CORE

What You Need to Know

A high-deductible medical plan with no cost for coverage to covered members. The CORE plan is a high-deductible PPO that generally provides the same level of coverage, whether you receive care at an in-network provider or an out-of-network provider.

 

Find care.

Have Questions or Need Help?

For help with the medical plans, call Accolade at (866) 406-1182, Monday–Friday, 5 a.m.–8 p.m. PT. Or visit the digital member portal any time.

How it Works

See the plan comparison chart [PDF] for more coverage details.

CORE is a high-deductible medical plan with no cost to employees for coverage. You pay only for the care you receive. Prescription drug coverage is also included.

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No-Cost Preventive Care

Preventive care, including services such as screenings, immunizations and exams for you and all covered family members when you see an in-network provider. (Out-of-network preventive care covered at 20% after the deductible.)

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What You Pay for Care

Deductible

For all services except preventive care, you first pay a deductible of $3,000 per covered person.

Cost for Care

After you meet the deductible, you pay 20% of the cost for most covered services.

Out-of-Pocket Maximum

This limits the amount you’ll pay for covered services during the year to a maximum of $6,350 (individual coverage) or $12,700 (family coverage), including the deductible. After you meet the out-of-pocket maximum, Anthem pays 100% for most covered medical services and Navitus pays for 100% of most prescription drugs, for the rest of the year.

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No Surprises

Did you know that if you receive emergency care or are treated by an out-of-network doctor or specialist at a hospital or ambulatory surgical center in your plan’s network, you are protected from surprise billing?

Learn more at anthem.com.

Behavioral Health

You and your covered family members can use behavioral health benefits for sessions with counselors, psychologists or psychiatrists for mental health services and substance abuse treatment. If you need help finding a provider and booking and appointment, call Accolade at (866) 406-1182 Monday–Friday, 5 a.m.–8 p.m. PT. You can also speak to a therapist or psychologist virtually through Accolade Care Telehealth and Virtual Visits.

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Prescription Drugs

The plan covers prescription drugs. Learn more about prescription drug coverage.

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Expert Medical Opinion From 2nd.MD

2nd.MD is Accolade’s expert medical opinion service. Get a second opinion from a leading specialist at no cost so that you feel confident about a new diagnosis, surgery, treatment plan or medication.

2nd.MD makes it easy to get an expert second opinion that can offer life-changing benefits. 2nd.MD services are available at no additional cost to you.

2nd.MD expert specialists can help you:

  • Ensure you’re on the right treatment path to better health
  • Learn about treatment options you may not be aware of
  • Consider options that are a better fit for your lifestyle
  • Gain peace of mind for you and your loved ones

The 2nd.MD panel of more than 900 expert doctors are industry leaders across hundreds of subspecialties and thousands of conditions including cancer, heart disease and stroke, digestive problems, immunological disorders, women’s health, mental health concerns and musculoskeletal issues.

Book an Expert Medical Consultation on the digital member portal at member.accolade.com or download the 2nd.MD mobile app on the App Store or Google Play.

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Infertility Support

The journey to parenthood is not always easy. If you are struggling to conceive, WINFertility is here to help.

UC families enrolled in the Anthem UC Care, HSP, and CORE medical plans are provided a 2-cycle lifetime maximum benefit toward eligible expenses related to fertility treatment and related fertility medications. Coverage includes IVF, GIFT, and ZIFT coverage with 50% coinsurance (after deductible), up to a combined limit of two treatment cycles per lifetime, per member.

The benefit also includes artificial/intrauterine insemination (IUI) cycles, assisted reproductive technologies (ART), and related services as well as infertility specialty medications. It does not cover expenses for surrogacy, fees associated with surrogacy or expenses for procuring donated oocytes or sperm.

All fertility services are subject to medical necessity and prior authorization by WINfertility, which will also provide a range of support services. 

What You Can Expect

WIN will help you better understand your options so you can maximize your benefit and choose the best course of treatment. More importantly, WIN knows this can be an extremely stressful and emotional time in your life. We are here to support you through every step of your fertility journey.

