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| Comparison of Medical Coverage (continued) « previous 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 | ||||
| Outpatient Surgery | Facility: You pay $100 co-pay | You pay $150 co-pay | You pay $200 co-pay; Plan pays 50% of UCR up to $2,700 You pay remainder of charges |
You pay $100 co-pay | You pay $15 co-pay | You pay $50 co-pay |
| Doctor: 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 | |
| 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 | Plan pays 100%, Autologous (self-donated) blood up to $120/unit |
| Authorized Home Health Care |
Not available | Plan pays 80%, up to 100 visits per person each year You pay 20% |
Plan pays 50% of UCR, up to 100 visits per person each year |
You pay $15 per visit (Limited to 3 two hour visits) You pay remainder of charges |
You pay $15 per visit | You pay $15 per visit Limited to 100 visits per calendar year |
| Durable Medical Equipment |
Not available | Plan pays 80%, You pay 20%; no coverage if not within Plan description; Over $2,000 requires pre-authorization | Plan pays 50% of UCR; You pay remainder of charges. No coverage if not within Plan description and no prescription; Over $2,000 requires pre-authorization | Plan pays 100% in most instances, up to $2,000 each calendar year | Plan pays 100% in most instances | Plan pays 100% in most instances Limited to $5,000 annual maximum per calendar year |
| Hospice Care | $20,000 combined maximum lifetime benefit | Plan pays 100% | Plan pays 100% | Plan pays 100% with 180-day Lifetime maximum | ||
| Mental Health/ Substance Abuse |
Mental Health: You pay $100 a day for hospital, for up to 30 days; $35 a day for doctor Substance Abuse: Detox only: You pay $100 a day |
Mental Health: $100 co-pay per admission; up to 45 days/year MH Parity: $0 visit; No visit limit Substance Abuse: $100 co-pay per admission up to 60 days per year. Not to exceed 120 days within 5 years. |
Mental Health: $100 co-pay per admission, not to exceed 30 days Substance Abuse: IP/OP combined max. lifetime benefit of $35,000 SA Rehab.: 1 treatment per year Detox only: 100% |
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| —In Hospital | 90 days paid at 90% | 90 days paid at 80% | No coverage | |||
| Substance Abuse rehabilitation treatment is limited to four (4) courses, whether inpatient or outpatient, per lifetime. | No coverage | |||||
| —Out of Hospital | 64 visits paid at 90% | 64 visits paid at 80% | 40 visits paid at 50% of UCR For children under 19, visits are paid at 90% of UCR |
Mental Health: You pay $35 per visit for up to 20 visits each 12 month period Substance Abuse: No coverage |
Mental Health: You pay $15 per visit for up to 20 visits per year MH Parity: $15 visit; No visit limit Substance Abuse: $15 per visit for individual therapy; $5 for group therapy |
Mental Health: $35 co-pay up to 20 visits for crisis intervention per calendar year Substance Abuse: IP/OP combined max. lifetime benefit of $35,000 Detox only: 100% |
| Child Immunizations | Plan pays 100% through age 18 | You pay $15 per office visit | You pay $15 per office visit | You pay $15 per office visit | ||
| Routine Eye Exams | Provided by Vision Service Plan (VSP). One eye exam every calendar year. VSP provider: $10 co-pay, Non-VSP provider: Reimbursed up to $40 |
You pay $15 per exam | You pay $15 per exam | You pay $15 per exam | ||
| Eyeglasses/ Contact Lenses |
Provided by Vision Service Plan (VSP). One pair of frames every 24 months and lenses every calendar year. VSP: Frames and/or lenses—$25 co-pay. Non-VSP: Frames reimbursed up to $45, Lenses reimbursed up to $125. Contact lenses: VSP and non-VSP, reimbursed up to $105. |
None | $125 allowance every 24 months for eyewear purchased from Kaiser optical | None | ||
| Coverage in Foreign Countries |
Yes | Yes | Yes | Yes, full coverage for emergencies, subject to co-pays | Yes, full coverage for emergencies, subject to co-pays | Yes, full coverage for emergencies, subject to co-pays |
| Coordination with Other Plans |
Yes | Yes | Yes | Yes | Yes | Yes |
| Convertible to Individual Policy if under 65† |
No | No | No | Yes | Yes | Yes |
| Convertible to Medicare Supplement or Medicare Advantage at Retirement | Yes, to USC Senior Care or other plans with Medicare Part A and B | Yes, with Medicare A and B | Yes, with Medicare A and B | Yes, with Medicare A and B | ||
| †(following COBRA) | ||||||
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