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What You Pay for Care

Note: Your cost for urgent care visits are changing in 2018. Learn more.

Following are your costs for many common treatments. For more details about these or other treatments that are not listed, go to anthem.com/ca or call Anthem Health Guide, toll-free, at (844) 437-0486, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific).

  UC Select1 Anthem Preferred Out-of-Network

Medical/Behavioral Health Calendar-Year Deductible2

The deductible is the amount you pay before the plan begins to share in the cost for covered services.

No deductible

Self: $250
Family: $750

Self: $500
Family: $1,500

Medical/Behavioral Health Out-of-Pocket Maximum3

(Combined with pharmacy out-of-pocket expenses)

The out-of-pocket maximum is the most you’ll pay for covered health care services in a calendar year.

Self: $5,100
Family: $8,700

Self: $6,600
Family: $13,200

Self: $8,600
Family: $19,200

Preventive Health Visits

ACA Preventive Travel Vaccinations (hepatitis A, hepatitis B, meningitis, polio)

No charge No charge, no deductible 50% after deductible5

Physician and Specialist Office Visits

Outpatient X-ray, Pathology and Lab4

$20 copayment 20% after deductible4 50% after deductible5
Virtual Care (LiveHealth Online) Your first 3 consultations are free with coupon code UCPSYCH; $20 per visit thereafter. (Coupon code must be applied when making your appointment. Fees cannot be adjusted after appointments are booked.) Your first 3 consultations are free with coupon code UCPSYCH; $20 per visit thereafter. (Coupon code must be applied when making your appointment. Fees cannot be adjusted after appointments are booked.) Your first 3 consultations are free with coupon code UCPSYCH; $20 per visit thereafter. (Coupon code must be applied when making your appointment. Fees cannot be adjusted after appointments are booked.)
Outpatient Surgery in a Hospital $100 per surgery (Deductible does not apply) 20% after deductible4 50% after deductible5
Outpatient Surgery at an Ambulatory Surgical Center $100 copayment per visit 20% after deductible4 50% after deductible5
Inpatient Non-Emergency Facility Services $250 per admission 20% after deductible4 50% after deductible5
ER Services (Not resulting in an admission) $200 $200 (Not subject to the deductible) $200 (Not subject to the deductible)
ER Services (Resulting in an admission) $250 $250 (Not subject to the deductible) $250 (Not subject to the deductible)
ER Physician Services No charge No charge (Not subject to the deductible) No charge (Not subject to the deductible)
Emergency Care Outside of California or the U.S. Not available Access to providers for emergency and non-emergency care through the Blue Cross Blue Shield Global Core network Access to providers for emergency and non-emergency care through the Blue Cross Blue Shield Global Core network

1. Some services are not available in UC Select, only Anthem Preferred. Details can be found in the 2017 UC Care Benefit Booklet.
2. In-network and out-of-network calendar-year deductibles are separate—what you pay toward one doesn’t count toward the other. The Anthem Preferred deductible does apply toward the in-network out-of-pocket copayment maximum. The out-of-network deductible applies toward the out-of-network out-of-pocket copayment maximum.
3. In-network (Anthem Preferred and UC Select) medical and prescription drug out-of-pocket copayment maximums count toward each other. In-network and out-of-network medical copayment maximums are separate—what you pay toward one doesn’t count toward the other. Annual out-of-pocket maximums include deductibles, copays, coinsurance and prescription drug charges.
4. A $20 separate copayment may apply for interpretation of results by another provider.
5. You may be billed for charges above the allowable charge—this is called balance billing. You will be responsible for these charges in addition to any copayment. For inpatient non-emergency facility services, the maximum plan payment amount is $300 per day.

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.

Privacy

Anthem Blue Cross protects the confidentiality and privacy of your personal and health information—including your name, address, telephone number, Social Security number and medical information. That’s why you are required to sign an Authorization of Release of Personal Health Information when you request health information for your spouse/same-sex domestic partner or dependents over age 18.

If you have questions about how Anthem protects your privacy and confidentiality, please Call Anthem Health Guide, toll-free, at (844) 437-0486, or view the privacy policy.