UC Care PPO

• Monthly premiums will increase. ALEX is the best resource to understand your specific costs.
• Accolade is becoming Transcarent, with a new app, tools and features to help you understand benefits, find care and get answers to health care questions. Usernames, passwords, and all Accolade information and support history will carry over to the new app, and the same phone number will remain available for help. 
• Behavioral health office visits with Tier 1 providers will continue to have a $30 copay. Tier 2 providers will be 30% coinsurance, up to a maximum of $30. Next year, the copay and coinsurance will apply beginning with the first visit.
• Tier 1 Network Changes: The following facilities in Los Angeles, California, will no longer be in the Tier 1 network: St. Mary Medical Center Long Beach; PIH Health Downey Hospital; Whittier Hospital Medical Center; PIH Health Good Samaritan Hospital. These facilities will move to Tier 2 starting Jan. 1.
• High-risk human papillomavirus (hrHPV) testing for cervical cancer will be designated as the preferred screening method for average risk women ages 30-65, and additional follow-up testing will be covered at $0 cost share.
• All members will receive new ID cards with both medical and pharmacy information.

• Blue Shield Tier 1 (UC Select) network (available only in California): You pay set copayments for covered services, and there’s no deductible. The annual out-of-pocket maximum is $6,100 for individual coverage and $9,700 for family coverage.
  • Office visits/urgent care: $30
  • Emergency room visits: $300
  • Hospital stay: $250
  • Navitus network pharmacies:
    • Tier 1: $10
    • Tier 2: $30
    • Tier 3: $50
• Blue Shield Tier 2 network: You pay 30% of the cost of service after the deductible has been met.
  • Individual coverage: $500 deductible; $7,600 out-of-pocket maximum
  • Coverage for a family of three or more: $1,000 deductible; $14,200 out-of-pocket maximum
• Non-preferred or out-of-network: After the deductible has been met, you pay 50% of the allowable cost of service plus any billed charges that exceed the allowed amount.
  • Individual coverage: $750 deductible; $9,600 out-of-pocket maximum
  • Coverage for a family of three or more: $1,750 deductible; $20,200 out-of-pocket maximum

*UC Care deductible and out-of-pocket maximums do not cross-accumulate for in-network and out-of-network services. The UC Select and Anthem Preferred (transitioning to Blue Shield next year) out-of-pocket maximum do cross-accumulate.