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Prenatal and postnatal office visits for services mandated by the Affordable Care Act (ACA): Plan pays 70% of allowed charges 2 after deductible 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 $2,000/person $4,000/family, in-network and out-of-network combined See the Evidence of Coverage for more details. Health plan or call your health plan if you have questions about coverage.Ĭopay varies by office visit type. Preventive Services Task Force and federal regulations. Preventive care coverage includes preventive services rated A or B by the U.S. Plan pays for one hearing aid per ear every 24 months

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 100% after $100 copay/visit copay waived if admitted Plan pays 100% after $100 copay/ visit copay waived if admitted To review PCP availability in other areas, review the “Finding Network Providers” section of the provider you are interested inĮmergency Room Care for True Emergencies (severe chest pains, breathing difficulties, etc.) If you select HMO coverage and you reside outside of City of Los Angeles 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 of and willing to travel into the Los Angeles area each time you seek care. As City employees, your health coverage options discussed in this guid e are available to City of Los Angeles work addresses. Note: Health coverage with an HMO plan is typically restricted to a specific distance from a home or work address. LAwell provides coverage where most City employees live to enroll, a member must reside/work within the region served by the HMO. 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. HMOs – Health Maintenance Organizations (HMOs) provide healthcare through a network of doctors, hospitals, and other healthcare providers.