2021 Comparing Your Health Plan Options - USC
NO N- U NION2021 Comparing Your Health Plan OptionsUSC TROJANCARE EPOUSC EPO PLUSPAG EUSC PPOANTHEM HMOKaiser HMOBENEFITEPO NetworkEPO Plus Network*Tier 1: Keck MedicineTier 2: Anthem PrudentBuyerTier 3: Out-of-NetworkAnthem CaliforniaCareNetworkKaiser NetworkIs a referral requiredto see a specialist?NoNoNoNoNoYesYesMEDICAL DEDUC TIBLESIndividual 100 100 125 275 600 0 0Family (3 members) 300 300 375 825 1,800 0 0Tier 1–2 deductibles cross accumulate(count toward one another)M E D I C A L O U T- O F - P O C K E T M A X I M U MEmployee only 1,000** 1,000** 1,500** 2,500** 12,500*** 1,500** 3,000**Employee plus adult 2,000** 2,000** 3,000** 5,000** 25,500*** 3,000** 6,000**Employee plus children 3,000** 3,000** 4,500** 7,500** 37,500*** 4,500** 9,000**Employee plus family 3,000** 3,000** 4,500** 7,500** 37,500*** 4,500** 9,000**Employee plus childP R E S C R I P T I O N O U T- O F - P O C K E T M A X I M U MEmployee only 2,000** 2,000** 4,850**No out-of-pocket maxCombined with medicalCombined with medicalEmployee plus adult/child(ren) family 4,000** 4,000** 7,200** (two or more people)No out-of-pocket maxCombined with medicalCombined with medical* EPO Network Anthem Prudent Buyer/BlueCard (for dependents residing out of state & in No. Calif counties).** 100% thereafter.*** 100% of UCR thereafter. Usual and customary rate. Refers to the rate generally charged for a specific service by doctors or other providers in the same geographic area.This is a summary only and does not include all the details, exclusions, or limitations about covered services. For more details about coverage or costs, contact the HR Service Center at uschr@usc.edu or (213) 821-8100.1
NO N- U NION2021 Comparing Your Health Plan OptionsUSC TROJANCARE EPOUSC EPO PLUSUSC PPOEPO NetworkEPO Plus Network*Tier 1: Keck MedicineTier 2: Anthem PrudentBuyerPCP office visit(including maternity)Plan pays 100% aftermember pays 20 copay ( 10copay with designated PCP)Plan pays 100% aftermember pays 20 copay ( 10copay with designated PCP)Plan pays 100% aftermember pays 25 ( 15copay with designated PCP)Plan pays 100% aftermember pays 40 ( 30copay with designated PCP)SCP office visitPlan pays 100% aftermember pays 20Plan pays 100% aftermember pays 20Plan pays 100% aftermember pays 25Plan pays 100% aftermember pays 40Preventive carePlan pays 100%Plan pays 100%Plan pays 100%Urgent care centersMember pays 35Member pays 35Emergency care(waived if admitted)Member pays 150 copayMember pays 150 copayBENEFITPAG EANTHEM HMO2Kaiser HMOAnthem CaliforniaCareNetworkKaiser NetworkPlan pays 50% of UCR**after deductible/memberpays deductible plusbalance of chargesPlan pays 100% aftermember pays 20Plan pays 100% aftermember pays 25Plan pays 100% aftermember pays 20Plan pays 100% aftermember pays 50Plan pays 100%Plan pays 50% of UCR**after deductible/memberpays deductible plusbalance of chargesPlan pays 100%Plan pays 100%Not AvailableMember pays 35Plan pays 50% of UCR**after deductible/memberpays deductible plusbalance of chargesMember pays 30Member pays 25Member pays 200 copay(only available at USCVerdugo Hills Hospital)Member pays 200 copayMember pays 200 copayand any charges above100% of UCR**; plan pays100% of UCRMember pays 150 copayMember pays 200 copay 10 copay 15 copayBrand/formulary: 20% ofcost, with a minimum 30copay; 125 max copay 35 copay (formulary only)Brand/non-formulary:45% of cost (min 50, max 250)Not coveredSame as above, except selfadministered injectabledrugs 200 (does not applyto insulin) 35 copay (formulary only)Tier 3: Out-of-NetworkMEDICAL BENEFITSPRESCRIPTION COST SHARINGGeneric 5 copay 5 copay 5 copayBrand(no generic available) 25 copay 25 copay 25 copayBrand(generic available) 70 copay 70 copay 70 copaySpecialty drug 125 copay 125 copay 125 copayIf filled at a non-Networkpharmacy, the Plan willreimburse you 50% of thePlan’s Navitus’ contractedrate (not of cost);Reimbursement requestmust be received within60 days of fill* EPO Network Anthem Prudent Buyer/BlueCard (for dependents residing out of state & in No. Calif counties).** Usual and customary rate. Refers to the rate generally charged for a specific service by doctors or other providers in the same geographic area.This is a summary only and does not include all the details, exclusions, or limitations about covered services. For more details about coverage or costs, contact the HR Service Center at uschr@usc.edu or (213) 821-8100.
