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What You Pay for Care

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

  Tier 1
UC Medical Center providers
Tier 2
From an Anthem PPO Network Provider
Tier 3
From an Out-of-Network Provider1
Benefit-Year Deductible2

$0

$100 Individual

$200 Family

$200 Individual

$500 Family

Benefit-Year Out-of-Pocket Maximum

$1,000 Individual

$2,000 Family

$1,000 Individual

$2,000 Family

$2,000 Individual

$4,000 Family

Preventive Care3

$0

$0

$0

Doctor, Specialist and Therapist Office Visits

$15 copayment

$15 copayment

30%

Virtual Care (LiveHealth Online) Not applicable $15 per visit Not applicable
Virtual Care (LiveHealth Online Psychology) Not applicable $15 per visit Not applicable

Urgent Care Visits

$15 copayment

$15 copayment

30%

Emergency Room Visits

$0

$100 copayment
(waived if admitted)

$100 copayment
(waived if admitted)

Inpatient Hospitalization4

$250 copayment

10%

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, the maximum plan payment amount is $350 per day. For outpatient surgery at an out-of-network 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 Medical 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 copay of $250 applies if you do not receive preauthorization for non-network providers.

Emergency Room Billing

Most emergency rooms are in-network, meaning they have a contract with Anthem. In rare cases, you may need to get care in an out-of-network emergency room (ER). If you get a bill for an out-of-network ER visit, before paying it, call Anthem Health Guide toll-free at (833) 674-9256. They can help you understand your responsibility and advocate on your behalf for a lower bill.