84 $448.36 $815.19
Employee + Family $366.84 $692.91 $1,059.75
Anthem Narrow Network (Select) HMO
Employee Only $366.84 $70.03 $436.86
Employee & Spouse/DP $366.84 $594.31 $961.14
Employee + Child(ren) $366.84 $463.26 $830.09
Employee + Family $366.84 $769.09 $1,135.92
Anthem Full Network (CACare) HMO
Employee Only $366.84 $250.06 $616.89
Employee + Spouse/DP $366.84 $990.33 $1,357.16
Employee + Child(ren) $366.84 $805.27 $1,172.10
Employee + Family $366.84 $1,237.11 $1,603.94
Anthem Vivity (LA & Orange Counties) HMO
Employee Only $330.06 $36.68 $366.73
Employee + Spouse/DP $366.84 $440.00 $806.83
Employee + Child(ren) $366.84 $329.97 $696.80
Employee + Family $366.84 $586.69 $953.52
Anthem PPO
Employee Only $366.84 $359.47 $726.30
Employee + Spouse/DP $366.84 $1,231.01 $1,597.84
Employee + Child(ren) $366.84 $1,013.11 $1,379.94
Employee + Family* $366.84 $1,521.53 $1,888.36

2024 Full-Time Employee Costs

2024 LAwell Plan Costs

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 LAwell Pay Plan Costs

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

2024 LAwell Plan Costs

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 $775.93
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 $674.99
Employee + Family $387.96 $627.16 $1,015.12
Anthem Full Network (CACare) HMO
Employee Only $387.96 $163.33 $551.29
Employee + Spouse/DP $387.96 $824.87 $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 and 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 LAwell Pay Plan Costs

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 and Orange Counties) HMO
Employee Only $294.96 $32.78 $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

2023 LAwell Plan Costs

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 LAwell Pay Plan Costs

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

2023 LAwell Plan Costs

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 LAwell Pay Plan Costs

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

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.

Medical Coverage Eligible for Cash-in-Lieu

  • 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

Medical 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

If you are currently enrolled in Cash-in-Lieu, nothing is required to continue your current Cash-in-Lieu election. Cash-in-Lieu will continue until you notify the LAwell Benefits Program of a qualifying life event change.

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

  • Report your Cash-in-Lieu election to the LAwell Benefits Program.

  • Complete the Cash-In-Lieu Affidavit, providing required supporting documentation of your eligible medical coverage, by the deadline listed on your confirmation statement. 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.

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