Non-Medicare Retirees
Anthem Blue Cross is the medical plan administrator and Navitus is the pharmacy benefit manager of CORE, UC Care and UC Health Savings Plan. Health Net is the administrator of the UC Blue and Gold HMO plan. Kaiser Permanente — California is the administrator of the Kaiser HMO plan.
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Definitions
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.)
Annual Out-of-Pocket Maximum: The amount you must pay during the calendar year before the plan will pay 100% of covered charges (or 100% after Medicare, where applicable). Some expenses do not apply toward the maximum; see the plan’s evidence of coverage booklet.
Calendar year deductible (Medicare plans): The calendar year deductible is the amount you must pay before the medical plan begins to pay a percentage of the total cost of benefits. Until the deductible is met, you pay the total cost of services not covered by Medicare. Review each plan’s annual deductible and monthly premium to decide which plan is best for you.
Calendar year deductible (non-Medicare plans): The calendar year deductible is the amount you must pay before the medical plan begins to pay a percentage of the total cost of benefits. Until the deductible is met, you pay the total cost of services not covered by Medicare. Review each plan’s annual deductible and monthly premium to decide which plan is best for you.
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.
Medicare Allowable: The Medicare-approved amount for a covered service.