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. 

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 Which medical plan is right for you

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

The annual out-of-pocket maximum combines medical, behavioral health and prescription drugs.

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.

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.

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.

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)

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.