All of UC’s medical plans offer comprehensive coverage, but benefits and costs do vary. Check out the quick reference guide below for 2023 details. Visit the Open Enrollment website for 2024 details.
Note: The charts below show what the member pays at the time of care. See employee medical plan premium contributions for your share of premium costs for each plan.
This is a summary only. Important details — such as limitations, exclusions, exceptions, and other qualifiers — may not be included. For detailed information, call the plan or see their website for specific benefits, benefits when traveling overseas, provider information, and plan booklets. If any information on the website conflicts with plan documents, plan documents prevail.
Download:
| Plan |
Calendar Year Deductible |
Health Savings Account (HSA) UC contribution |
Annual Out-of-Pocket Maximum1 |
| UC Blue & Gold HMO |
$0 (in-network coverage only) |
Not applicable; can be paired with Health FSA |
Individual: $1,000
Family (3 persons or more): $3,000 |
| Kaiser HMO |
$0 (in-network coverage only) |
Not applicable; can be paired with Health FSA |
Individual: $1,500
Family (2 persons or more): $3,000 |
| UC Care |
| UC Select Network |
$0 |
Not applicable; can be paired with Health FSA |
Individual: $6,1002
Family: $9,7002 |
| Anthem Preferred Network |
Individual: $5002
Family: $1,0001 |
Individual: $7,6002
Family: $14,2002
|
| Out-of-Network |
Individual: $7502
Family: $1,7502 |
Individual: $9,6002
Family: $20,2002 |
| CORE |
Individual: $3,000 |
Not applicable; can be paired with Health FSA |
Individual: $6,350
Family: $12,700 |
| UC Health Savings Plan |
| In-Network |
Individual Coverage: $1,5003
Family Coverage: $3,0003
(You may use your HSA funds to pay for your deductible and other eligible out-of-pocket expenses.) |
Employee: up to $5004
Employee & Adult: up to $1,0004
Employee & Children: up to $1,0004
Family: up to $1,0004
|
Individual Coverage: $4,000
Family Coverage: $6,400 |
| Out-of-Network |
Individual Coverage: $2,5503
Family Coverage: $5,1003
(You may use your HSA funds to pay for your deductible and other eligible out-of-pocket expenses.) |
Individual Coverage: $8,000
Family Coverage: $16,000 |
| Plan |
Inpatient |
Surgeon |
Emergency Room |
Ambulance |
Urgent Care |
| UC Blue & Gold HMO |
$250 copayment per admittance |
No charge |
$125 (waived if admitted) |
No charge |
$20 |
| Kaiser HMO |
$250 copayment per admittance |
No charge |
$125 (waived if admitted) |
No charge |
$20 |
| UC Care |
| UC Select Network |
$250 copayment |
No charge |
Facility: $300 copay per visit not resulting in admission, $250 if admitted
ER Physician Services: No charge (not subject to calendar year deductible)
|
N/A (services covered under Anthem Preferred) |
$20 |
| Anthem Preferred Network |
30% |
30% |
$200/trip (not subject to calendar year deductible) |
$20 (not subject to calendar year deductible) |
| Out-of-Network |
50% (non-preferred hospitals subject to maximum payment
of $300/day) |
50% |
50% |
| CORE |
20% (out-of-network
hospitals subject to maximum payment of $480/day) |
20% |
20% |
20% |
20% after deductible |
| UC Health Savings Plan |
| In-Network |
20% |
20% |
20% |
20% |
20% after deductible |
| Out-of-Network |
40% (out-of-network
hospitals subject to maximum payment of $360/day) |
40% |
40% after deductible |
| Plan |
Office Visit |
Hospital Visit |
Preventive Physical Exam/Well Baby Care |
Maternity Outpatient Care |
Maternity Inpatient Care |
| UC Blue & Gold HMO |
$20 |
No charge |
No charge |
No charge |
$250 copayment per admittance |
| Kaiser HMO |
$20 |
No charge |
No charge |
No charge |
$250 copayment per admittance |
| UC Care |
| UC Select Network |
$20 |
No charge |
No charge |
$20 (initial visit only) |
$250 copayment per admittance |
| Anthem Preferred Network |
30% |
30% |
No charge (not subject to calendar year deductible) |
30% |
30% |
| Out-of-Network |
50% |
50% |
50% |
50% |
50% (non-preferred hospitals subject to maximum payment of $300/day) |
| CORE |
20% |
20% |
No charge (not subject to calendar year deductible) |
20% |
20% (out-of-network hospitals subject to maximum payment of $480/day) |
