HomeHealthcareMedical plans

Comparison of medical coverage


 
USC Network Medical Plan (PPO) Anthem Blue Cross HMO Kaiser Permanente (HMO)
Tier 1
Keck Medicine of USC¹ (Anthem Blue Cross/BlueCard for covered persons up to 26 years of age)
Tier 2
Anthem Blue Cross Prudent Buyer/BlueCard providers
Tier 3
Non-Network
(UCR = Usual, customary and reasonable charges)
   
Annual medical deductible None None
  –Individual $100 $250 $500
  –Family $300 $750 $1,500
Annual medical out of pocket maximum    
  –Individual $1,000 (100% thereafter) $2,500 (100% thereafter) $10,000 (100% of UCR thereafter) $2,000 (medical and prescription) $3,000 (medical and prescription)
  –Family $3,000 (100% thereafter) $7,500 (100% thereafter) $30,000 (100% of UCR thereafter) $6,000 (medical and prescription) $6,000 (medical and prescription)
Annual prescription out of pocket copay maximum Individual: $4,350
Family (two or more people): $6,200
No out of pocket maximum None None
Lifetime maximum benefit None None None None None
Office visits You pay $15 You pay $25 Plan pays 50% of UCR after deductible
You pay remainder of charges
You pay $25 You pay $25 primary care
$50 specialist
Preventive care² Plan pays 100% Plan pays 100% Plan pays 50% of UCR after deductible
You pay remainder of charges
Plan pays 100% Plan pays 100%
Prescription drugs If prescription is filled at a Network pharmacy, your copay for a 30-day supply is:
  • For generic: $10 copay
  • For brand when no generic available: 20% of cost, with a minimum $30 copay; $125 max copay
  • For brand when generic available: 50% of cost, with a minimum $50 copay; no max copay
  • For specialty drugs: $200 copay
See specialty drug list (.pdf)

Mail service available on maintenance medications but copays are the same as above per 30-day fill
If filled at a non-Network pharmacy, the Plan will reimburse you 50% of the Plan's CVS Caremark contracted rate (not of cost)

Reimbursement request must be received within 60 days of fill
You pay $10 per prescription for generic drugs and $25 per prescription for brand name formulary drugs and 45% of cost for brand name non-formulary drugs, up to a maximum $100 copay at participating pharmacies

Retail maximum: 30-day supply

Mail maximum: 90-day supply
You pay $15 per prescription for generic drugs and $35 per prescription for brand name drugs (up to 30-day supply) at Kaiser Permanente pharmacy

Retail maximum: 30-day supply

Mail maximum: 100-day supply
Maternity (doctor only) You pay $15 You pay $25 Plan pays 50% of UCR after deductible
You pay remainder of charges
You pay $25 per office visit³ You pay $25 for prenatal care and first postpartum, unless visit deemed as an ACA-required preventive visit
Well baby care Plan pays 100% newborn exam and circumcision at hospital No charge No charge
  –Physical exams No charge No charge Plan pays 50% of UCR per office visit after deductible
You pay remainder of charges
Emergency care You pay $150 copay (only at USC Verdugo Hills Hospital) (waived if admitted) You pay $150 copay (waived if admitted) You pay $150 copay (waived if admitted) and any charges above 100% of UCR You pay $200 copay (waived if directly admitted to hospital) You pay $200 copay (waived if directly admitted to hospital)
Urgent care centers Not available You pay $35 copay Plan pays 50% of UCR after deductible
You pay remainder of charges
You pay $25 copay You pay $25 copay
Ambulance
(ground)
Not available Plan pays 80% after deductible
You pay 20% after deductible
Plan pays 80% of UCR after deductible
You pay remainder of charges
Plan pays 100% You pay $50 copay
Inpatient hospital expenses All hospital admissions are subject to the Prior Authorization Program    
  –Facility Plan pays 100%
Maternity delivery only at USC Verdugo Hills Hospital
Plan pays 100% after copay
You pay $300 copay per admission

