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Within California and the U.S. Outside of the U.S.

Coverage Around the U.S. and the World

The UC PPO plans for Medicare members supplement your Medicare coverage. Medicare (not the UC medical plan) is your primary insurance, meaning Medicare typically pays for covered services first. Depending on your plan, your UC plan then covers most or all of the costs for covered services that Medicare doesn’t cover.

With some exceptions, the UC plan covers only Medicare-covered services. These exceptions are called “Benefit Beyond Medicare” and include:

Services that fall under the UC Benefits Beyond Medicare, are subject to the applicable coinsurance of your plan (e.g. you pay 20% of costs). Learn more about Benefits Beyond Medicare.

Within California and the U.S.

Choose a Provider That Accepts Medicare

Medicare-Covered Services

You should always choose providers that accept Medicare for Medicare-covered services. Go to medicare.gov to find providers near you that accept Medicare.

Choose UC: Most UC Health providers and facilities accept Medicare. To be certain, first verify with medicare.gov before making your appointment.

UC Davis Medical Group: (800) 2-UC-DAVIS (282-3284)

  • Offices in 10 communities across the region.
  • Formally recognized for patient-centered care.
  • Online scheduling, messaging, health records and more.
  • Same- and next-day urgent care appointments.

UC Irvine Health: (714) 456-7002

  • Services including treatment for acute or chronic illness, physical exams, flu shots and more.
  • Primary care providers at eight locations.

UCLA Health System: (800) UCLA-MD1 (825-2631)

  • More than 150 primary care offices throughout Southern California.

UC San Diego Health: (800) 926-8273

  • More than 30 primary care doctors named in San Diego Magazine’s 2015 annual survey of top doctors.
  • No. 1-ranked health care system in San Diego.

UC San Francisco Medical Center: (844) PCP-UCSF (727-8273)

  • Primary care clinics offering a wide range of services, including routine health examinations, pediatric care, internal medicine, women’s health and chronic condition management.

Benefits Beyond Medicare

For Benefits Beyond Medicare—services Medicare does not cover but the UC plan does—choose doctors and other providers in the Anthem Blue Cross network to ensure you receive the highest level of benefits and the lowest out-of-pocket costs. To find an Anthem provider:

  • Register with anthem.com/ca and then download the free Engage Wellbeing app and register. Through the Engage Wellbeing app, you can click on Find a Doctor, Hospital or Urgent Care (under Useful Tools).
  • Enter the type of provider you’re looking for, such as primary care or behavioral health.
  • Enter your location and the distance you’re willing to travel.

Not all Providers Accept Medicare

There may be times when you use a what Medicare calls a “non-participating provider.” Because these providers are not bound by Medicare, they can charge you more than the Medicare “allowable amount.” For the lowest costs, use Medicare participating providers whenever possible. To find a provider participating in Medicare, go to medicare.gov. If you choose a provider who has opted out of Medicare, you will pay the full cost of the services you receive.

Medicare Participating Provider—Accepts Medicare
Medicare Covered Service First Medicare pays its share. Then Anthem covers 80% of the expenses not covered by Medicare
Medicare Covered Behavioral Health
Medicare covered services, after Medicare maximums are reached (inpatient medical) 80% coverage (after deductible)
Benefits Beyond Medicare: Services not covered by Medicare but covered by Anthem (acupuncture, hearing aids, marriage and family counseling, etc.) N/A
Medicare Non-Participating Provider—Not Contracted With Medicare But Will Accept Medicare Payment
Medicare Covered Service First Medicare pays its share. Then Anthem covers 80% of the expenses not covered by Medicare.
Medicare Covered Behavioral Health
Medicare covered services, after Medicare maximums are reached (inpatient medical) 80% coverage (after deductible); you may be responsible for any additional charges after Medicare and Anthem have paid their share
Benefits Beyond Medicare: Services not covered by Medicare but covered by Anthem (acupuncture, hearing aids, marriage and family counseling, etc.) N/A
Opt-Out-Providers—Will Not Accept Medicare Payment
Medicare Covered Service Not covered
Medicare Covered Behavioral Health Anthem pays 80% of the Anthem allowed amount (after deductible) for behavioral health/substance abuse only. You pay the remaining 20%. 
Medicare covered services, after Medicare maximums are reached (inpatient medical) N/A
Benefits Beyond Medicare: Services not covered by Medicare but covered by Anthem (acupuncture, hearing aids, marriage and family counseling, etc.) N/A

Services Not Covered by Medicare but Covered by UC

 
Medicare Covered Service N/A
Medicare Covered Behavioral Health Anthem pays 80% of the Anthem allowed amount (after deductible) for behavioral health/substance abuse only. You pay the remaining 20%.
Medicare covered services, after Medicare maximums are reached Anthem pays 80% after deductible, subject to certain criteria and medical necessity. Other limitations may apply. Please contact Anthem Health Guide for assistance.
Benefits Beyond Medicare: Services not covered by Medicare but covered by Anthem (acupuncture, hearing aids, marriage and family counseling, etc.) Anthem pays 80% of the Anthem allowed amount (after deductible) for behavioral health/substance abuse only. You pay the remaining 20%.

