Click Below for your Health Questions

I am a retiree enrolled in Kaiser; once I or my spouse reaches 65 what do I do in regards to Medicare?

You and/or your spouse must apply for Medicare Part A & B with the social security department. You must complete and submit an application for Kaiser Senior Advantage in the month prior to your 65th birthday. Please contact Kaiser directly to obtain an application. You must also submit a copy of your Medicare card to Benefits administration.

I am a retiree enrolled in Health Net; once I or my spouse reaches 65 what do I do in regards to Medicare?

You and/or spouse must apply for Medicare Parts A and B with the social security department. You must complete and submit an application for HealthNet Seniority Plus the month prior to your 65th birthday. Please contact HealthNet directly to obtain an application. You must also submit a copy of your Medicare card to Benefits administration.

I am a retiree enrolled in Anthem Blue Cross; once I or my spouse reaches 65 what do I do in regards to Medicare?

You and/or your spouse must apply for Medicare Parts A & B. You must also submit a copy of your Medicare card to Benefits administration.

If I want to change doctors or dentists during the year, how do I do this?

To change providers, call your Plan directly. Your Plan will tell you when your provider election will become effective, and the Plan will send you identification cards, if applicable.

Are there limitations on preexisting conditions if I change health plans?

No, there are no limitations on preexisting conditions if members change health plans during the annual benefits open enrollment.

Are there any survivor benefits?

In the event of a retiree’s death, the District will not pay for the health plan coverage of a surviving spouse or other dependents. Surviving spouses may continue coverage at their own expense under the District’s AB528 Continuation Plan, and may also be eligible for COBRA coverage for a limited time. Other dependents, however, are eligible for COBRA only. Your surviving spouse or dependent(s) must notify the District of your death within 60 days. The District will notify the COBRA/AB528 administrator, FBMC, to mail an enrollment packet to your surviving spouse/dependent(s). Failure to notify the District of a retiree’s death may cause the surviving spouse and dependent(s) to forfeit their COBRA/AB528 rights.

What about Life Insurance Program?

Conversion plans are available for both the basic (District-paid) and optional (employee-paid) life insurance plans at your expense. If you are enrolled in optional life insurance when you retire, you will be eligible to enroll in a special “decreasing term” policy. Your coverage will equal 50% of the amount of your active employee coverage. This amount decreases each year by 10% of your original coverage amount and the minimum coverage amount will never be less than $5,000. If you would like to continue or cancel this coverage or need more information, contact MetLife at (866) 492-6983.

I need information on Domestic Partners. Is there any information available?

Sure! click here

Are my child dependents covered when I retire?

Yes! Please see the chart below for coverage options.

What happens if I move?

If your new address is within California, fill out Retiree - Change of Address Form (In California).pdf

If you move out of California, you must contact Benefits Administration for benefit plan availability in your new area. Fill out the Retiree Out Of Area Enrollment Form 2011.pdf

There is NO out of country coverage. However employees who retired prior to 1/1/10 and already resided outside of the country were grandfathered and have limited coverage (retiree responsible for 20% plus deductible; Medicare would not apply.)

If I choose a new medical plan does that mean I have a new pharmacy benefit t provider?

Yes, each medical plan has a different pharmacy benefit manager. To find out more about the network of pharmacies, covered drugs and transition of care available under each plan, visit the plan website or contact the plan’s customer service number.

What is a formulary drug?

A formulary, sometimes called a recommended drug list, is a list of preferred generic and brand name drugs. This list includes a wide selection of medications and offers you a choice while helping keep the cost of your prescription drug benefits affordable. Every drug on the formulary has been approved by the Food and Drug Administration (FDA) and reviewed by an independent group of doctors and pharmacists for safety and efficacy. The list can be obtained by contacting the plan.

What is the primary/preferred drug list and what is a preferred drug?

The Primary/Preferred Drug List is a list of commonly prescribed drugs in select drug classes, or grouping of drugs that are used to treat the same condition. There are preferred brand drugs as well as generic drugs on the drug list. The drugs listed are considered preferred drug choices as they provide the greatest economic value in the drug class. It is important to note that preferred medications are not chosen for inclusion on the Primary/Preferred Drug List based on price alone; they are selected based on comparable clinical efficacy to other products in the same drug classes. The Primary/Preferred Drug List is reviewed and updated on a quarterly basis. Medical specialists (physicians and pharmacists) conduct a rigorous clinical and economic review and evaluate any proposed changes to ensure they are consistent with the most recent and relevant clinical findings.

What is a maintenance medication?

A maintenance medication is one that you take on a daily and ongoing basis to maintain your health and most likely no dosage changes are required. Examples of this type of medication are those that you take to manage blood pressure or cholesterol.

Is prior authorization ever required?

Yes, some medications are covered by your plan only under certain circumstances or in certain quantities.

Why do some drugs require prior authorization?

Prior authorization is a patient safety process that ensures members get the safest medications with the best value and are approved by the Food and Drug Administration (FDA). Medications selected for prior authorization are based on at least one of the following criteria:

• have a high potential for abuse;

• require laboratory tests/monitoring for safety reasons;

• are part of a step-care guideline;

• used for indications not approved by the FDA or the plan;

• has high potential for “off -label” or experimental use;

• benefit exclusions or limitations may apply.

How do I obtain a prior authorization for medication on the Formulary or Recommended Drug List?

The pharmacy will let you know if additional information is required. You or the pharmacy can then ask your doctor to call a special toll-free number. This call will initiate a review that typically takes one to three business days. This is a common practice for pharmacies and physicians. Contact the plan either by visiting the website or calling the phone number noted behind the front cover of this enrollment guide.

What if I refill a prescription at a non-participating pharmacy?

For some plans there may be limitations on filling prescriptions at non-participating pharmacies. For example, you may only be able to receive reimbursement for drugs purchased at non-participating pharmacies in an emergency or urgent situation or when you are traveling. Check with the plan to determine any limitations.

When are student verifications required?

This is now only required for retirees (over age 65). Between the ages of 19 through 25, the district will request documentation; Every (April) Spring and (September) Fall

• Dependents of active employees and early retirees may now be covered through age 26 without attending school.
• Dependents of retirees (over age 65) are eligible for full benefits through age 25 if they are full time students. They are eligible for medical only through age 26 if they are not full time students.
• Dependents of retirees over the age of 65 are not eligible for benefits if the retiree is enrolled in an HMO plan (Kaiser Senior Advantage, Secure Horizons or Health Net Seniority Plus)
• All dependents who lose coverage may apply for COBRA

I’ve got additional questions, who can I call?

If you have additional questions regarding your health insurance coverage, would like to add or delete dependents, update your address or obtain benefit information, contact Benefits Administration at (213) 241-4262, or write to Benefits Administration P.O. Box 513307, Los Angeles, CA 90051-1307 or via email at benefits@lausd.net. For additional information regarding your coverage, call your plan.