Medical Coverage

What to Know

Medical coverage is administered through Anthem Blue Cross and includes coverage for important services such as preventive care, doctor’s office visits, hospitalization and prescription drugs.

Anthem Blue Cross PPO (All Campuses)

Your medical and behavioral health benefits are provided through the Anthem Blue Cross PPO (preferred provider organization) plan. All campuses, except UCSF, pay no monthly premiums for this coverage; UC pays the entire premium cost.

The Anthem PPO plan allows you to get care from any doctor, hospital or provider you want. But you’ll usually pay less out of pocket when you see a UC Health provider or one of the more than 60,000 providers in the statewide Anthem Blue Cross Prudent Buyer (PPO) network.

UCSF Pays Monthly Premium

For UC San Francisco residents and fellows, you will pay a small monthly cost to enroll yourself and any eligible dependents in the Anthem PPO plan.

Plan Highlights

The Anthem PPO plan features include:

No-cost in-network preventive care for you and all enrolled family members through UC Health centers and Anthem providers. There’s no deductible or out-of-pocket cost for preventive screenings and lab tests recommended by Anthem based on your age and gender.

Coverage for other types of care, including doctor’s office visits, hospitalization, behavioral health services and prescription drugs, when you see an Anthem provider. Each year, you have to meet an annual deductible ($100 for individual / $200 for family coverage) before the plan begins to share in the cost of covered services. There’s no deductible for services received at a UC Health center.

Behavioral health benefits for mental health services and substance abuse treatment. You and your covered family members can use behavioral health benefits for sessions with counselors, psychologists or psychiatrists to address issues such as:

  • Depression and anxiety
  • Alcohol or drug abuse
  • Eating disorders
  • Medication management
  • Autism and pervasive developmental disorders

You’re protected for the worst-case scenario. The health plan protects your physical health, while the out-of-pocket maximum limits your financial liability for covered expenses.

  • After you meet the out-of-pocket maximum ($1,000 for individual / $2,000 for family, which includes the deductible), Anthem pays 100% for most covered services, including prescription drugs, for the remainder of the benefit year.
  • If you’re enrolled in family coverage, you must meet the family out-of-pocket maximum before Anthem will pay 100% of expenses.
  • In-network expenses count toward the out-of-network out-of-pocket maximum, but out-of-network expenses do not count toward the in-network out-of-pocket maximum.
  • Benefit year runs from July 1 through June 30 of each year.

What You Pay for Care Under the Anthem PPO Plan

What you pay for care depends on where you get care.

You’re protected by the out-of-pocket maximum, which is essentially a year-long safety net for the worst-case scenario. Once you reach the maximum, the plan pays 100% of covered services for the rest of the benefit year.

Tier 1: UC Health Center Providers
You Pay
Benefit-Year Deductible²
$0
$1,000 Individual
$2,000 Family
$0
Doctor, Specialist and Therapist Office Visits
$15 copayment
Urgent Care Visits
$15 copayment
Emergency Room Visits
$0
Inpatient Hospitalization⁴
$250 copayment
Outpatient Surgery at a Hospital or Ambulatory Surgical Center
($350 maximum allowance for out-of-network providers)
$0
  1. In addition to any deductible and coinsurance, you are responsible for any billed charge that exceeds Anthem’s maximum allowed amount for services provided by an out-of-network provider. For outpatient non-emergency services or surgery at an out-of-network facility or ambulatory surgical center, the maximum plan payment amount is $350 per day. For inpatient non-emergency services at an out-of-network facility, the maximum plan payment amount is $600 per day.
  2. In-network and out-of-network benefit-year deductibles are separate — what you pay toward one doesn’t count toward the other. UC Health Center deductibles apply to the Anthem PPO in-network deductible. The deductible and out-of-pocket maximum reset every year on July 1.
  3. Not all services provided during a preventive care visit are considered preventive health benefits. For more information about what services are covered, go to anthem.com/ca.
  4. An additional copayment of $250 applies if you do not receive preauthorization for non-network providers.
Tier 2: Anthem PPO Network Providers
You Pay
Benefit-Year Deductible²
$100 Individual
$200 Family
$1,000 Individual
$2,000 Family
$0
Doctor, Specialist and Therapist Office Visits
$15 copayment
Virtual Care (LiveHealth Online)
$15 per visit
Virtual Care (LiveHealth Online Psychology)
$15 per visit
Urgent Care Visits
$15 copayment
Emergency Room Visits
$100 copayment
(waived if admitted)
Inpatient Hospitalization⁴
10%
Outpatient Surgery at a Hospital or Ambulatory Surgical Center
($350 maximum allowance for out-of-network providers)
10%
  1. In addition to any deductible and coinsurance, you are responsible for any billed charge that exceeds Anthem’s maximum allowed amount for services provided by an out-of-network provider. For outpatient non-emergency services or surgery at an out-of-network facility or ambulatory surgical center, the maximum plan payment amount is $350 per day. For inpatient non-emergency services at an out-of-network facility, the maximum plan payment amount is $600 per day.
  2. In-network and out-of-network benefit-year deductibles are separate — what you pay toward one doesn’t count toward the other. UC Health Center deductibles apply to the Anthem PPO in-network deductible. The deductible and out-of-pocket maximum reset every year on July 1.
  3. Not all services provided during a preventive care visit are considered preventive health benefits. For more information about what services are covered, go to anthem.com/ca.
  4. An additional copayment of $250 applies if you do not receive preauthorization for non-network providers.
Tier 3: From an Out-of-Network Provider1
You Pay
Benefit-Year Deductible²
$200 Individual
$500 Family
$2,000 Individual
$4,000Family
$0
Doctor, Specialist and Therapist Office Visits
30%
Virtual Care (LiveHealth Online)
Not applicable
Virtual Care (LiveHealth Online Psychology)
Not applicable
Urgent Care Visits
30%
Emergency Room Visits
$100 copayment
(waived if admitted)
Inpatient Hospitalization⁴
30%
Outpatient Surgery at a Hospital or Ambulatory Surgical Center
($350 maximum allowance for out-of-network providers)
30%
  1. In addition to any deductible and coinsurance, you are responsible for any billed charge that exceeds Anthem’s maximum allowed amount for services provided by an out-of-network provider. For outpatient non-emergency services or surgery at an out-of-network facility or ambulatory surgical center, the maximum plan payment amount is $350 per day. For inpatient non-emergency services at an out-of-network facility, the maximum plan payment amount is $600 per day.
  2. In-network and out-of-network benefit-year deductibles are separate — what you pay toward one doesn’t count toward the other. UC Health Center deductibles apply to the Anthem PPO in-network deductible. The deductible and out-of-pocket maximum reset every year on July 1.
  3. Not all services provided during a preventive care visit are considered preventive health benefits. For more information about what services are covered, go to anthem.com/ca.
  4. An additional copayment of $250 applies if you do not receive preauthorization for non-network providers.

