Evidence of Coverage

Evidence of Coverage

Overview

Evidence of Coverage (EOC) is a document that describes the coverage offered in LACERS-sponsored medical and dental plans.

Due to the various legal reviews (Federal, State, and Carrier), the EOCs for the 2023 plan year may not be posted at the time of Open Enrollment; they will be posted when they become available.

Post

Medical

Click the applicable plan below to view corresponding Evidence of Coverages.

Anthem Blue Cross

2023

2023 Anthem EOCs will be posted when available

2022

California HMO (For Member Residing in California only)

2022 Anthem HMO Member under age 65 or 65+ with only Medicare Part B and no Part D

2022 Anthem HMO Member 65+ with only Medicare Part B and Part D

California PPO (For Member Residing in California only)

2022 Anthem PPO for Member under age 65 (CA)

2022 Anthem PPO Member age 65+ with only Medicare Part B and Part D (CA)

Non-California PPO (For Member Residing in the U.S. & Its Territories only)

2022 Anthem PPO for Member under age 65 (non-CA)

2022 Anthem PPO Member age 65+ with only Medicare Part B and Part D (non-CA)

Medicare

2022 Anthem Medicare Preferred (PPO) with Senior Rx Plus - Part A and B MAPD

2022 Anthem MedicareRx (PDP) with Senior Rx Plus - Part B PDP

Anthem PPO Out of Country (For Member Residing Outside the U.S. & Its Territories)

2022 Anthem Member – Out of Country

Kaiser Permanente

2023

Kaiser Senior Advantage (Southern CA)

2023 Kaiser Senior Advantage HMO with Part D Southern CA

2023 Kaiser Chiropractic and Acupuncture Services and Silver&Fit Southern CA

Kaiser Senior Advantage (Northern CA)

2023 Kaiser Senior Advantage HMO with Part D Northern CA

2023 Kaiser Chiropractic and Acupuncture Services and Silver&Fit Northern CA

Kaiser (non-Medicare) (Southern CA)

2023 Kaiser Traditional HMO Southern CA

2023 Kaiser non-Medicare Retiree Chiropractic and Acupuncture Services and Silver&Fit Southern CA

Kaiser (non-Medicare) (Northern CA)

2023 Kaiser Traditional HMO Northern CA

2023 Kaiser non-Medicare Retiree Chiropractic and Acupuncture Services and Silver&Fit Northern CA

2022

Kaiser Senior Advantage (Southern CA)

2022 Kaiser Senior Advantage HMO with Part D Southern CA

2022 Kaiser Chiropractic and Acupuncture Services and Silver&Fit Southern CA

Kaiser Senior Advantage (Northern CA)

2022 Kaiser Senior Advantage HMO with Part D Northern CA

2022 Kaiser Chiropractic and Acupuncture Services and Silver&Fit Northern CA

Kaiser (non-Medicare) (Southern CA)

2022 Kaiser Traditional HMO Southern CA

2022 Kaiser non-Medicare Retiree Chiropractic and Acupuncture Services and Silver&Fit Southern CA

Kaiser (non-Medicare) (Northern CA)

2022 Kaiser Traditional HMO Northern CA

2022 Kaiser non-Medicare Retiree Chiropractic and Acupuncture Services and Silver&Fit Northern CA

SCAN Health Plan

2023 SCAN EOC will be posted when available

2022 SCAN

UnitedHealthcare

2023

2023 UHC EOCs will be posted when available

2022

2022 UHC AZ

2022 UHC NV

2022 UHC Northern CA

2022 UHC Southern CA

Post

Dental

Click the applicable plan below to view corresponding Evidence of Coverages.

DeltaCare USA HMO

2023 DeltaCare USA HMO EOC will be posted when available.

2022 DeltaCare CA and NV

Delta Dental PPO

2023 Delta Dental PPO EOC will be posted when available.

2022 Delta Dental PPO

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Vision

Anthem Blue View Vision for vision coverage is available to those enrolled in a LACERS medical plan other than Kaiser Permanente. Kaiser Permanente members obtain their vision benefits from Kaiser; please see the above Medical section for Kaiser’s medical EOC. 

2023 Anthem Blue View Vision EOC will be posted when available

2022 Anthem Blue View Vision

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