6/19/2018. L.A. Care Health Plan Benefits. L.A. Care Local Initiative: History. L.A. Care Health Plan

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1 L.A. Care Health Plan Benefits Melissa Gutierrez, Director of Sales & Business Development Phoi Tran, Specialist, Business Development Margarita Lopez, Field Manager 1 L.A. Care Local Initiative: History L.A. Care Health Plan began operations in 1997 to provide health coverage to vulnerable Angelenos, and to support the health care safety net. During this time, we have worked closely with our Plan Partners to provide access to health care for our members, granted millions of dollars to organizations that are working to improve quality of life for residents of L.A. County, introduced new product lines, including our first commercial health plan, and more. Today, 21 years later, our membership has grown to over two million, and the organization is anchored by the ideas, commitment and expertise of nearly 2,000 employees. While the health care landscape may change, L.A. Care remains committed to making a difference. 2 L.A. Care Health Plan Our Mission To provide access to quality health care for Los Angeles County's vulnerable and low income communities and residents and to support the safety net required to achieve that purpose. Our Vision A healthy community in which all have access to the health care they need. 3 1

2 About L.A. Care Health Plan L.A. Care Health Plan (L.A. Care) is a public entity that serves the residents of Los Angeles County through: Cal MediConnect Plan Medi-Cal Covered California PASC-SEIU Plan With more than 2.2 million members, L.A. Care is the nation s largest publicly operated health plan providing quality health care coverage to Los Angeles County residents. L.A. Care Cal MediConnect Plan is an HMO Plan with an extensive network of over 5,600 Doctors & Specialists and over 60 Hospitals throughout Los Angeles County. 4 L.A. Care Health Plan Medi Cal L.A. Care Covered Cal Medi Connect Collective Benefits/Services Overview PASC SEIU Health Education for the Community Family Resource Centers Member Portal IHSS Unlimited Transportation Dental Acupuncture/Chiropractor Vision Medication and many more 5 Sales Team Outreach and Assistance Sales Team Outreach and Assistance: Partnerships with contracted physicians throughout Los Angeles County. Collaborate with our Family Resource Centers in providing health education and health prevention classes. Field Sales Representative conduct full benefit presentations. Enrollment Support Services Representatives conduct full benefit presentations over the phone. 6 2

3 L.A. Care Health Plans: Medi-Cal Plan What is Medi-Cal? Medi-Cal is a public program that provides health care coverage to adults, families, older adults, and people with disabilities who meet the income requirements. Who can apply? People who live in Los Angeles County; People who are a parent, child, adults without children, older adults or disabled; and People who meet the income guidelines How much will I pay? Medi-Cal with L.A. Care is free for families who qualify. There are no monthly premiums or co-pays. 7 L.A. Care Health Plans: L.A. Care Covered Sales Team Outreach and Assistance : Certified Plan Based Enrollers. Assist with the Medi-Cal application process. Search and recommend physicians in the community.. Enrollment into L.A. Care Covered (Covered California Plan). Insurance Plan quotes / Shop and Compare. 8 Cal Medi-Connect Program When a patient enrolls in the L.A. Care Cal MediConnect Plan, their Medicare and Medi-Cal benefits will be covered under one plan. Additionally, as an L.A. Care Cal MediConnect Plan member, your Medicare Medi-Cal patients can receive enhanced benefits not available in Medicare Fee-For-Service or Medi-Cal. 9 3

4 Cal-MediConnect Benefits at a Glance Benefits Covered Co-Pays Premium and Deductible Office Visits (Doctor & Specialist Services) Hospital Services Mental Health Services (Inpatient & Outpatient) Skilled Nursing Care Home Health Care Hospice Case Management 10 Benefits at a Glance (cont.) Benefits Covered Co-Pays Outpatient Substance Use Emergency Care Ambulance Services Urgent Care Durable Medical Equipment & Prosthetic Devices Medical Supplies Diabetic Supplies (monitor, test strips, lancets) Incontinence Cream And Diapers 11 Referral Options Have an individual call us Filled out a lead card us: ptran@lacare.org 12 4

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