| UC Health Savings Plan |
| In-Network |
20% |
20% |
No charge (not subject to calendar year deductible) |
20% |
20% |
| Out-of-Network |
40% |
40% |
40% |
40% |
40% (out-of-network hospitals subject to maximum payment of $360/day) |
| Plan |
Home Health Care |
Skilled Nursing Facility |
Outpatient X-Ray and Lab |
Chiropractor |
Acupuncture |
| UC Blue & Gold HMO |
No charge |
No charge (up to 100 days/ calendar year) |
No charge |
$20 (24 visit limit/calendar year combined with acupuncture) |
$20 (24 visit limit/calendar year combined with chiropractor) |
| Kaiser HMO |
No charge (up to 100 visits/ calendar year) |
No charge (up to 100 days/ calendar year) |
No charge |
$15 (24 visit limit/calendar year combined with acupuncture) |
$15 (24 visit limit/calendar year combined with chiropractor) |
| UC Care |
| UC Select Network |
N/A (services covered under Anthem Preferred) |
N/A (services covered under Anthem Preferred) |
$20 |
N/A (services covered under Anthem Preferred) |
N/A (services covered under Anthem Preferred) |
| Anthem Preferred Network |
30% |
30% (up to 100 visits/calendar year) |
30% (up to 100 days/calendar year) |
30% (preferred providers and 24 visit limit/calendar year combined with acupuncture) |
30% (preferred providers and 24 visit limit/calendar year combined with chiropractor) |
| Out-of-Network |
50% (up to 100 days/calendar year). If authorized, paid at Anthem Preferred tier. |
50% (up to 100 days/calendar year). If authorized, paid at Anthem Preferred tier, subject to maximum payment of $300/day. |
50% |
50% (up to allowed amount and 24 visit limit/calendar year combined with acupuncture) |
30% (up to allowed amount and 24 visit limit/calendar year combined with chiropractor) |
| CORE |
20% (up to 100 visits/calendar year)
(out-of-network not covered) |
20% (up to 100 days/calendar year) |
20% |
20% (24 visit limit/calendar year
combined with acupuncture) |
20% (24 visit limit/calendar year combined with chiropractor) |
| UC Health Savings Plan |
| In-Network |
20% (up to 100 visits/calendar year) |
20% (up to 100 days/calendar year) |
20% |
20% (24 visit limit/calendar year combined with acupuncture) |
20% (24 visit limit/calendar year combined with chiropractor) |
| Out-of-Network |
Not covered unless prior authorized. If authorized, in-network benefit applies. |
20% (up to 100 days/calendar year) |
40% |
40% (up to allowed amount and 24 visit limit/calendar year combined with acupuncture) |
20% (up to allowed amount and 24 visit limit/calendar year
combined with chiropractor) |
| Plan |
Retail (up to 30-day supply) |
Mail Order (up to 90-day supply) |
| UC Blue & Gold HMO |
Generic: $55
Brand: $255, 6
Non-Formulary: $405, 6 |
Generic: $10
Brand: $506
Non-Formulary: $806 |
| Kaiser HMO |
30-day supply—Generic: $5; Brand: $25;
31–60 day supply—Generic: $10; Brand: $50;
61–100 day supply—Generic: $15; Brand: $75
Non-Formulary: does not apply |
30-day supply—Generic: $5; Brand: $25;
31–100 day supply—Generic: $10; Brand: $50
Non-Formulary: does not apply |
| UC Care |
| UC Select Network |
At select pharmacies:
Tier 1: $55, 7, 8
Tier 2: $255, 7, 8
Tier 3: $405, 7, 8 |
Tier 1: $107, 8
Tier 2: $507, 8
Tier 3: $807, 8 |
| Anthem Preferred Network |
At select pharmacies:
Tier 1: $55, 7, 8
Tier 2: $255, 7, 8
Tier 3: $405, 7, 8 |
Tier 1: $107, 8
Tier 2: $507, 8
Tier 3: $807, 8 |
| Out-of-Network |
50% (of billed charges per prescription)9 |
Not covered |
| CORE |
20%5, 9 |
Preferred: 20%9
Non-preferred: Not covered |
| UC Health Savings Plan |
| In-Network |
20%5, 9 |
20%9 |
| Out-of-Network |
40%9 |
Not covered |
| Plan |
Mental Health Inpatient9 |
Mental Health Outpatient9 |
Substance Abuse Inpatient9 |
Substance Abuse Outpatient9 |
| UC Blue & Gold HMO |
$250 copayment per admittance or course of treatment (preauthorization required)
|
Visits 1–3: No copayment
Visits 4+: $20
|
$250 copayment per admittance or course of treatment (preauthorization required) |
Visits 1–3: No copayment
Visits 4+: $20 |
| Kaiser HMO |
Kaiser: $250 copayment per admittance
Optum: $250 copayment per admittance or course of treatment (preauthorization required) |
Kaiser: $20 for individual visit; $10 for group visit.
