University of Southern California

Medical

Health care coverage that meets your needs is one of the most important benefits offered to you by the university, as it pays for many of the costs of medical care for you and your family. You can choose from two types of medical plans: our preferred provider organization (PPO), the USC Network Medical Plan; or a health maintenance organization (HMO). The USC Network Medical Plan offers the most flexibility in your choice of health care providers. Information on finding providers is available on the USC Network page and directly from Anthem Blue Cross. The HMOs (CaliforniaCare, Kaiser Permanente, and UnitedHealthcare SignatureValue HMO) place limits on your choice of health care providers.

For a detailed comparison of the benefit schedules of the four medical plans, see Comparison of medical coverage. For additional help in choosing your medical and vision coverage, visit the websites of the health plans or pick up detailed brochures about each plan from Benefits. You may wish to use those resources to compare the availability of physicians or physician groups in your area before choosing a health plan. Once you have chosen your health plan, customer service representatives from your health plan are available by telephone to answer your questions.

Prescription drug coverage is included in all plans. Vision care is provided as part of the USC Network Medical Plan and as an optional add-on to the HMO plans, which do include routine vision care but may not cover corrective or contact lenses.

In the USC Network Medical Plan, USC has arranged for charges to be discounted with hospitals, physician groups, and pharmacies throughout the U.S. Generally, the plan allows you to designate any primary care provider who participates in our network and who is available to accept you or your family members. You may designate a pediatrician as the primary care physician for a child. For information on how to select a primary care provider, and for a list of participating primary care providers, contact USC Health Plans.

USC's HMO choices include a "staff model" (Kaiser Permanente) which owns its own facilities and employs physicians (Kaiser contracts with Permanente Medical Group). The other two HMOs (CaliforniaCare and UnitedHealthcare SignatureValue HMO) are "Independent Practice Association (IPA) Group Models." In a Group or IPA model, 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, a copayment is required at the time service, then coverage is provided at 100% of authorized services.

The HMOs generally require you to designate a primary care provider from their network who is available to accept you or your family members. You may designate a pediatrician as the primary care physician for a child. For information on how to select a primary care provider, and for a list of participating primary care providers, contact your HMO plan.

None of the plans require prior authorization to access obstetrical or gynecological care from a participating health care professional who specializes in obstetrics or gynecology. The health care professional may, however, be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact your medical plan.

Cancer Expense Protection

This insurance from AFLAC provides direct cash payments to the insured who is diagnosed with cancer. It also pays for several types of expenses associated with cancer treatment. These benefits are paid regardless of any other insurance you may have. You can enroll in this program at any time. For more information, contact Benefits.

Long Term Care

Not to be confused with disability insurance, which pays a portion of your salary should you become disabled, long term care insurance provides additional coverage intended to complement your health care plan. Long term care insurance provides benefits for extended care resulting from long-term, chronic illnesses or injuries that Medicare or MediCal and USC's health care plans are not designed to cover. It reimburses charges for covered in-home and facility care (up to the benefit maximums you select). These services can be extremely costly. For example, the national average cost of a nursing home private room now averages approximately $77,000 per year, and basic home health services can cost nearly $21 per hour.

As of spring 2012, USC's long term care insurance program is available through Genworth Financial. (If you are a participant with the former provider, John Hancock, you can contact them directly at (888) 524-6167.)

Visit the Genworth site at www.genworth.com/groupltc using the group name USC and the access code groupltc to log in.

Opting Out—USC's Plan C

If you already have primary medical coverage under another medical plan, you may choose our no-cost "opt out" program, Plan C, instead of enrolling in a USC medical plan. Frequently, benefits-eligible employees who have medical coverage through their spouse's employer choose Plan C for additional vision, dental and prescription reimbursement coverage as well as additional life and accident insurance. Plan C also is available to spouses or registered domestic partners who both work at USC—one can enroll in a university-sponsored medical plan and include dependent coverage; the other can choose Plan C, which includes the following free benefits:

• Reimbursement for prescription drug co-payments or for 50% of prescription costs if your medical insurance does not provide prescription drug coverage, up to $5,000 per calendar year
• Vision Service Plan coverage for you and your eligible dependents
• Dental coverage for you and your dependents
• $50,000 basic term life insurance coverage for you
• $100,000 Accidental Death and Dismemberment insurance coverage for you and your dependents
• AXA emergency travel assistance program for you and your dependents

You must show proof of your other medical coverage. Like all medical and dental plans, Plan C may only be selected during initial benefits enrollment, during open enrollment, or within 30 days of a qualifying life event. For more information, contact Benefits.