USC PPO

The USC PPO offers the most freedom to choose where you go for care, including non-network providers. The USC PPO has three provider coverage tiers, and includes international coverage.

Provider coverage tiers

Tier 1 (USC providers):

  • Keck Medicine of USC physicians (available at UPC, HSC, and numerous other locations around L.A.)
  • Keck Hospital of USC
  • USC Norris Comprehensive Cancer Center
  • USC Verdugo Hills Hospital

Tier 2: All Anthem Blue Cross Prudent Buyer and BlueCard providers. At this tier level you may also access LiveHealth Online for online primary care physician visits; see details below. For all covered individuals up to age 18, Tier 2 services are available at Tier 1 costs.

Tier 3: All other (out-of-network) providers

 TIER COVERAGE COMPARISON Office visit copay/preventive and well child visits Annual medical deductible Annual medical out-of-pocket max for individual/family (3 or more in same family) Maternity
Tier 1 $20 office visit/no charge for most preventive or well child visits $100 individual/$300 family $1500 individual/$4500 family PPO pays 100% of hospital room/board charges for maternity delivery at USC Verdugo Hills Hospital (only Tier 1 provider for hospital delivery)
Tier 2 $30 office visit/no charge for most preventive or well child visits $250 individual/$750 family $2500 individual/$7500 Hospital room/board charges at Good Samaritan Hospital are covered at a $100 copay when delivery is performed by a USC Care Medical Group obstetrician
Tier 3 For office visits, preventive care and well child visits, PPO pays half of “usual, customary and reasonable” charges; you pay the rest $600 individual/$1800 family $12,500 individual/$37,500 family

Finding a provider

Tier 1 Providers – Keck Medicine of USC

  1. Go to http://www.keckmedicine.org/
  2. From the tool bar, select Medical Professionals
  3. Click on Doctor Directory
  4. In the How may we help you today? box, you may search for a provider by name, specialty, department or condition

Tier 2 Providers – Anthem Blue Cross Prudent Buyer (Large Group) Network

  1. Go to www.anthem.com/ca and scroll down the home page to click on Find A Doctor. You may search as a member, or click on Continue under Search as a Guest, then follow the steps below.
  2. Under “How do you get Insurance?” select Through my employer.
  3. Under “What state do you want to search in?” select the name of your state.
  4. Under “What type of care are you searching for?” select Medical.
  5. Under “Select a plan/network,” enter “BlueCross PPO (Prudent Buyer – Large Group)” if you reside in California or “National PPO (BlueCard PPO)” if you reside outside of California, then click on Continue.
  6. Using the drop-down boxes, select what type of doctor, specialty and location you’re looking for, then select Search.
  7. For more information about a provider, such as skills and training, click on the provider’s name on the screen that appears after you select Search.

LiveHealth Online

USC PPO participants may access LiveHealth Online, where a primary care physician visit can be conducted online via two-way video consultation. Physicians can answer questions, make a diagnosis and even prescribe basic medication if needed. LiveHealth Online physicians are considered Tier 2 providers so your online consultation will involve a $30 copay ($20 if you are under age 19). Physicians are available year-round, 24/7. This service is only available within the United States. Visit www.livehealthonline.com for information on system requirements and supported mobile devices. Note that you will need your subscriber ID which begins with NP followed by the 7 digits of your employee ID number (NPXXXXXXX). Be sure you select “Anthem Blue Cross and Blue Shield” when asked which insurance you have. Employees and their spouses will need to create their own LiveHealth account to access a doctor visit; children can be seen using the employee’s account, but you will need to create a profile for each child.

Outside the United States

See this information on Blue Cross Blue Shield international care.

Visit Blue Cross Blue Shield Global Core or call (800) 810-2583:

  1. Read the Site Use Agreement and check the I accept terms box
  2. Enter TRJ as the three ID letters under the Identification Number field and click on Go
  3. Under Select a Provider Type choose what type of provider you want – example: “Hospital/Inpatient” (NOTE: Pharmacy and Dentists are NOT part of the USC PPO – do not search for this type of provider)
  4. Enter the CountryCity and Range – example: “Bahamas”, “Freeport”, “10 miles”
  5. Click on Search

Your Tier 2 international provider results will be displayed. Remember when making an appointment with a provider, always verify with their office that they continue to participate in the BlueCard Worldwide network. See more BlueCard Worldwide information.

Accessing urgent care

Save time and money by using a participating urgent care center if you don’t have a life-threatening emergency, but have a condition that requires prompt medical attention – an urgent care copay is only $35. Find a participating urgent care center in CA by clicking here – then just enter your zip code in the “Located near” field, and search. For participating locations elsewhere in the U.S., call BlueCard at (800) 810-2583.

Prescription coverage

Although the USC PPO does not have a prescription formulary, some medications may have limitations or restrictions. Other medications may require a clinical prior authorization. To learn coverage details about your medication under the PPO, including an estimated copay, visit the MedImpact site. Login under user name: USCPPO2019 and password: Password1. Once logged in, select “Drug Price Check” and enter your medication name.