Optum: Visits 1–3: No copayment. Visits 4+: $20
|
Kaiser: $250 copayment per admittance
Optum: $250 copayment per admittance or course of treatment (preauthorization required) |
Kaiser: $20 for individual visit.
Visits 1–3: No copayment
Visits 4+: $20 |
| UC Care |
| UC Select Network |
$250 copayment per admittance or course of treatment |
Visits 1–3: No copayment
Visits 4+: $20 |
$250 copayment per admittance or course of treatment (preauthorization required) |
Visits 1–3: No copayment
Visits 4+: $20 |
| Anthem Preferred Network |
$250 copayment per admittance or course of treatment |
Visits 1–3: No copayment
Visits 4+: $20 |
$250 copayment per admittance or course of treatment |
Visits 1–3: No copayment
Visits 4+: $20 |
| Out-of-Network |
50%
Additional $250 copayment for failure to preauthorize |
50% |
50%
Additional $250 copayment for failure to preauthorize |
50% |
| CORE |
20% |
20% |
20% |
20% |
| UC Health Savings Plan |
| In-Network |
20% |
20% |
20% |
20% |
| Out-of-Network |
40%
Additional $250 copayment for failure to preauthorize |
40% |
40%
Additional $250 copayment for failure to preauthorize |
40% |
Definitions
Calendar year deductible: The amount you must pay for medical services before the plan will provide benefits.
Annual out-of-pocket maximum: The amount you must pay during the calendar year before the plan will pay 100% of covered charges. Some expenses do not apply toward the maximum; see the plan’s evidence of coverage booklet.
Copayments: Shown in dollars; represents the amount you pay after the deductible (if any) has been met.
Coinsurance: Shown as a percentage; represents the percentage of the allowable amount you pay after the deductible (if any) has been met.
Allowable amount: The dollar amount considered payment-in-full for services provided by the health plan carrier’s network of healthcare providers. (Out-of-network providers may bill members for amounts in excess of the allowable amount.)
Footnotes
1 The annual out-of-pocket maximum combines medical, behavioral health and prescription drugs.
2 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 out-of-pocket maximum do cross-accumulate.
3 In-network expenses count toward meeting the out-of-network deductible, but out-of-network expenses do not count toward meeting the in-network deductible (except for authorized ambulance and emergency medical services).
4 This assumes you are covered Jan. 1, 2023. If you enroll later in the year, the UC contribution is prorated.
5 90-day supply available for maintenance medication at UC Medical Center pharmacies at plan’s mail order copay benefit level. UC PPO plan members can also access this benefit at additional Navitus Preferred Retail Pharmacies.
6 When a generic drug is available and you or your physician choose the brand name drug, the drug will not be covered by the plan. If you obtain a brand name drug in this scenario, you will be responsible for 100% of the cost and it will not count towards your annual out-of-pocket maximum. With prior authorization, exceptions for medical necessity can be made and you pay the non-formulary (Tier 3) copay.
7 The Navitus prescription drug formulary classifies (and charges for) medications by tier, as follows:
- Tier 1—Preferred generics and some lower cost brand products
- Tier 2—Preferred brand products and some high cost non-preferred generics
- Tier 3—Non-preferred products (could include some high cost non-preferred generics)
8 When a generic drug is available and you or your physician choose the brand-name drug, you must pay the applicable brand copay plus the difference between the cost of the brand-name drug and the generic equivalent. With prior authorization, exceptions for medical necessity can be made and you pay the Tier 3 (Non-preferred) copay.
9 PPO members receive behavioral health benefits through their medical plan. UC Blue & Gold HMO members receive behavioral health benefits from Managed Health Network (MHN). Kaiser members have access to the Kaiser benefit shown, in addition to the Optum in-network benefits and network of providers.
