Health Maintenance Organizations (HMOs)
USC offers two types of Health Maintenance Organizations (HMO): a staff model (Kaiser Permanente) and an Independent Practice Association (IPA) group model (Anthem Blue Cross HMO). Generally, a staff model HMO owns its own facilities and employs physicians (Kaiser contracts with Permanente Medical Group). In a Group or IPA model HMO, the HMO contracts with private health care providers to provide services to plan members. Benefits are payable based on services and charges authorized by an HMO-affiliated doctor or representative.
For all HMO plans offered by USC, you will pay a copayment at the time of service, then you are covered at 100% of authorized services (no deductibles).
Kaiser Permanente (Group No. 101728-0000)
Kaiser Permanente health care providers dispense services exclusively to Kaiser plan members. Participants can select any Kaiser doctor at any Kaiser facility. You must receive services from Kaiser, or obtain authorization from Kaiser before obtaining care outside the HMO.
Kaiser facilities are located throughout Southern California. A list of their locations is available on the Kaiser website. To enroll in Kaiser, you must reside within their service area.
You pay $15 per generic prescription and $30 per brand name prescription for up to a 30-day supply at Kaiser Permanente pharmacies.
You pay a $25 copayment for routine eye exams. Optical eyewear is not covered. Coverage for vision care services is provided only at Kaiser facilities. Participants may purchase additional vision care through the Vision Service Plan.
Anthem Blue Cross HMO (Group No. 175082 H001)
Upon enrollment, participants in this HMO select a primary care physician for each covered family member from Anthem Blue Cross HMO's list of affiliated physicians. You must see your primary care physician for a referral to any other Anthem Blue Cross HMO physician, and obtain authorization before seeking care outside the HMO.
Doctors and affiliated healthcare providers are located throughout the greater Los Angeles area. Hospitalization coverage is provided through Anthem Blue Cross HMO-contracted hospitals affiliated with your physician group.
A directory of the affiliated doctors is available on the Anthem Blue Cross HMO website or from the benefits office. You must reside within Anthem Blue Cross HMO's service area in order to enroll.
Your copayment is $10 per prescription for generic drugs, $25 per prescription for brand name formulary drugs and 45% of the cost for brand name non-formulary drugs at participating pharmacies. You can find a participating pharmacy near you on the Anthem Blue Cross HMO website or by calling (800) 235-8631.
You pay a $20 copayment for routine eye exams. No coverage for corrective lenses or frames. Participants may purchase additional vision care through the Vision Service Plan.