Evidence of Coverage
Medical
Click the applicable plan below to view the corresponding Evidence of Coverage.
Anthem Blue Cross
2024
California HMO (For Members Residing in California only)
2024 Anthem HMO Member under age 65 or 65+ with only Medicare Part B and no Part D
2024 Anthem HMO Member 65+ with only Medicare Part B and Part D
California PPO (For Members Residing in California only)
2024 Anthem PPO for Member under age 65 (CA)
2024 Anthem PPO Member age 65+ with only Medicare Part B and Part D (CA)
Non-California PPO (For Members Residing in the U.S. & Its Territories only)
2024 Anthem PPO for Member under age 65 (non-CA)
2024 Anthem PPO Member age 65+ with only Medicare Part B and Part D (non-CA)
Medicare
2024 Anthem Medicare Preferred (PPO) with Senior Rx Plus - Part A and B MAPD
2024 Anthem MedicareRx (PDP) with Senior Rx Plus - Part B PDP
2024 Anthem Life & Health Medicare Supplement - Part A, B, and D
Anthem PPO Out of Country (For Members Residing Outside the U.S. & Its Territories)
2024 Anthem Member - Out of Country
2023
California HMO (For Members Residing in California only)
2023 Anthem HMO Member under age 65 or 65+ with only Medicare Part B and no Part D
2023 Anthem HMO Member 65+ with only Medicare Part B and Part D
California PPO (For Members Residing in California only)
2023 Anthem PPO for Member under age 65 (CA)
2023 Anthem PPO Member age 65+ with only Medicare Part B and Part D (CA)
Non-California PPO (For Members Residing in the U.S. & Its Territories only)
2023 EOC will be posted when available.
Medicare
2023 EOC will be posted when available.
Anthem PPO Out of Country (For Member Residing Outside the U.S. & Its Territories)
2023 EOC will be posted when available.
2022
California HMO (For Members 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 Members 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 Members 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
2025
Kaiser Senior Advantage (Southern CA)
2025 Kaiser Senior Advantage HMO with Part D Southern CA
2025 Kaiser Chiropractic and Acupuncture Services Southern CA
Kaiser Senior Advantage (Northern CA)
2025 Kaiser Senior Advantage HMO with Part D Northern CA
2025 Kaiser Chiropractic and Acupuncture Services Northern CA
Kaiser (non-Medicare) (Southern CA)
2025 Kaiser Traditional HMO Southern CA
2025 Kaiser Chiropractic and Acupuncture Services Southern CA
Kaiser (non-Medicare) (Northern CA)
2025 Kaiser Traditional HMO Northern CA
2025 Kaiser Chiropractic and Acupuncture Services Northern CA
2024
Kaiser Senior Advantage (Southern CA)
2024 Kaiser Senior Advantage HMO with Part D Southern CA
2024 Kaiser Chiropractic and Acupuncture Services and Silver&Fit Southern CA
Kaiser Senior Advantage (Northern CA)
2024 Kaiser Senior Advantage HMO with Part D Northern CA
2024 Kaiser Chiropractic and Acupuncture Services and Silver&Fit Northern CA
Kaiser (non-Medicare) (Southern CA)
2024 Kaiser Traditional HMO Southern CA
2024 Kaiser non-Medicare Retiree Chiropractic and Acupuncture Services and Silver&Fit Southern CA
Kaiser (non-Medicare) (Northern CA)
2024 Kaiser Traditional HMO Northern CA
2024 Kaiser non-Medicare Retiree Chiropractic and Acupuncture Services and Silver&Fit Northern CA
SCAN Health Plan
2025
2024
UnitedHealthcare
2025
2025 UHC Northern CA- Coming Soon
2024
- 2023 Kaiser Senior Advantage HMO with Part D Southern CA
- 2023 Kaiser Senior Advantage HMO with Part D Northern CA
- 2023 Kaiser Traditional HMO Southern CA
- 2023 Kaiser Traditional HMO Northern CA
- 2023 Kaiser Chiropractic and Acupuncture Services and Silver&Fit Southern CA
- 2023 Kaiser Chiropractic and Acupuncture Services and Silver&Fit Northern CA
- 2024 Anthem PPO Member age 65+ with only Medicare Part B and Part D (CA)
- Read more
Dental
Click the applicable plan below to view corresponding Evidence of Coverages.
DeltaCare USA HMO
Delta Dental PPO
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 is the same as 2022, please refer to the 2022 EOC.