Maternity delivery: $100 copay per admission only at Good Samaritan Hospital when delivery is done by a USC Care Medical Group obstetrician
Plan pays 50% of UCR after copay. You pay $500 copay per admission plus all charges over 50% of UCR You pay $250 copay per admission You pay $250 copay per admission
  –Surgery/doctor visits Plan pays 90% after deductible
You pay 10% after deductible
Plan pays 80% after deductible
You pay 20% after deductible
Plan pays 50% of UCR after deductible
You pay remainder of charges
No charge No charge
  –Skilled nursing facility Limited to 100 days per calendar year regardless of cause You pay $250 copay per admission (up to 100 days per calendar year) You pay $250 copay per admission (up to 100 days per calendar year)
Not available Plan pays 100% after copay
You pay $300 copay per admission
Plan pays 50% of UCR after copay
You pay $500 copay per admission plus all charges over 50% of UCR
Outpatient surgery expenses
  –Facility Plan pays 100% Plan pays 100% after copay
You pay $200 copay per admission
Plan pays 50% of UCR up to $2,700
You pay $400 copay per admission plus remainder of charges
You pay $250 copay per admission You pay $250 copay per admission
  –Doctor Plan pays 90% after deductible
You pay 10% after deductible
Plan pays 80% after deductible
You pay 20% after deductible
Plan pays 50% of UCR after deductible
You pay remainder of charges
No charge No charge
Blood, plasma Plan pays 90% after deductible
You pay 10% after deductible
Plan pays 80% after deductible
You pay 20% after deductible
Plan pays 50% of UCR after deductible
You pay remainder of charges
Plan pays 100% Plan pays 100% if replaced
Authorized home health care Any treatment plan in excess of ten visits must be submitted in writing for Prior Authorization by Anthem Blue Cross. Up to 100 visits per person each year You pay $20 per visit (Limited to 100 visits per calendar year) No copay (up to 100 visits per calendar year)
Plan pays 90% after deductible
You pay 10% after deductible
Plan pays 80% after deductible
You pay 20% after deductible
Plan pays 50% of UCR after deductible
You pay remainder of charges
Durable medical equipment Purchase price or rental cost over $2,000 requires preauthorization Plan pays 100% in most instances Plan pays 100% in most instances
Plan pays 90% after deductible
You pay 10% after deductible
Plan pays 80% after deductible
You pay 20% after deductible
Plan pays 50% of UCR after deductible
You pay remainder of charges
Hospice care Plan pays 100% Plan pays 100% Plan pays 100% of UCR Plan pays 100% Plan pays 100%
Mental health and substance abuse
  –In hospital Plan pays 100% Plan pays 100% after copay
You pay $300 copay per admission
Plan pays 50% of UCR after copay
You pay $500 copay per admission plus all charges over 50% of UCR
You pay $250 copay per admission (preauthorization required) Mental health and substance abuse: You pay $250 copay per admission.
Transitional residential recovery services: $100 copay per admission
  –Outpatient visits You pay $15 copay per visit You pay $25 copay per visit Plan pays 50% of UCR (80% of UCR for covered person under 26 years of age) after deductible
You pay remainder of charges
You pay $25 copay per visit (pre-service review required after 12th visit) Mental health: You pay $25 copay per visit and $12 copay for group visits
Substance abuse: $25 copay per visit for individual therapy; $5 copay for group
Child immunizations Plan pays 100% (through age 25) No charge No charge
Routine eye exams None None You pay $25 copay per exam
Eyeglasses/contact lenses None None None
Coverage in foreign countries No Yes Yes Yes, full coverage for emergencies, subject to copays Yes, full coverage for emergencies, subject to copays
Coordination with other plans Yes Yes Yes No No
Convertible to individual policy if under 65 (following COBRA) No No No Yes Yes
Convertible to Medicare Supplement or Medicare Advantage at retirement Yes, to USC Senior Care Plan with Medicare Parts A and B Yes, with Medicare Parts A and B Yes, with Medicare Parts A and B
1 Keck Medicine of USC includes—USC Care Medical Group, Keck Hospital of USC, USC Norris Cancer Hospital, and USC Verdugo Hills Hospital.
2 Includes certain childhood immunizations, adult screenings and certain adult immunizations
3 Healthcare Partners Medical Group does not deliver at Huntington Memorial Hospital.

HomeHealthcareMedical plans