2021 Plan Benefits

• Medical and Hospital care
• Prescription Medications, including Part D Prescription coverage
• Mental and Behavioral Health Care
• Managed Long-Term Services and Supports (MLTSS)
• Connection to Home and Community Based Social Services
• Individual Care Plans and the support of a Care Manager

• A $0 monthly premium
• No out-of-pocket costs to see your primary care doctor and specialists
  • You must get your care from network providers. Usually, the plan will not cover care from a provider who is not contracted with the health plan.
• Vision Services:
  • $0 co-pay for up to 1 supplemental routine eye exam every year
  • Up to $300 for eyeglasses or contact lenses every 2 years 
• $35 Monthly Over-the-Counter Allowance
  • Cal MediConnect Plan members will receive a $35 monthly allowance in a pre-loaded member card
  • Unused amounts will expire at the end of the month.

Members can use this benefit to purchase approved non-prescription items at the following participating retail locations: Walmart (Mail Order Available, Kroger (Ralphs and Food4Less, and CVS). You can also order by phone or online to have items mailed to you. 

• Silver Sneakers™ Physical Fitness Benefit:
  • Access to over 15,000 physical fitness centers nationwide including most LA Fitness, 24 Hour Fitness, Gold's Gym, Curves, Planet Fitness locations in LA County.
  • A variety of group exercise classes designed for beginners and older adults.
  • Members can also get home exercise information and one home exercise kit per year.
• Emergency and Urgently needed services coverage:
  • $0 co-pay for emergency and urgently needed care services received anywhere in the world up to a $10,000 limit per calendar year. You may get covered emergency and urgent medical care wherever and whenever you need it.
• Transportation services that are available to L.A. Care Cal MediConnect members include:

  • Non-Emergency Medical Transportation (NEMT)
    NEMT Physician Certification Statement Form is required

    This transportation type can include transport by ambulance, litter van, wheelchair van medical transportation services, and/or coordinating with para transit.

    These forms of transportation are authorized when:

    • Your medical and/or physical condition does not allow you to travel by bus, passenger car, taxicab, or another form of public or private transportation, and
    • Transportation is required for the purpose of obtaining needed medical care.

  • Non-Medical Transportation (NMT)
    NMT Referral may be required

    This benefit allows for transportation to approved medical services by passenger car, taxi, Lyft or other forms of public/private transportation.

    • You will have access to an unlimited number of round-trips per year.
    • This benefit does not limit your non-emergency medical transportation benefit.
• Prescription drugs:
  • Generic Drugs (Tier 1 drugs): $0 co-pay for a 30-day supply
  • Brand-Name Drugs (Tier 2 drugs): $0 - $9.20 co-pay for a 30-day supply
  • Non-Medicare Rx Drugs (Tier 3 drugs): $0 co-pay
  • Over-the-Counter (OTC) Drugs (Tier 4 Drugs): $0 co-pay
• Acupuncture Services:
  • We will pay for up to two outpatient acupuncture services in any one calendar month, or more often if they are medically necessary.

    With prior authorization, we will also pay for up to 12 acupuncture visits in 90 days if you have chronic low back pain, defined as:

    • lasting 12 weeks or longer;
    • not specific (having no systemic cause that can be identified, such as not associated with metastatic, inflammatory, or infectious disease);
    • not associated with surgery; and
    • not associated with pregnancy.

• Telehealth Services:
  • $0 co-pay to use digital technology to remotely access covered health care services from a licensed provider outside the provider’s office.