Monthly Employee Contributions for 2013
|USC Network Medical Plan
|Employee + Adult:|| ||$339.00
|Employee + Child(ren):|| ||$211.00
|Employee + Adult + Child(ren): || ||$339.00
Keck Medical Center of USC — UPC
Effective January 3, 2013 Covered Persons under the USC Network Medical Plan will be able to access care from USC Care Medical Group doctors at the new Engemann Student Health Center, fourth floor on the University Park Campus. Please call (323) 442-5100 to make an appointment with a USC Care Medical Group doctor at this location.
The Doctors of USC — Downtown
333 S. Hope St., Suite C-145
The The Doctors of USC — Downtown clinic is located in downtown Los Angeles. Faculty, Staff and their covered dependents can be seen at this site between the hours of 9:00 a.m. and 5:00 p.m., Monday through Friday. The The Doctors of USC — Downtown is located at:
Los Angeles, CA 90017
Please call (213) 437-1000 to schedule an appointment.
Tier 2 Participating Providers - Nationwide Coverage
You have access to participating providers nationwide. What this means to you is that you are able to access a larger network of contracted physicians and hospitals within the state of California and across the United States (with the exception of vision and dental providers) and have benefits calculated at a negotiated contract rate.
You may look up participating providers throughout the U.S. at the Anthem website at www.anthem.com/ca. You can also call Anthem Blue Cross for assistance at (800) 810-2583, 24 hours a day, seven days a week. When making an appointment with any participating provider, you must verify with their office that the provider continues to participate either in Prudent Buyer (for California providers) or BlueCard program (all other U.S. participating providers). Otherwise, benefits will be calculated at the non-contracted Network level if they no longer participate.
Network Referral to Non-Network Provider
If your Network Physician refers you to another physician or health care provider, it is your responsibility to verify that the physician or other provider is also a Network provider. If the physician or other provider is not a Network provider, benefits will be paid at the out-of-Network rate.
Pharmacy benefits for the USC Network Medical Plan are managed by CVS Caremark.
Prescription Copay Information
The retail Copayment for prescription drugs filled at a Network pharmacy for each 30 day supply is:
Generics - $10 Copay
Brand with no Generic available - 20% of the cost, with a minimum Copay of $30.00. Maximum Copay of $125 per prescription.
Brand with Generic available - 50% of the cost with a minimum Copay of $30.00 - No Maximum Copay.
Specialty Drugs - $200 Copay (for a current list of Specialty Drugs, click here)
The Plan has a mandatory Step Therapy in place for Proton Pump Inhibitors (PPI) and Antihistamines. What this means is that you must first fill a generic/over the counter (OTC) medication at a $0 Copay before a Brand name prescription under these two categories will be covered by the Plan. The following is a list of the generic/OTC medications that are covered at $0 copay with a written prescription from your doctor:
PPIs: omeprazole, omeprazole OTC, omeprazole-sodium bicarbonate, pantoprazole, lansoprazole, Prevacid OTC, Prilosec OTC, and Zegerid OTC
Antihistamines: cetirizine, cetirizine OTC, fexofenadine-pseudoephedrine, levocetirizine, loratadine OTC, Alavert, Alavert-D, Claritin OTC, Claritin-D 12 HR, and Zyrtec OTC.
For maintenance medications dispensed in excess of a one month's supply at a retail pharmacy, multiple copayments will be charged.
A Mail Service is available for maintenance drugs through which you can obtain up to a 90 day supply of medication, as long as your physician has written the prescription for a 90 day supply. The above retail Copay also applies to each 30 day supply of medication purchased through mail order.
For more information about Mail Service, please see www.caremark.com or call CVS Caremark at (877)889-3402.
CVS Caremark Pharmacies: USC Pharmacy, USC Medical Plaza Pharmacy, CVS, Rite Aid, Wal-Mart, Vons, Walgreens, Albertsons, Payless Drugs, Costco, and other small independent pharmacies. Please call (877)807-7341 to verify the participation of a pharmacy.
If you have any questions regarding pharmacies or outstanding prescription claims previously submitted by you, please call CVS Caremark at (877)807-7341.
For prescriptions filled at a non-Network pharmacy, the Plan will reimburse 50% of the Plan's CVS Caremark contracted rate (not 50% of cost). Prescriptions filled at a non-Network pharmacy must be paid in full by the Covered Person at the time of service. The Covered Person must then submit a prescription claim form to CVS Caremark within 60 days of the fill to get reimbursed 50% of the Plan's contracted rate.
If you have prescription claims that need to be submitted for reimbursement, please forward them within 60 days of the fill to: Commercial Paper Claims, CVS Caremark, P.O. Box 53992, Phoenix, AZ 85072-3992.
Medical Claims Information
All inquiries regarding Explanation of Benefit correspondence or any medical bill in question should be directed to HealthComp at (855) 727-5267, Monday-Friday, 6:00 a.m. -- 4:30 p.m. You can also view your paid claims information on HealthComp's web site at www.healthcomp.com. You must first register on their site as a member before you will be allowed to view your information.
All medical claim forms, bills and receipts that require reimbursement to the Patient should be forwarded to:
P.O. Box 45018
Fresno, CA 93718-5018
Medical claim forms for submission to HealthComp can be downloaded at www.healthcomp.com.
USC Network Medical Plan ID cards are issued and mailed by HealthComp. ID cards are mailed to your home address in a USC envelope with large words written across the envelope, "USC Network Medical Plan ID Card Enclosed." HealthComp automatically sends a maximum of two (2) ID cards to subscribers with family coverage. If you have family coverage and need an extra ID card, you may request an additional card by logging into the HealthComp website at www.healthcomp.com or you can call HealthComp at (855) 727-5267 for assistance. It may take up to two (2) weeks from the day you place your request to receive the ID card.
You have access to a network of mental health and substance abuse treatment providers. Anthem Blue Cross Prudent Buyer mental health providers in California and Anthem BlueCard providers in all other states will be providing services to all our participants at the Tier 2 benefit level. You can search for providers at www.anthem.com/ca. You can access Tier 1 providers from USC Care Medical Group. You can search for these providers at www.doctorsofusc.com.
Inpatient admissions, partial hospital (day treatment), residential treatment center and intensive outpatient visits require prior authorization and Anthem Blue Cross should be contacted at (800) 274-7767.
For benefit questions or concerns, please call HealthComp at (855) 727-5267.
Vision Service Plan
Employees enrolled in the USC Network Medical Plan are automatically enrolled in Vision Service Plan (VSP) Choice Network. You can verify your eligibility, plan coverage and other information by accessing the VSP website at www.vsp.com. You must enter your USC Network Medical Plan Subscriber ID number (which can be located on the front of your Plan ID card) on their web site instead of your social security number to view your coverage. You can also call VSP at (800) 877-7195 for assistance.