Instructions: Enter retired member's years of service credit, select the coverage, carrier, and State if applicable.

Disclaimer: This does not guarantee service areas offerings by medical carriers. Please contact each carrier to confirm that the zip code you reside in can be serviced. In order to receive a health insurance subsidy, a retired city employee must be age 55 with at least 10 years of service credit or have retired under the special provisions of age 50 with 30 years of service (9/1/1996-9/30/2003). An eligible surviving spouse/qualified domestic partner is entitled to a medical insurance subsidy based upon when the deceased member would have been eligible for a subsidy.

Service Credit:			years
Coverage:
Retiree Only       Retiree under 65 or over age 65 with only Medicare Part B Retiree over age 65 with both Medicare Parts A & B   Retiree & 1 Dependent        Retiree & Dependent both under 65 or both over age 65 with Medicare Part B Retiree under 65 & Dependent over 65 with both Medicare Parts A & B Retiree over 65 with both Medicare Parts A & B Dependent under 65 Retiree & Dependent both over 65 with both Medicare Parts A & B   Retiree & Family       Retiree & Dependents all under 65 or over 65 with Medicare Part B Retiree under 65 & 1 Dependent over 65 with both Medicare Parts A & B Retiree over 65 with Medicare Parts A & B & Dependents under 65 Retiree & 1 Dependent over 65 with Medicare Parts A & B   Surviving Spouse/ Domestic Partner       Under 65 or over 65 with only Medicare Part B Over 65 with both Medicare Parts A & B
	Kaiser and Anthem Blue Cross HMO are the two HMO plans in California for Members who are under 65 or 65 or older with only Medicare Part B. For a two party or family where one has Medicare Parts A & B and the other does not (known as split couples), and the couple does not wish to enroll in Kaiser HMO, there is the option of LACERS Dual Care HMO. This option "marries" the superior premium rate offered by Anthem BlueCross HMO with a Medicare HMO Provider - SCAN or UHC Secure Horizons. For more details please contact a LACERS Health Counselor. In addition, split couples are eligible to enroll in the Anthem Blue Cross PPO/Medicare Supplement Plan.
Medical Carriers:
	All parties over 65 with both Medicare Parts A & B Anthem Blue Cross PPO/Medicare Supplement (U.S.) Kaiser Sr. Advantage (CA)** SCAN (CA & AZ-Maricopa County only) ** UHC Secure Horizons   AZ - Arizona NV - Nevada ** UHC Secure Horizons (CA)**   All parties under 65 or over 65 with only Medicare Part B Anthem Blue Cross PPO (U.S.) Kaiser HMO (CA)** Anthem Blue Cross HMO (CA)**
	Split Couples/Families* Anthem Blue Cross Medicare Supplement/Anthem Blue Cross PPO (U.S.) Kaiser Sr. Advantage/Kaiser HMO SCAN (Southern CA)/Anthem Blue Cross HMO(CA only)** UHC Secure Horizons (CA)/Anthem Blue Cross HMO (CA only)**

*Split Couples/Families - These combinations are only available for members in a two-party or family plan where at least one person has Medicare Parts A & B and at least one person does not.

**Must live in zip code service area. Please contact carrier to verify.