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Medical and Pharmacy

Your medical, pharmacy and behavioral health benefits are provided by Western Health Advantage HMO (health maintenance organization). You choose a primary care physician (PCP) from a UC Medical Center (UCMC) or the Western Health Advantage HMO network who coordinates your care. Except for emergencies, only care received from Western Health Advantage HMO doctors and facilities is covered. UC pays the entire cost of coverage. You pay only the out-of-pocket costs for the care you receive.

  Western Health Advantage Network Provider
Deductible $0 Individual
$0 Family
Annual out-of-pocket maximum $1,500 Individual
$2,500 Family
Lifetime maximum benefit Unlimited
Office visit copay $20
Annual preventive exam No charge
Specialist visit copay $20
Inpatient hospitalization No charge
Outpatient surgery (office setting) $20 copay
Emergency room copay $100 (waived if admitted)
Diagnostic X-ray/lab No charge
Complex imaging No charge
Prosthetic devices $20 copayment
Mental health and substance abuse Inpatient physician: No charge
Office visit: $20 copay
Prescription drugs $10 for Tier 1—typically generic
$30 for Tier 2—typically brand
$50 for Tier 3—typically non-preferred brand
20% ($100 max) for Tier 4—typically specialty drugs
Mail order drugs (90-day supply) 2.5x Retail

Learn more.