Medical Plans FAQ

General Questions

How much will my plan cost?

You can view your plan costs here:

• Employee plan costs
• Retiree plan costs

Why is my doctor in the lowest cost network of some plans and not others?

Each medical plan carrier contracts with doctors, medical groups, hospitals and other providers. One plan may negotiate a lower rate than another, and so be able to include a doctor or medical group in its lowest cost network while another cannot. That's one of the reasons UC offers a choice of medical plans: to provide the widest choice of doctors and facilities at the lowest cost possible.

Can I have an HSA with an HMO or UC Care?

No, due to IRS regulations, the HSA must be combined with a qualifying high deductible medical plan such as the UC Health Savings Plan.

I have a child in an out-of-state college. What plan would provide the most convenient access to care for him/her?

CORE, UC Care and the UC Health Savings Plan are three convenient plan options for those with children at out-of-state colleges. All three plans allow members to access the nationwide Anthem provider network at the Preferred level of coverage (in-network). This means that once you meet your deductible, the plan pays 80 percent and you pay 20 percent co-insurance for covered services. To find a provider, visit the provider directory.

Where can I find information about coverage of a specific medical procedure?

The detailed benefits summary on each plan's website provides information on specific procedures.

Do all UC plans require that members agree to binding arbitration for malpractice claims? Which, if any, do not have this requirement?

No, not all plans require arbitration. UC-sponsored plans with benefits provided by Optum Health do not require arbitration. However, California state HMO regulations mandate that an HMO medical plan (UC Blue & Gold and Kaiser) disclose to enrollees that the plan requires resolution of disputes through binding arbitration. For more information about each plan’s provisions, please see the appropriate plan booklet or call the plan.

Does my medical plan include behavioral health benefits such as visits to a psychologist or psychiatrist?

Yes, UC’s medical coverage includes behavioral health benefits for mental health services and substance abuse treatment. Here are a few things you should know:

• If you select Kaiser, you may access care from Kaiser behavioral health providers or from Optum in-network providers.
• If you select UC Blue and Gold HMO, you may access care from MHN in-network providers. 
• If you select a PPO plan, you may access care from Anthem Blue Cross in-network providers. You may also access care from out-of-network providers, but your costs will be higher and you may need to pay your provider directly for services and submit a claim for reimbursement.
• Even if you are a member of an HMO plan, you do not need a referral from your primary care provider to see a behavioral health provider. Some services require preauthorization.

Questions About UC Blue & Gold

What is the UC Blue & Gold HMO?

UC Blue & Gold HMO was created exclusively for University of California employees and non-Medicare retirees and their families.

How was the UC Blue & Gold HMO network developed?

The university worked closely with Health Net to establish criteria for the Blue & Gold HMO network. Affordability was a key factor, but other factors included:

• Offering access in all 30 California counties.
• Incorporating the largest possible number of doctors currently caring for UC employees, non-Medicare retirees, and their families into the network.
• Having all the University of California medical groups and centers participate.

Where can I find a full list of available Blue & Gold HMO doctors, medical groups and hospitals?

The complete Blue & Gold HMO network list is online here. You may also visit www.healthnet.com/uc and click ProviderSearch to begin your search. The online information is always the most current; however, you can also call the dedicated Customer Contact Center for UC at 800-539-4072 to get help with choosing doctors or medical groups.

Questions About UC Care

Will UC Care work for me if I don't live near a UC Medical Center?

Yes, in addition to the UC Medical Centers, UC Care's UC Select network tier will include a select group of hand-picked, high-quality providers from the Anthem Blue Cross network in the areas surrounding all UC campuses.

How do I contact the Anthem Health Guide?

The Anthem Health Guide can be reached at 844-437-0486 between 6:30 a.m. and 6 p.m. PST, Monday through Friday.

Is it true that there is no COBRA extension for UC Care, and if so, how does UC Care meet what I believe is a Federal obligation to provide such coverage?

No, this is not true. Federal COBRA for UC Care allows coverage to be continued for up to 18, 29 or 36 months, depending on the qualifying event; however, UC Care enrollees are not able to extend enrollment up to 36 months under CalCOBRA (state law) because CalCOBRA is not available for self-insured plans, including the CORE plan.

Questions About UC Health Savings Plan

What's the difference between an HRA and an HSA?

