UC Care PPO

• 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.