Comparison of Medical Coverage   next page»
  USC Network Medical Plan CaliforniaCare Kaiser Permanente PacifiCare
  USC Faculty/Facilities (Blue Cross for Children under 19 years of age) Blue Cross Prudent Buyer Providers Non-Network  
Annual Deductible None None None None None None
Annual Out of Pocket
    Maximum—Individual
    Maximum—Family
$1,000
$3,000 (100% thereafter)
$2,500
$7,500 (100% thereafter)
$10,000
$30,000 (100% of UCR thereafter)
$1,000
$3,000
$1,500
$3,000
$1,500
$3,000
Lifetime Maximum Benefit $2,500,000 Not applicable Not applicable Not applicable
Office Visits Plan pays 90%
You pay 10%		 Plan pays 80%
You pay 20%		 Plan pays 50% of UCR
You pay remainder of charges		 You pay $15 You pay $15 You pay $15
Preventive Care* Plan pays 100% only for first annual screenings Plan pays 100% Plan pays 100% Plan pays 100%
Prescription Drugs

If prescription is filled at a Network pharmacy, your co-pay is:

  • 15% of cost, with a minimum of $5 for generic
  • 20% of cost, with a minimum of $20 for brand (when no generic available)
  • 40% of cost for brand when generic available

Mail service available for lower co-pays on maintenance medications

 If filled at a non-Network pharmacy, the Plan will reimburse 50% of Plan's RxAmerica contracted rate. You pay $10 per prescription for generic drugs and $20 per prescription for brand name formulary drugs and $40 for brand name non-formulary drugs at participating pharmacies You pay $10 per prescription for generic drugs and $20 per prescription for brand name drugs (up to 100-day supply) at Kaiser Permanente pharmacy You pay $10 for generic drugs and $20 for brand name drugs at participating pharmacies (30-day supply)
Self-Injectable Medication—$50 co-pay for a 30-day supply or prescribed course of treatment (whichever is shorter)
Maternity (Doctor only) Plan pays 90%
You pay 10%		 Plan pays 80%
You pay 20%		 Plan pays 50% of UCR
You pay remainder of charges		 You pay $15 per office visit** Plan pays 100% Pre-Natal Care and First Post-Partum You pay $15 per office visit**
Well Baby Care Plan pays 100% newborn exam and circumcision at hospital You pay $15 per office visit Plan pays 100% coverage for first 23 months of life Plan pays 100% coverage for first 23 months of life
You pay $15 if child is ill at time of visit
Plan pays 90% per office visit
You pay 10% per office visit
 Plan pays 90% per office visit
You pay 10% per office visit
 Plan pays 50% of UCR per office visit
You pay remainder of charges
Emergency Care You pay $75 co-payment, waived if directly admitted to hospital $75 co-payment and any charges above 100% of UCR You pay $50 co-payment, waived if directly admitted to hospital You pay $75 co-payment, waived if directly admitted to hospital You pay $50 co-payment, waived if directly admitted to hospital
Ambulance
(Ground)		 Not available Plan pays 80% if true Emergency
You pay 20%		 Plan pays 80% of UCR if true Emergency
You pay remainder of charges		 Plan pays 100% Plan pays 100% Plan pays 100%
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 $100 co-pay per day ($500 co-pay maximum per admission) You pay $150 co-pay per day ($750 co-pay maximum per admission) You pay $200 co-pay per day ($1,000 per admission plus 50% co-insurance) You pay $100 co-pay per admission You pay $100 co-pay per admission You pay $100 co-pay per admission
    Skilled Nursing Facility Not available You pay $150 per day co-pay ($750 co-pay maximum per admission), limited to 60 days per calendar year regardless of cause You pay $200 per day co-pay ($1,000 co-pay maximum per admission plus 50% of remainder of charges) Plan pays 50% of UCR limited to 60 days per calendar year regardless of cause You pay $100 co-pay per admission
Plan pays 100%, up to 100 days per calendar year		 You pay $100 co-pay per admission
Plan pays 100%, up to 100 days per calendar year		 You pay $100 co-pay per admission
Plan pays 100%, up to 100 consecutive calendar days from first treatment per disability
    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 No charge
UCR=Usual, customary and reasonable charges.
*Includes certain childhood immunizations, adult screenings and certain adult immunizations		 **Healthcare Partners Medical Group does not deliver at Huntington Memorial Hospital.
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