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 |
|
COVID-19 resources
- 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.
COVID-19 resources
- 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
Navitus | www.navitus.com (prescriptions)
(855) 673-6504