Health Plans
Benefits Effective July 1, 2026
The Relief PPO Medical Plan is one of the most comprehensive health plans in the fire service. Everything was designed—by firefighters for firefighters—for the unique needs and challenges facing those in our profession.
Key highlights include:
- $250 annual deductible for non-emergency in-patient services
- $15 copay for most in-network outpatient services
- 100% coverage for preventive care
- Preventive full body scan (every three years)
- 100% coverage for most in-network services
- In-house claims team
- Unlimited lifetime max
- Nationwide access
- Firefighter-tailored extras
Quick Links
Your Costs for Key Medical Services
| Benefit | PPO Provider | Non-PPO Provider |
|---|---|---|
| Annual Deductible | $250 annual deductible (non-emergency, inpatient admissions) |
$250 annual deductible (non-emergency, inpatient admissions) |
|
Annual Out-of-Pocket Maximum |
$2,000 (member only); $4,000 (family) |
None |
|
Physician Office Visits |
$20 copay, then 100% |
$40 copay, then 100% |
|
Emergency Room Services |
$100 copay (waived if admitted), then 100% |
$100 copay (waived if admitted), then 100% |
| Inpatient — Intensive Care & Coronary Care Units |
100% |
100% |
|
Inpatient — Hospital Room & Board, Mental Health or Substance Abuse |
$250 deductible, then 90% of the first $5,000; 100% thereafter | $250 deductible, then 70% |
|
Outpatient — Hospital |
$20 copay, then 100% |
$40 copay, then 80% |
|
Outpatient – Surgical Facility |
$20 copay, then 100% |
$40 copay, then 80% up to $3,000 |
|
Outpatient – Mental Health or Substance Abuse |
$20 copay, then 100% |
$40 copay, then 100% |
|
Diagnostic X-ray & Lab |
100% |
|
|
Physical Therapy and Chiropractic Care |
$20 copay, then 100% |
$40 copay, then 100% |
Additional Quick Links
Vision
Vision coverage through Vision Service Plan (VSP) is automatically included when you enroll in the Relief PPO Medical Plan. You have the flexibility to choose any provider, but you will find greater cost savings and ease when you see a VSP provider.
Eye-Catching Extras
We added some extras to the vision plan to help you “see” even more value:
- Exclusive LAFRA discounts: 30% off any lens extras and 15% off a contact lens exam
- WellVision Exam®: Comprehensive eye exam that detects both vision problems (nearsightedness, farsightedness, astigmatism) and early signs of serious health conditions like diabetes, high blood pressure, and glaucoma
- VSP LightCare: $200 allowance for ready-made non-prescription sunglasses or blue light filtering glasses (instead of prescription glasses or contacts)
- Eyeconic.com: One-stop online store where you can apply benefits, upload prescriptions, and order glasses
| Benefit | VSP Provider | Non-VSP Provider |
|---|---|---|
| Eye Exam (Every calendar year) | $10 copay |
Up to $45 |
|
Single Vision Lenses |
100% |
Up to $45 |
|
Bifocal Lenses |
100% |
Up to $65 |
|
Trifocal Lenses |
100% |
Up to $85 |
| Standard Progressive Lenses |
100% |
Up to $85 |
|
Premium Progressive Lenses |
$80 - $90 copay |
Up to $85 |
|
Custom Progressive Lenses |
$120 - $160 copay |
Up to $85 |
|
Frames (Every other year) |
Up to $200 |
Up to $47 |
|
Contact Lenses (in lieu of glasses) |
Up to $200 |
Up to $105 |
|
Laser Vision Care |
Up to $1,500 per eye, |
Up to $750 per eye, |
Ready to learn more?
Visit vsp.com or call (800)-877-7195 to check eligibility, find providers, view your benefits summary, or access Eyeconic.
Prescription drug benefits are automatically included with the Relief PPO Medical Plan, ensuring you can get the medications you need to stay healthy and recover quickly.
Download the Express Scripts mobile app from the App Store or Google Play.
| Benefit | Active Member | Retired Member Medicare-eligible (typically age 65 or older) |
|---|---|---|
| Provider | Express Scripts (pharmacy retailers) | Express Scripts Medicare Part D Prescription Drug Plan |
|
Where to Fill |
|
|
|
ID Cards |
Express Scripts |
Medicare |
Prescription Programs for All Members
- Prior Authorization: If your pharmacist tells you that your prescription needs a prior authorization, ask them to contact the Express Scripts Prior Authorization department, available 24/7 at (800) 753-2851 (active members and non-Medicare) or (844) 374-7377 (retirees on Medicare).
- Step Therapy Program: Generic drugs must be used before alternative brand-name drugs. If you wish to bypass the generic, you must get prior authorization.
- Specialty Medications: Most specialty medications are covered through Accredo (Express Scripts’ specialty pharmacy). Call Express Scripts at (800) 711-0917 to determine if specialty medications need to be ordered through Accredo.