Show your Anthem Blue Cross ID card when you get medical, behavioral health and prescription services. If you've misplaced your card, tap, click or call to get a new one.

Get Help

If you want help finding an Anthem Blue Cross provider or have questions, call Anthem Health Guide, toll-free, at (844) 437-0486, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific).

Outside the U.S.

Medicare does not cover services received outside the U.S. However, you’re covered through your Anthem plan for up to 6 months when traveling or living outside the U.S.* Emergency and non-emergency care is coordinated through Blue Cross Blue Shield Global Core—which offers access to health care providers in more than 200 countries and territories. If you need a prescription, you can use any pharmacy.

Find a Provider

If you need medical attention outside the U.S., first call the Blue Cross Blue Shield Global Core Service Center at +1 (804) 673-1177. (In an emergency go to the nearest hospital and call as soon as possible.) They’ll connect you to care near you, get approvals from Anthem and work to coordinate payment with the provider so you won’t have to pay the entire cost up-front.

What's Covered

Covered services include:

  • Doctor and specialist office visits
  • Preventive care
  • Outpatient X-ray, pathology and laboratory
  • Outpatient surgery in a hospital
  • Emergency room services
  • Acupuncture
  • Chiropractic
  • Physical and occupational therapy

See the international brochure for more details.

*If you are outside the U.S. for more than 6 months, contact the UC Retirement Administration Service Center (RASC) toll free at (800) 888-8267 (in the U.S.) or (510) 987-0200 (outside the United States). The RASC is available Monday through Friday from 8:30 a.m. to 4:30 p.m. Or, you can visit ucnet.universityofcalifornia.edu.

What You Pay

Medical care: You’ll pay 20% of the cost of covered medical services after you pay the deductible.

Medications: Medicare doesn’t cover outpatient prescription drugs filled by pharmacies outside of the U.S. However, they are covered in full (after any applicable copayment) through your Anthem plan (specific rules apply).

But be prepared to pay up-front. Despite Blue Cross Blue Shield Global Core’s efforts to guarantee payment, a health care provider or pharmacy outside the U.S. may require you to pay the full cost at the time of service. If so, you can submit a claim to Anthem for reimbursement once you return home.

  What You Pay
Annual Deductible $100 per individual
Medical Coverage Outside the U.S. 20% of covered costs after deductible
Prescription Drug Coverage Prescriptions from a foreign pharmacy will be reimbursed at the full cost of the medication, less any applicable plan copayment.

Travel Tips

Before You Go

  • If you take a regular prescription, ask for an extended supply so you don’t run out while traveling. Call Anthem Medicare Prescription Drug Member Services, toll-free, at (833) 279-0460, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific).
  • Bring your Anthem Blue Cross member ID card.

Outside the U.S.

  • Search for providers near your destination(s) through Blue Cross Blue Shield Global Core.
  • Get vaccinated. Check with your doctor about recommended vaccinations. The medical plan covers many travel vaccines. Learn more.
  • Travel smart with prescriptions. Keep medications in their original, clearly labeled containers. Check with the foreign embassy of the country (or countries) you are visiting to be sure that your medications are legal in that country.
  • Set aside extra cash or carry a credit card with access to cash in case you get sick or injured and have to pay for services at the time you receive them. While you are overseas, be prepared to make payment at the time of service and make sure you get an itemized record so you can submit a claim for reimbursement when you return.

Submitting Claims for Services Received When Traveling Outside the U.S.

Before leaving the provider, get copies of your medical records in English (required for your claim). If your provider can’t provide documentation in English, there are several online translation services that you can use, including Google Translate. Universities, consulates and embassies also offer translation assistance.

Then, follow these steps to submit a claim for reimbursement:

  • Download the International Medical Claim Form. On the form, be sure to include:
    • Your diagnosis
    • The description of service(s), provider name, and address and country where services were rendered
    • Itemized charges and proof of payment, such as a credit card receipt
    • Billed amounts in foreign currency or U.S. dollars
  • Attach all medical reports in English, including, but not limited to:
    • Ambulance trip
    • Emergency room
    • Admitting history
    • Surgical procedure
  • Attach an itemization of ALL charges if you had an inpatient stay in the hospital.
  • Submit the form and required documentation to the address indicated on the form.

For more information, see the international brochure.

A Note About Services

Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should always check ahead of time with your doctor, medical group, independent practice association or clinic or call Anthem Health Guide to ensure that you can obtain the health care services that you need.