Verdugo Hills PPO

The USC Verdugo Hills medical insurance plan is administered by HealthComp. See the summary plan description and the summary of benefits and coverage.

MEDICAL
 

 

BENEFIT

TIER 1 TIER 2
VHH/Keck Medicine of USC/ USC Care Medical Group Anthem Blue Cross Prudent Buyer

Network/ BlueCard® Providers

Deductible: Individual / Family None $500/$750
Out‐of‐pocket maximum (medical) $5,000 individual/$10,000 employee and all covered dependents combined
 

Physician office visit

Plan pays 100% after $10 copay

(USC Care Medical Group only)

Plan pays 100% after $25 copay

(deductible waived)

Preventive care (adult and child) Plan pays 100% Plan pays 100% (deductible waived)
Child immunizations (through age 18) Plan pays 100% Plan pays 100% (deductible waived)
 

Maternity ‐ physician office visit

Plan pays 100% after $10 copay

(USC Care Medical Group only)

Plan pays 100% after $25 copay

(deductible waived)

Maternity ‐ physician delivery Plan pays 100% Plan pays 70%
Maternity ‐ hospital charges Plan pays 100% Plan pays 70%
 

Urgent care centers

 

Not Available

Plan pays 100% after $50 copay

(deductible waived)

 

Emergency care

Plan pays 100%

after $100 copay

Plan pays 100% after $100 copay

(deductible waived)

Ambulance Plan pays 80%
Inpatient hospital physician visits Plan pays 100% Plan pays 70%
Inpatient hospital room and board Plan pays 100% Plan pays 70%
Outpatient surgery center ‐ physician Plan pays 90% Plan pays 70%
Outpatient surgery center ‐ facility Plan pays 100% Plan pays 70%
 

Skilled nursing facility

Plan pays 100% Plan pays 70%
(up to 120 days /calendar year)
 

Home health care

Plan pays 70%
(up to 50 days /calendar year)
Durable medical equipment Plan pays 90% Plan pays 70%
Hospice care Plan pays 80%
Mental health/substance abuse ‐

Inpatient room and board

 

Plan pays 100%

 

Plan pays 70%

Mental health/substance abuse ‐

Outpatient

Plan pays 100% after $10 copay

(USC Care Medical Group only)

Plan pays 100% after $25 copay

(deductible waived)

 

 

 

 

Prescription drugs

USC VHH Pharmacies

(90‐day supply)

 

Generic: You pay 10% up to $5 max Brand Name: You pay 20% Non‐Formulary: You pay 30%

Navitus Pharmacies

(30‐day supply)

 

Generic: You 20% up to $10 max Brand Name: You pay 30% Non‐Formulary: You pay 50%

Out‐of‐pocket maximum

Prescription: Individual/Family

 

$1,600 individual / $3,200 employee and all covered dependents

  • Screening and testing - The health plan will pay 100% for only medically necessary screening and testing of COVID-19. Beginning Saturday, Jan. 15, 2022, members covered by private health insurance or a group health plan are now able to purchase over-the-counter (OTC) COVID-19 tests authorized by the U.S. Food and Drug Administration (FDA) at no cost without a prescription. The reimbursement of OTC COVID-19 tests will remain in effect until the Public Health Emergency (PHE) is rescinded.
    • COVID-19 test kits can be purchased at network pharmacies at $0 member out-of-pocket, with a quantity limit of eight tests per covered individual every 30 days. This eight-test limit does not apply to such test kits ordered with a prescription. COVID-19 tests kits must be purchased at the pharmacy counter with your medical/rx insurance card to ensure that they are processed properly. View Navitus’ list of network pharmacies.
    • Members can also submit a claim for reimbursement for COVID-19 OTC test kits purchased on or after Jan. 15, including those from non-network pharmacies and non-pharmacy locations. The COVID-19 OTC Test Claim Form is also available for download at navitus.com/members. For more detailed information, please view the COVID OTC Testing FAQs.
  • Please see the Coronavirus FAQ and the Coronavirus member information.
  • Your Anthem health plan will cover the care you receive if you’re diagnosed with COVID-19. Anthem will also waive out-of-pocket expenses for the focused test used to diagnose COVID-19.
  • Visit anthem.com/ca/blog or the CDC website at cdc.gov/coronavirus to learn more.

Contact information

HealthComp | www.healthcomp.com

(800) 442-7247

Navituswww.navitus.com (prescriptions)

(855) 673-6504