For prescription drugs filled at a network pharmacy for each 30-day supply you pay:

  • Generics – $10 copay
  • Brand with no generic available – 20% of cost, with minimum copay of $30 and maximum copay of $125 per prescription
  • Brand with generic available – 50% of cost, with minimum copay of $50 and no maximum copay
  • Specialty drugs – generics – $10 copay; brand– 20% of cost, with minimum copay of $30 and maximum copay of $125 per prescription

Mandatory step-therapy: For Proton Pump Inhibitors (PPI), antihistamines and nasal corticosteroids, you must first fill a generic or over the counter (OTC) medication at a zero copay before a brand name prescription will be covered. The following are the generic or OTC medications covered at a zero copay with a written prescription from your physician:

  • PPIs – omeprazole, omeprazole OTC, omeprazole-sodium bicarbonate, pantoprazole, lansoprazole, lansoprazole ODT, Nexium OTC, Prevacid OTC, Prilosec OTC, Zegerid OTC
  • Antihistamines – cetirizine, cetirizine OTC, fexofenadine-pseudoephedrine, levocetirizine, loratadine OTC, Alavert, Alavert-D, Allegra OTC, Allegra-D OTC, Claritin OTC, Claritin-D 12 HR, Zyrtec OTC
  • Nasal corticosteroid – Flonase OTC and Nasacort OTC

Multiple copays will be charged for maintenance medications dispensed in excess of one month’s supply through a retail pharmacy or mail order. If your physician has written a prescription for a 90-day supply of a medication under the “maintenance medication” list, multiple copays will apply. For information about mail service, see the MedImpact site or call (844) 401-2054.

Some of the PPO’s network pharmacies include:

  • USC Pharmacy
  • USC Medical Plaza Pharmacy
  • USC Verdugo Hills Professional Pharmacy
  • CVS
  • Rite Aid
  • Ralph’s
  • Walmart
  • Vons
  • Albertsons
  • Payless Drugs
  • Costco

Some small independent pharmacies are also in-network. Call USC Health Plans at (213) 740-0035 to verify pharmacy participation.

For prescriptions filled at non-network pharmacies, the PPO will reimburse a member for 50% of the PPO’s MedImpact contracted rate (not 50% of the cost). You must pay in full for the prescription at the pharmacy, and then submit a reimbursement claim form to MedImpact within 60 days of your fill via:

Email

Claims@Medimpact.com

Fax

(858) 549-1569

Mail

MedImpact Healthcare Systems, Inc.
PO Box 509098
San Diego, CA 92150-9098

Your member ID card also includes the phone number and link for MedImpact – (844) 401-2054 or mp.medimpact.com.

Annual prescription out-of-pocket copay maximums

The following calendar year prescription out-of-pocket copay maximums are separate from the USC PPO’s calendar year medical out-of-pocket maximum (noted in chart above):

  • $4850 maximum – individual
  • $7200 maximum – family (2 or more people)

Maximum excludes out-of-network pharmacy prescription copays.

This means that after a single person meets the out-of-pocket maximum of $4850 in a calendar year, or after a family cumulatively meets the $7200 maximum, all covered individuals will be covered at 100% for prescriptions filled at in-network pharmacies for the remainder of the calendar year.

Claims, billing and reimbursement

The USC PPO plan is administered by HealthComp. Call (855) 727-5267 with questions about plan benefits, bills, or claims.

You can view your paid claims information on the HealthComp site, but you must first register as a member – see the HealthComp online instructions. You can also sign up to receive Explanation of Benefits (EOB) statements online only – see the HealthComp electronic EOB statement instructions.

Medical claim forms can be downloaded from the same site; a PDF version is posted here for your convenience:

HealthComp claim form

Submit claim forms along with copies of bills and receipts for documentation in one of three ways:

  1. Scan and email to scanform@healthcomp.com– be sure you fill in the subject line with: ATTN: Claims
  2. Fax to (559) 499-2464
  3. Mail to: HealthComp Administrators, PO Box 45018, Fresno, CA 93718-5018

Your ID card

USC PPO plan identification cards are issued by HealthComp. Cards are mailed to your home in a USC envelope printed with “USC PPO Plan ID Card Enclosed” in bold letters. HealthComp automatically sends two ID cards to subscribers with family coverage. If you need an extra card, log into the HealthComp site or call (855) 727-5267. Cards take about two weeks to arrive, or you can download a HealthComp Digital ID Card on that site.

Plan documents

2019 PPO Summary Plan Description

Notice of Privacy Practices

Contact information

USC PPO | USC Health Plans (213) 740-0035 or healthplans@usc.edu

Claim, eligibility or plan coverage questions
HealthComp | www.healthcomp.com
(855) 727-5267

Medical prior authorizations
Anthem Blue Cross
(800) 274-7767