Verdugo Hills PPO
COVID-19 update for PPO members
- 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.
The USC Verdugo Hills medical insurance plan is administered by HealthComp. See the summary plan description.
| 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% |
US Script 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 |
|
HealthComp | www.healthcomp.com
(800) 442-7247
US Script | www.usscript.com (prescriptions)
(800) 460-8988