Costs – Active Member
| Benefit | Retail (30-Day Supply) | Mail Service / Walgreens / CVS (90-Day Supply) |
|---|---|---|
| Annual Out-of-Pocket Maximum | $8,600 individual, $17,200 family |
$8,600 individual, $17,200 family |
|
Generic |
$10 |
$20 |
|
Preferred Brand |
$35 |
$70 |
|
Non-preferred Brand |
$70 |
$140 |
| Specialty Preferred Brand |
20% coinsurance, $200 max per 30-day supply |
20% coinsurance, $600 max per 90-day supply |
|
Specialty Non-preferred Brand |
20% coinsurance, $200 max per 30-day supply | 20% coinsurance, $600 max per 90-day supply |
Costs – Retired Member
| Benefit | Retail (30-Day Supply) | Mail Service / Walgreens / CVS (90-Day Supply) |
|---|---|---|
| Annual Out-of-Pocket Maximum* |
$8,600 individual, $17,200 family |
$8,600 individual, $17,200 family |
|
Generic |
$10 |
$20 |
|
Preferred Brand |
$25 |
$50 |
|
Non-preferred Brand |
$50 |
$100 |
| Specialty Preferred Brand |
20% coinsurance, $200 max per 31-day supply |
20% coinsurance, $600 max per 90-day supply |
|
Specialty Non-preferred Brand |
20% coinsurance, $200 max per 31-day supply | 20% coinsurance, $600 max per 90-day supply |
*Annual Out-of-Pocket Maximum only applies to retirees that are not Medicare eligible.
We offer a Kaiser Permanente HMO plan as an additional option. Kaiser is an all-in-one network, with your primary care provider coordinating all care. With this plan, you must use Kaiser providers and facilities, and if you need to see a specialist, you’ll first need a referral from your primary care provider.
Key highlights include:
- $0 deductible
- 100% coverage for preventative care
- $15 copay for primary care visit
- $15 copay for specialist visit
- $150 copay for emergency room visits
Quick Links
| Benefit | Active | Retiree |
|---|---|---|
| Annual Deductible | $0 |
$0 |
|
Annual Out-of-Pocket Maximum |
$1,500 (member only) $1,500 (family coverage: each member in a family of 2+) $3,000 (family coverage: entire family of 2+) |
$1,000 (member only) $1,000 (family coverage: each member in a family of 2+) $2,000 (family coverage: entire family of 2+) |
|
Physician Office Visits |
$15 per visit |
$15 per visit |
|
Emergency Room Services |
$150 per visit |
$120 per visit |
|
Inpatient — Hospital Room & Board, Mental Health or Substance Abuse |
$0 | $0 |
|
Outpatient — Surgery & Procedures |
$15 per procedure |
$15 per procedure |
|
Outpatient – Mental Health |
$15 per visit |
$0 |
|
Outpatient – Substance Abuse |
$15 per visit |
$15 per visit |
|
Diagnostic X-ray & Lab |
$0 |
$0 |
|
Urgent Care |
$15 per visit |
$15 per visit |
|
Physical, Occupational, & Speech Therapy |
$15 per visit |
$15 per visit |
|
Optometrist Routine Eye Exam |
$0 |
$15 |
|
Eyeglasses or Contact Lenses (every 24 months) |
Amount above $200 allowance |
Amount above $200 allowance |
Prescription drug benefits are automatically included with the Kaiser HMO Medical Plan. Just like the health plan, you must use pharmacies within the Kaiser network to fill any prescriptions. To view a list of covered medications, go to kp.org/formulary.
| Benefit | Kaiser Pharmacy | Mail Order Service |
|---|---|---|
| Generic (Tier 1) |
$10 for up to a 30-day supply |
$20 for up to a 100-day supply |
|
Brand-name (Tier 2) |
$20 for up to a 30-day supply |
$40 for up to a 100-day supply |
|
Specialty items (Tier 4) |
$20 for up to a 30-day supply |
N/A |
Retirees: Kaiser Permanente Senior Advantage (HMO) with Part D
A similar HMO plan is available to retirees: Kaiser Permanente Senior Advantage (HMO) with Part D. It offers the same coverage—preventive, hospital, urgent care, mental health services, and more—but has a different prescription plan that is part of Medicare.
- Active Member: Member in good standing or newly appointed firefighter
- LAFRA Employee: Regular full-time employee working 80 or more hours per pay period
- Retired Member (Not Medicare-Eligible): Active firefighter on retirement date
- Retired Member (Medicare-Covered): Active firefighter at time of retirement and covered by Medicare
- Surviving Spouse/Domestic Partner: Legally married spouse or qualified domestic partner of covered member at the time of the member’s death.
- A common law spouse is not considered a “legally married spouse” or “qualified domestic partner” under the plan.
- A surviving spouse of a previously covered member may not add a domestic partner for any coverage.
- Dependents:
- Legally married spouse or qualified domestic partner
- Children under age 26
- Children totally dependent on you because of a physical or mental disability
Note: An eligible child has a legally-qualifying relationship with you (i.e., a son, daughter, stepson or stepdaughter, a legally adopted child, a child for whom you are appointed as the legal guardian, a child who is placed with you for legal adoption, or an eligible foster child).
Go to lafra.org to view information about the medical plans through June 30, 2026. New benefit elections, which are highlighted here on health.lafra.org, are effective July 1, 2026.