Health Maintenance Organization Plans
USC offers two types of Health Maintenance Organizations (HMO): a staff model (Kaiser Permanente) and an Independent Practice Association (IPA) Group Model (CaliforniaCare and PacifiCare). 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, coverage is subject to a co-payment at the time of service and then covered at 100% of authorized services.
Prescription Coverage
Your co-payment is $10 per prescription for generic drugs and $20 per prescription for brand name drugs at participating pharmacies. You can find a participating pharmacy near you on the CaliforniaCare Web site or by calling (800) 235-8631.
Vision Care
CaliforniaCare covers routine eye exams with a $15 co-payment, but provides no coverage for corrective lenses or frames. Participants may purchase additional vision care through the Vision Service Plan.
The Kaiser Permanente HMO provides coverage of medical services. With Kaiser, you pay co-payments but no deductibles. The 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 Web site. To enroll in Kaiser, you must reside within the service area of Kaiser Permanente.
Prescription Coverage
You pay $10 per generic prescription and $20 per brand name prescription at Kaiser Permanente pharmacies.
Vision Care
Kaiser Permanente covers routine eye exams with a $15 co-payment. Kaiser will provide a $125 allowance every 24 months for eyeglasses and contact lenses. Coverage for vision care services is provided only at Kaiser facilities. Participants may purchase additional coverage through the Vision Service Plan.
The PacifiCare HMO provides coverage of medical services. With PacifiCare, you pay co-payments but no deductibles. Participants in this health plan must select a primary care physician for each covered family member from PacifiCare's list of affiliated physicians when they enroll. You must see your primary care physician for a referral to any other PacifiCare 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 PacifiCare contracted hospitals affiliated with your physician group. A directory of the affiliated doctors is available on the PacifiCare Web site or from your benefits office. You must reside within PacifiCare's service area in order to enroll.
Prescription Coverage
You pay $10 per generic prescription and $20 for brand name prescriptions at participating pharmacies. You can find a participating pharmacy near you on the PacifiCare Web site or by calling (800) 624-8822.
Vision Care
PacifiCare covers routine eye exams with a $15 co-payment, but provides no coverage for corrective lenses or frames. Participants may purchase additional vision care through the Vision Service Plan.
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