The Big Headlines
- The medical, pharmacy, and behavioral health programs for the UC PPO plans will all be managed by Anthem Blue Cross. This means you’ll be able to get information about all of these benefits from one vendor and website.
- Anthem Health Guide will continue to provide support for medical and behavioral health services.
- You’ll get a new ID card in December 2017.
- This website is your new online resource for UC medical and pharmacy benefits information. During Open Enrollment, you can learn about and compare your choices. Then, during the rest of the year, get information about your medical plan and find links to other resources at your convenience and from any device.
PPO Medical Plan Benefits
- You’ll get a new ID card. In late December, you and each covered family member will get one ID card from Anthem that you’ll use beginning January 1, 2018, for medical, prescription drug and behavioral health services.
- LiveHealth Online, which lets you see a licensed doctor from your home via video chat, will expand to include visits with psychiatrists.*
- For the HSP and CORE plans, your cost for a psychiatrist visit (before you meet the deductible) is $175 for the initial evaluation and $75 per visit for follow-up visits. After the deductible, you pay $35 for the initial visit and $15 per visit thereafter.
- For UC Care, your cost is $20 per visit. Get three free visits with coupon code UCHEALTH.
- Expanded ACA preventive care coverage. In compliance with the Affordable Care Act (ACA):
- For those who meet certain criteria, low- to moderate-dose statins will be covered at a $0 copayment for cardiovascular disease prevention.
- Up to a 12-month supply of oral contraceptives will be covered.
The University of California is recognized as a national leader in health research and has numerous clinical trial opportunities. As a UC member, you have may access to volunteer to participate in these trials, such as the trial described below.
The Wisdom Study is a UC-wide trial designed to test a new personalized approach to breast cancer screening based on individual risk factors. The Wisdom Study is recruiting 100,000 women across California, with the goal to improve breast cancer screening for all. All female UC PPO members ages 40-74 with no history of breast cancer or ductal carcinoma in situ (DCIS) are invited to join this voluntary study. To learn more and see if you’re eligible, visit wisdomstudy.org.
*LiveHealth Online psychiatrists are not able to prescribe controlled substances.
- Calendar-year deductibles (the amount you pay before the plan pays benefits) are increasing:
- The in-network calendar year deductible will increase from $1,300 to $1,350 for individual coverage and from $2,600 to $2,700 for family coverage.
- The out-of-network calendar year deductible will increase from $2,500 to $2,550 for individual coverage and from $5,000 to $5,100 for family coverage.
- The maximum Health Savings Account (HSA) contribution will increase to $3,450 for individual coverage and $6,900 for family coverage, including UC’s contribution of $500 for individual coverage and $1,000 for family coverage. If you will be age 55 or older, you can contribute an additional $1,000 over and above these limits.
The cost for urgent care visits (through an Anthem Preferred provider) is changing from 20% coinsurance (after deductible) to a copayment of $30 per visit (no deductible).
- Anthem is replacing OptumRx as the administrator of prescription drug benefits. Anthem will process claims, create a network of pharmacies, and set clinical policy and guidelines. Anthem will also run the home delivery service for maintenance medications and a specialty pharmacy—Accredo—for complex drugs.
- Prior authorizations or approvals for exceptions to prescription benefit rules and regulations (e.g., quantity limits, step therapy, or using a brand name drug instead of generic) that are still active on December 31, 2017 will be honored by Anthem for as long as you are taking that specific medication.
- Most open prescriptions will transfer automatically:*
- If you have an open prescription at a retail pharmacy, simply show your new ID card when you get your first prescription filled in 2018.
- Most open mail order prescriptions will be transferred to the Anthem mail service vendor, Express Scripts.
- You’ll get more information about this, including any steps you need to take, directly from Anthem by early 2018.
- In late December, you and each covered family member will each get one ID card from Anthem that you’ll use beginning January 1, 2018. Use this ID card for medical, prescription drug and behavioral health services. It’s critical that you show your new ID card for prescription drugs beginning January 1; otherwise, your claims may be delayed or processed incorrectly.
- Your copayment amount/coinsurance for each drug tier will be the same as your current plan. However, drugs may be classified differently (in a different tier or coverage level), which could affect your out-of-pocket costs. For example, the Anthem drug list features four tiers of medications, including generic and brand name drugs, with the lowest out-of-pocket costs in Tier 1. This is different from the way OptumRx classifies and prices drugs, which means that you might pay more, or less, for your prescriptions than you do today. Anthem will mail information to you about any changes to your prescription tier before the end of the year.
- HSP and CORE members can get a 90-day supply at CVS, Walgreens, Safeway/Vons, Costco, UC Medical Center Pharmacies and Retail90 pharmacies. (Retail90 pharmacies are identified with asterisks.) This applies to all medications that can be safely filled at that quantity, not just maintenance medications.
- UC Care members can get a 90-day supply for the cost of two copayments at CVS, Walgreens, Safeway/Vons, Costco and UC Medical Center Pharmacies. A 90-day supply for the cost of three copayments is available at designated Retail90 pharmacies. (Retail90 pharmacies are identified with asterisks.) This applies to all medications that can be safely filled at that quantity, not just maintenance medications.
*By law, certain prescriptions cannot be automatically transferred. If your prescription cannot be transferred, Anthem will notify you. Or call Anthem Health Guide at (844) 437-0486 during Open Enrollment to confirm if your prescription can be transferred, or to get answers to your questions about the transition.