With an HRA (Health Reimbursement Arrangement), only UC contributes and you can use the balance in the account to pay expenses for you and your family members covered on your medical plan. If you have funds left at the end of the year and remain enrolled in the plan, you can roll them over to the next year, but you can't keep the account if you leave UC.

With an HSA (Health Savings Account), both UC and you can contribute to the account. For 2019, UC will contribute $500 to an individual account and $1,000 to a family account. You can contribute to the account on a regular basis throughout the year up to a set limit. Your contributions are pretax and lower your taxable income. You can use the money in the account to pay eligible medical expenses for you and your eligible tax dependents, and when you withdraw funds for qualified medical expenses, the funds continue to be tax-free. Funds in the account earn interest and carry over at the end of the year. If you leave UC or retire, the account goes with you and you can continue to use the money in it to pay for eligible medical expenses. It's like an FSA without the "use it or lose it" provision and a retirement savings vehicle combined. There are other advantages. Please see our HSA frequently asked questions for further information.

If I enroll in the UC Health Savings Plan can I also enroll in the Health FSA?

No, IRS rules do not allow you to have a health savings account and a flexible spending account.

If I am enrolled in the UC Health Savings Plan, can I use my HSA funds to pay for medical expenses I incur abroad?

Yes, you can use HSA funds to pay for any IRS defined covered medical expenses even if incurred abroad.

Remember, however, the medical coverage component of the plan (the high deductible PPO) covers only emergency and urgent care outside the USA.

If my parent is a tax dependent, can I use HSA money to pay for their care?

Yes, if you claim the parent as a tax dependent, you can use HSA funds to pay for his or her care.

If a spouse is over age 55 but the employee is not, can the employee (under 55) make the $1,000 catch-up contribution?

No. The account holder must be 55 to make the catch-up contribution. However, if the spouse is over 55 and has his or her own HSA, he or she can contribute the catch up to that account.

Non-Medicare retirees in the plan who make deposits into their HSA are not doing so through payroll deduction. Is there any tax benefit for these individuals?

Non-Medicare retirees will submit contributions to Health Equity directly (i.e., not through pension deduction), and the tax benefit would be realized as a tax deduction (write off) at the time they file their taxes.

Does the amount UC or I contribute toward the HSA affect or limit my contribution limits for my IRA or 403b plans?

No. HSA contributions do not reduce the amount you can contribute toward these retirement plans. Remember, however, you cannot be enrolled in the UC Health Flexible Spending Account (administered through WageWorks) and also be enrolled in the UC Health Savings Plan.

How do I contact the Anthem Health Guide?

The Anthem Health Guide can be reached at 844-437-0486 between 6:30 a.m. and 6 p.m. PST, Monday through Friday.

Questions About Via Benefits

Can you confirm that enrollment in Via Benefits does not expose out-of-state retirees to risk of losing their existing Medigap or Medicare Advantage policies as the result of pre-existing conditions? Is this covered by Federal regulation?

All University of California out-of-state retirees using Via Benefits are eligible for the Medicare plan of their choice — either a Medigap policy or a Medicare Advantage plan — as long as they enroll during our special enrollment period, which ends Dec. 31 of the plan year. No one can be denied enrollment based on pre-existing conditions during this time. However, going forward, if a retiree wants to change plans, Medicare rules limit the plan and cost options for retirees who do not have “guaranteed issue” rights. Medigap insurance companies are generally allowed to increase the cost a retiree pays based on medical underwriting for the Medigap policy and may, in some instances, be allowed to deny the retiree’s plan application. On the other hand, Medicare Advantage plans typically do not deny coverage in these situations.

Contact Medicare for confirmation based on individual circumstances.

Have any out-of-state UC retirees reported such a situation?

No — see above.

If I enroll in a Medigap plan now with Extend Health at my current residence, but later move to another state, are my wife and I subject to medical underwriting? Could we be denied Medigap Insurance?

Per the Medicare.gov website, you can keep your current Medigap policy regardless of where you live as long as you still have Original Medicare. However, if you want to switch to a different Medigap policy, you'll have to check with your current or the new insurance company to see if they will offer you a different Medigap policy. In most cases, you won't have a right under Federal law to switch Medigap policies, unless you're eligible under a specific circumstance or guaranteed issue rights. Contact Medicare for confirmation based on individual circumstances.