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.

Click here for more information about costs, covered items, and services.

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

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