  • 24/7 access to WIN’s Nurse Care Managers for emotional guidance and support
  • Assistance in selecting a high-quality, in-network provider based on your individual treatment needs 
  • Expertise in understanding complex information and decisions regarding infertility causes, testing and treatment option success rates and risk
  • Guidance to help increase the efficient use of hormonal medications to avoid wastage and over-stimulation
  • Education on your pharmacy dosing usage, storage, and medication side effects and also assistance in maximizing your infertility medication benefit

WINFertility will assist you in selecting the right provider and navigating the system, your care and benefits. Working together with your health plan network of doctors and pharmacies, we provide you with total support and coordination of care. WIN has you covered!

What It Costs

After any applicable deductible, you pay 50% coinsurance for each treatment cycle. (Maximum of two combined cycles per lifetime for each covered member.) Your costs do not count toward the plan's out-of-pocket maximum.

Get Started

For benefit details and eligibility, contact WINFertility at (877) 451-3077, or visit managed.winfertility.com/universityofcalifornia. Service team members are available Monday–Friday 6 a.m.–4:30 p.m. PT. And download the WINFertility Companion app from Google Play or the App Store to take advantage of your benefits on the go. (App code: UCA23.)

For more details, see the WINFertility flyer [PDF] and detailed coverage information [PDF].

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Care Outside California and the U.S.

Outside California

Find care

You or family members traveling or living outside California can access care across the U.S. through the BlueCard Program, which offers access to 92% of U.S. doctors and 97% of U.S. hospitals. You are not required to use a BlueCard provider; however, you’ll pay less when you do, because services received from BlueCard providers are reimbursed at the in-network level of coverage for your medical plan.

There is no charge for in-network preventive care. For other services, you must first meet your medical plan’s deductible. Then the plan pays the same percentage of the cost for covered services as if you received care in California.

If you seek out-of-network care, you may need to submit a claim, and you’ll pay a higher deductible and a greater share of the costs.

See the benefit booklet [PDF] for complete information about covered services.

Outside the U.S.

Find care

All of the PPO plans provide access to care through Blue Cross Blue Shield Global Core. The UC Care and CORE plans both cover non-emergency, urgent and emergency care at the same level as within the U.S. (UC Care members are covered at 80%, after meeting the Anthem Preferred deductible.)

Outside the U.S., the Health Savings Plan covers only urgent and emergency services.

See the Global Core program brochure [PDF] for details about coverage through each plan.

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Referrals and Prior Authorizations

Some specialists — and specialty treatment centers (like nephrology or infusion) — may require a referral from your primary care doctor or prior authorization from Accolade before you can make an appointment. When scheduling an appointment, call Accolade at (866) 406-1182, Monday–Friday, 5 a.m.–8 p.m. PT to ask if a preservice review or precertification is required prior to your initial visit.

Certain services, such as a planned surgery with an overnight hospital stay, require prior authorization from Accolade. If you have a procedure scheduled or a condition that will require treatment, you may need a preservice review. For assistance, call Accolade at (866) 406-1182, Monday–Friday, 5 a.m.–8 p.m. PT.

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Anthem Blue Cross Life and Health Insurance Company is the claims administrator for UC PPO Plans. On behalf of Anthem Blue Cross Life and Health Insurance Company, Anthem Blue Cross processes and reviews the medical, pharmacy and behavioral health claims submitted under the PPO plans. Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Navitus is an independent company providing pharmacy benefit management services on behalf of the University of California for the PPO plans. Accolade is an independent company providing benefits advocacy services on behalf of the University of California for the PPO plans. Health Net is the claims administrator for the UC Blue & Gold HMO. Health Net processes and reviews the medical, pharmacy and behavioral health claims submitted under the UC Blue & Gold HMO. All plan benefits are provided by the Regents of the University of California. The content on this website provides highlights of your benefits under the UC non-Medicare PPO Plans plans and the Blue & Gold HMO. The official plan documents and administrative practices will govern in any and all cases.