How the Plan Works

UC Select

The UC Select network tier—available only in California—includes UC physicians, UC medical centers and a group of other quality providers. Every campus—even those without a UC medical center—has access to UC Select providers.

Providers in UC Select include:

• UC medical centers
• UC doctors
• Other quality providers so that all campuses—even those without UC medical centers—have access to UC Select providers

With UC Select:

• There’s no deductible.
• There is no charge for preventive care.
• You pay set copayments for most covered services.

Because UC Care is a PPO, you can go to many types of providers without a referral. However, some specialists—as well as certain treatments and procedures—may require a referral or prior authorization before your first visit. Learn more.

Services Not Available Under UC Select

Some services are not available in UC Select and are accessible only under Anthem Preferred. These services are not covered under UC Select:

• Outpatient surgery performed at an ambulatory surgery center
• Services by a free-standing skilled nursing facility
• Emergency or authorized transport by an ambulance
• Prosthetic and orthotic equipment and devices
• Durable medical equipment, including breast pumps
• Home health services
• Hospice programs
• Chiropractic care
• Acupuncture

This means that you can only receive in-network coverage for the services above through Anthem Preferred. Also, any covered services you receive outside of California and the U.S. will be provided under Anthem Preferred. Read the 2018 UC Care Benefit Booklet to learn more.

Anthem Preferred

Providers in Anthem Preferred include:

• More than 60,000 providers in the statewide Anthem Preferred network.
• BlueCard® providers in the U.S. and Blue Cross Blue Shield Global Core providers throughout the world.

With Anthem Preferred:

• You must first meet an in-network deductible—$250 (individual coverage) or $750 (family coverage).
• Once you meet the deductible, the plan pays 80%, and you pay 20% of the cost for covered services through coinsurance.

UC Care provides coverage wherever you are.

• Within California: More than 60,000 California doctors and specialists and 330 hospitals participate in the statewide Anthem Preferred network. That translates to 90% of all facilities and 87% of physicians and specialists in the state.
• Outside California: Care is provided through BlueCard®, which includes 92% of U.S. doctors and 96% of U.S. hospitals.

Learn more about care around the state and around the world.

• You can see most types of in-network providers without a referral. However, some specialists—as well as certain treatments and procedures—may require a referral or prior authorization before your first visit. Visit Prior Authorizations to learn more.

Out-of-Network

You can also choose to receive care from out-of-network providers. However, it’s important to know that your costs will be significantly higher when you get out-of-network care, and you’ll have to file claims.

• You must first meet a deductible—$500 (individual) or $1,500 (family).
• Once you do, the plan pays 50%, and you pay 50% of the allowable amount for covered services. You may receive a bill for the difference between the amount the plan reimburses for covered services—the allowable amount—and what an out-of-network provider chooses to charge. This is known as balance billing.

What’s the Difference Between UC Select and Anthem Preferred?

Here are some things to consider when choosing between a UC Select and Anthem Preferred provider:

	Coverage	Cost
UC Select	UC medical centers UC physicians Other quality providers near every campus—even those without UC medical centers	$ out of your pocket Lower rates negotiated by Anthem No deductible Set copayments (doctor visits are $20)
Anthem Preferred	60,000+ providers in the Anthem Preferred network 92% of U.S. doctors and 96% of U.S. hospitals participate in the BlueCard® Program Outside the U.S., Blue Cross Blue Shield Global Core® provides access to doctors and hospitals in nearly 200 countries and territories	$$ out of your pocket Lower rates negotiated by Anthem You must first meet a deductible—$250 (individual) or $750 (family) Once you meet your deductible, the plan pays 80%, and you pay 20%
Out-of-network	Any provider you wish	$$$ out of your pocket NO lower rates negotiated by Anthem You must meet a deductible—$500 (individual) or $1,500 (family) Once you meet your deductible, the plan pays 50% of the allowed amount, and you pay the rest

If you see an out-of-network provider, you may receive a bill for the difference between the amount the plan reimburses for covered services—the allowable amount—and what an out-of-network provider chooses to charge. This is known as balance billing.

Again, the choice of provider is yours. If you visit an out-of-network provider, you won’t get Anthem’s lower rates. As a result, your out-of-network provider may bill you for charges in above the Anthem allowable amount.