University of Southern California

USC Benefits

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
   
Annual deductible None None None None None
Annual out of pocket maximum (UCR=Usual, customary and reasonable charges.)  
–Individual $1,000 $2,500 $10,000 $1,000 $1,500
–Family   $3,000 (100% thereafter) $7,500 (100% thereafter) $30,000 (100% of UCR thereafter) $3,000 $3,000
Lifetime maximum benefit None None None None None
Office visits You pay $10 You pay $20 Plan pays 50% of UCR
You pay remainder of charges
You pay $20 You pay $25 primary care
$50 specialist
Preventive care² Plan pays 100% Plan pays 100% Plan pays 50% of UCR
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
  • For brand when no generic available: 20% of cost, with a minimum of $30; $125 max copay
  • For brand when generic available: 50% of cost, with a minimum of $30; no max copay
  • For specialty drugs: $200 copay
See specialty drug list (.pdf)

Mail service available on maintenance medications but copays are the same
If filled at a non-Network pharmacy, the Plan will reimburse 50% of the Plan's CVS Caremark contracted rate

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 at participating pharmacies (Maximum copay for non-formulary brand is $100) 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
Maternity (doctor only) You pay $10 You pay $20 Plan pays 50% of UCR
You pay remainder of charges
You pay $20 per office visit³ You pay $10 for prenatal care and first post-partum
Well Baby Care Plan pays 100% newborn exam and circumcision at hospital No charge No charge
No charge No charge Plan pays 50% of UCR per office visit
You pay remainder of charges
Emergency care You pay $100 copay (only at USC Verdugo Hills Hospital; waived if admitted) You pay $100 copay (waived if admitted) You pay $100 copay (waived if admitted) and any charges above 100% of UCR You pay $100 copayment, waived if directly admitted to hospital You pay $100 copayment, waived if directly admitted to hospital
Urgent Care Centers Not available You pay $35 copay Plan pays 50% of UCR
You pay remainder of charges
You pay $20 copay You pay $25 copay
Ambulance
(ground)
Not available Plan pays 80%
You pay 20%
Plan pays 80% of UCR
You pay remainder of charges
Plan pays 100% You pay $50
Inpatient hospital expenses All hospital admissions are subject to a Pre-Hospital Review Program. Benefits are reduced by 50% if program is not followed. You pay $250 copay per admission You pay $250 copay per admission
You pay $100 per day copay ($500 copay maximum per admission)
$100 copay per admission for maternity delivery only at USC Verdugo Hills Hospital
You pay $150 per day copay ($750 copay maximum per admission) You pay $200 per day copay ($1,000 copay maximum per admission) plus all charges in excess of 50% UCR
–Skilled Nursing Facility Not available You pay $150 per day copay ($750 copay maximum per admission) You pay $200 per day copay ($1,000 copay maximum per admission) plus 50% of remainder of charges
Plan pays 50% of UCR
Plan pays 100%, up to 100 days per calendar year You pay $250 copay per admission
Plan pays 100%, up to 100 days per calendar year
Limited to 100 days per calendar year regardless of cause
–Surgery/doctor visits Plan pays 90%
You pay 10%
Plan pays 80%
You pay 20%
Plan pays 50% of UCR
You pay remainder of charges
No charge No charge
Outpatient surgery expenses
–Facility You pay $100 copay You pay $150 copay You pay $200 copay; Plan pays 50% of UCR up to $2,700
You pay remainder of charges
You pay $250 copay You pay $100 copay
–Doctor Plan pays 90%
You pay 10%
Plan pays 80%
You pay 20%
Plan pays 50% of UCR
You pay remainder of charge
No charge No charge
Blood, plasma Plan pays 90%
You pay 10%
Plan pays 80%
You pay 20%
Plan pays 50% of UCR
You pay remainder of charges
Plan pays 100% Plan pays 100% if replaced
Authorized home health care Not available Plan pays 80%
You pay 20%
Plan pays 50% of UCR You pay $20 per visit (Limited to 100 visits per calendar year) Plan pays 100% for up to 100 visits per calendar year
Up to 100 visits per person each year
Durable medical equipment Not available Plan pays 80%
You pay 20%
Plan pays 50% of UCR
You pay remainder of charges
Plan pays 100% in most instances Plan pays 100% in most instances
No coverage if not within Plan description
Over $2,000 requires preauthorization
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 You pay $100 per day copay ($500 copay maximum per admission) You pay $150 per day copay ($750 copay maximum per admission) You pay $200 per day copay ($1,000 copay per admission) plus 50% co-insurance Mental health and substance abuse: You pay $250 per admission (preauthorization required). You pay $20 copay for physician hospital visits Mental health and substance abuse: You pay $250 copay per admission
Transitional residential recovery services: $100 copay per admission
–Out of hospital You pay $10 copay You pay $20 copay Plan pays 50% of UCR (80% of UCR for covered person under 26 years of age)
You pay remainder of charges
Mental health and substance abuse: You pay $20 Mental health: You pay $25 per visit and $12 for group visits
Substance abuse: $25 per visit for individual therapy; $5 for group
Child immunizations Plan pays 100% up to age 26 No charge No charge
Routine eye exams Provided by Vision Service Plan (VSP). One eye exam every calendar year. VSP provider: $15 copay. Non-VSP provider: Reimbursed up to $45 100% coverage for exam You pay $25 per exam
Eyeglasses/contact lenses Provided by Vision Service Plan (VSP Choice Network). Lenses every calendar year and one pair of frames every other calendar year
VSP: Lenses and/or frames $25 copay; frames covered up to $170
Non-VSP: Frames reimbursed up to $55; lenses reimbursed from $45 to $125
Contact lenses (in lieu of lenses and frames): VSP and non-VSP, reimbursed up to $150
Maximum you will pay for laser eye surgery with a VSP provider: $1,500 per eye for PRK; $1,800 per eye for LASIK; $2,300 per eye for Custom LASIK. Non VSP: No benefit
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 Yes Yes
Convertible to individual policy if under 65 No No No Yes Yes
Convertible to Medicare Supplement or Medicare Advantage at retirement Yes, to USC Senior Care with Medicare Part A and B Yes, with Medicare A and B Yes, with Medicare A and B
(following COBRA)
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.

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