UC Medicare PPO Plan Without Prescription Drugs

What You Need to Know

UC offers a range of health plan options to Medicare-eligible employees and retirees and their eligible family members.

 

All UC Medicare supplement plans protect your and your family’s health and include behavioral health coverage and virtual care options. The difference among them comes down to things like how much you pay when you get care, how much you pay in paycheck contributions, and whether prescription drug coverage is included.

How it works

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

Medicare Providers

You receive the highest level of benefits when you get care from hospitals or doctors who accept Medicare. You have the option to see providers who do not accept Medicare assignment, but your out-of-pocket costs will be higher. Learn more about provider options.

Back to top

No-Cost Medicare Preventive Care

When you see a provider that accepts Medicare, Medicare covers 100% of the cost (no deductible) for annual Medicare-recommended preventive screenings and lab tests based on your age and gender. While Medicare does not cover what you might think of as a physical exam, it does cover certain wellness services focused on keeping you healthy. Here’s a quick look at the types of visits and services Medicare does and does not cover, so you’ll know what services you’re getting — and what you’ll pay. For more information, go to medicare.gov.

Annual Medicare Wellness Visit

If You’re New to Medicare (Part B)

If You’ve Been a Medicare Member 12+ Months

Ongoing Preventive Care

Coverage of Physical Exams

What You Pay for Care

Deductible

The plan covers the Medicare deductible in full. There is a $100 per individual for services not covered by Medicare but covered by UC’s Benefits Beyond Medicare coverage.

Out-of-Pocket Maximum

This limits the amount you’ll pay for covered services during the year. After you meet the out-of-pocket maximum of $1,500 per covered person (which includes the deductible), you get 100% coverage for covered medical services for the remainder of the year. 

Back to top

Benefits Beyond Medicare

What’s Included

  • Virtual visits with a doctor or therapist through LiveHealth Online (no deductible)
  • Behavioral health office visits from providers who opt out of Medicare (do not participate in Medicare or do not accept Medicare payment for services)
  • Inpatient hospital care beyond Medicare limits
  • Acupuncture (Note: Some acupuncture services may be covered by Medicare. For details, see the Medicare and You handbook at Medicare.gov.)
  • Hearing aids
  • Care when you travel outside the U.S.
  • Certain travel immunizations
  • Skilled nursing facility care beyond Medicare limits
  • Transgender surgery

Except for LiveHealth Online visits, you’ll pay your medical plan’s annual deductible for Benefits Beyond Medicare services. After you meet the deductible, the plan covers 80% of allowable charges.2 However, when you see a non-contracted provider, you are responsible for paying any amount over the Anthem-allowed amount, which does not count toward the plan’s out-of-pocket maximum.

1. Services must be medically necessary as determined by Anthem to be covered after Medicare limits are reached.

2. The calendar-year deductible does not apply to LiveHealth Online services. However, the $20 copay will count toward the plan’s out-of-pocket maximum.

Back to top

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 immediate help, call the Anthem Behavioral Health Resource Center, available 24/7 at (844) 792-5141. You can also speak to a therapist or psychologist virtually through LiveHealth Online.

Back to top

Care Outside the U.S.

Access to providers for emergency and non-emergency care through the BlueCard® or Blue Cross Blue Shield Global Core network. You pay 20% of Anthem-allowed amount after the deductible. Learn more about care outside California or the U.S.

Back to top

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 plan. 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. 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 PPO Plans. The official plan documents and administrative practices will govern in any and all cases.