Anthem Blue Cross HMO (UCSF, UCSD, UCR Only)

You must be a UC resident or clinical fellow at UC San Francisco, UC San Diego or UC Riverside to enroll in the Anthem Blue Cross HMO.

You choose a primary care physician (PCP) from a UC Health center or the Anthem Blue Cross HMO network, and your PCP coordinates all your care, including behavioral health.

 

Plan Highlights

  • Except for emergencies, only care received from UC Health or Anthem HMO providers (also must be at Anthem HMO facilities) is covered at the in-network level.
  • There’s no deductible. For most services, you pay a small copayment, and the plan pays the rest.
  • If you have covered dependents living outside of California, you might want to consider the PPO, because the HMO typically doesn’t cover care received outside the HMO.

Choosing a Primary Care Physician

If you enroll in the Anthem HMO plan, you must choose an Anthem primary care physician (PCP) to coordinate your care.

Follow these steps:

  1. Visit anthem.com/ca, click on Find a Doctor under the Employers tab.
  2. Scroll to Search as a Guest by Selecting a Plan, and click Continue.
    • Select Medical as the type of care you want and California for the State.
    • Choose Medical (Employer-Sponsored) as the type of plan you want to search, and then choose Blue Cross HMO (CACare) – Large Group as the plan/network. Click Continue.
    • Choose Doctor/Medical Professional for your selection. Then select Family/General Practice.
  3. Enter your ZIP code, and choose a distance preference, then click Search.
  4. Select a physician, and copy the 3- or 6-digit Primary Medical Group/Primary Care Physician code, located under the physician’s name.
  5. Call the customer service number on the back of your ID card, and give them your PCP information.

If you don’t select a PCP, you’ll automatically be assigned one. But you can change your PCP at any time.

What You Pay for Care Under the Anthem HMO Plan

You can choose to receive care from a UC Health Center or Anthem HMO doctors, hospitals and other providers. Except for emergencies, no care is covered from non-UC Health Center or Anthem HMO providers. UC pays the entire monthly premiums for the Anthem HMO.

UC Health and Anthem HMO Providers/Facilities Only
You Pay
Benefit-Year Deductible
$0
$1,500 Individual
$2,500 Family
$0
Doctor, Specialist and Therapist Office Visits
$10 copayment
Virtual Care (LiveHealth Online)
$10 per visit
Virtual Care (LiveHealth Online Psychology)
$10 per visit
Urgent Care Visits
$10 copayment
Emergency Room Visits
$100 copayment (waived if admitted)
Inpatient Hospitalization*
$0
Outpatient Surgery at a Hospital or Ambulatory Surgical Center
($350 maximum allowance for out-of-network providers)
$0

* An additional copayment of $250 applies if you do not receive preauthorization for non-network providers.

Provider Contact Information

Graduate Medical Education Office

Anthem Blue Cross

Group Number: 281636
PPO members: (833) 674-9256, Monday through Friday, 8 a.m. to 8 p.m. PT
HMO members: (833) 674-9257, Monday through Friday, 8 a.m. to 8 p.m. PT
First Impressions (for first-time PPO and HMO plan members): (888) 831-2238
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