NO N- U NION2021 Comparing Your Health Plan OptionsUSC TROJANCARE EPOBENEFITUSC EPO PLUSPAG EUSC PPOEPO NetworkEPO Plus Network*Tier 1: Keck MedicinePlan pays 100%Plan pays 100%Not availableTier 2: Anthem PrudentBuyerANTHEM HMOKaiser HMOAnthem CaliforniaCareNetworkKaiser NetworkPlan pays 80% of billedcharges after deductible.You pay 20% of billedcharges after deductiblePlan pays 100% 50 per tripPlan pays 50% of UCR**after copay. You pay a 600 copay per admissionplus all charges above50% of UCRPlan pays 100% aftermember pays 250 copay/admissionPlan pays 100% aftermember pays 250 copay/admissionTier 3: Out-of-NetworkAMBULANCEEmergency groundtransportation(non-emergency transportrequires prior authorization)Plan pays 80% afterdeductible; member pays20% after deductibleI N PAT I E N T H O S P I TA L S E R V I C E S ( A L L H O S P I TA L A D M I S S I O N S A R E S U B J E C T T O P R I O R AU T H O R I Z AT I O N)FacilitySurgery/doctor visitsPlan pays 100% aftermember pays 100 copay/admissionPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 100% aftermember pays 100 copay/admissionPlan pays 100% (notsubject to deductible)Maternity delivery onlyavailable at USC VerdugoHills HospitalPlan pays 100% aftermember pays 300 copay/admissionMaternity delivery: 100copay/admission only atGood Samaritan Hospitalwhen delivery is done bya USC Care Medical GroupObstetricianPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 80% afterdeductible; member paysdeductible and 20% ofallowed amountPlan pays 50% of UCR**after deductible; memberpays deductible andremainder of chargesabove 50% of UCRPlan pays 100%Plan pays 100%A M B U L AT O RY S U R G E RYFacilityPlan pays 100% aftermember 200 copay/admissionPlan pays 100% aftermember 200 copay/admissionPlan pays 100%Plan pays 100% aftermember pays 200 copay/admissionPlan pays 50% of UCR**not to exceed 2,700 aftermember pays 600 copay/admission plus remainderof chargesPlan pays 100% aftermember 250 copay/admissionPlan pays 100% aftermember 250 copay/admissionPhysicianPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 80% afterdeductible; member paysdeductible and 20% ofallowed amountPlan pays 50% of UCR**after deductible; memberpays deductible plusremainder of chargesPlan pays 100%Plan pays 100%* EPO Network Anthem Prudent Buyer/BlueCard (for dependents residing out of state & in No. Calif counties).** Usual and customary rate. Refers to the rate generally charged for a specific service by doctors or other providers in the same geographic area.This is a summary only and does not include all the details, exclusions, or limitations about covered services. For more details about coverage or costs, contact the HR Service Center at uschr@usc.edu or (213) 821-8100.3
NO N- U NION2021 Comparing Your Health Plan OptionsUSC TROJANCARE EPOBENEFITEPO NetworkUSC EPO PLUSEPO Plus Network*PAG EUSC PPOTier 1: Keck MedicineTier 2: Anthem PrudentBuyerANTHEM HMOTier 3: Out-of-Network4Kaiser HMOAnthem CaliforniaCareNetworkKaiser NetworkB E H AV I O R A L H E A LT H A N D S U B S TA N C E U S E D I S O R D E R S E R V I C E SAuthorizationInpatient, partialhospitalization, residentialtreatment center, andintensive outpatient visitsrequire prior authorizationInpatient, partialhospitalization, residentialtreatment center, andintensive outpatient visitsrequire prior authorizationInpatient services, partial hospitalization, residential treatment center, and intensiveoutpatient visits require prior authorizationInpatient, partialhospitalization andresidential treatmentrequire prior authorizationInpatient, partialhospitalization andresidential treatmentrequire prior authorizationInpatient - facilityPlan pays 100% aftermember pays 100 copay/admissionPlan pays 100% aftermember pays 100 copay/admissionPlan pays 100%Plan pays 100% aftermember pays 300 copay/admissionPlan pays 50% of UCR.**Member pays 600 copay/admission plus balanceof chargesPlan pays 100% aftermember 250 copay/admissionPlan pays 100% aftermember pays 250 copay/admissionInpatient - physicianPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 80% afterdeductible; member paysdeductible and 20% ofallowed amountPlan pays 50% of UCR**after deductible; memberpays deductible andbalance of chargesPlan pays 100%Plan pays 100%Partial hospitalizationPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 90% afterdeductible; member paysdeductible and 10% ofallowed amountPlan pays 90% afterdeductible; memberpays deductible and10% of allowed amountPlan pays 80% afterdeductible; memberpays deductible and20% of allowed amountPlan pays 50% of UCR**after deductible; memberpays deductible andbalance of chargesPlan pays 100%Plan pays 100%Residential treatmentPlan pays 100% aftermember pays 100 copay/admissionPlan pays 100% aftermember pays 100 copay/admissionPlan pays 100%Plan pays 100% aftermember pays 300 copay/admissionPlan pays 50% of UCR.**Member pays 600 copay/admission plus balanceof chargesPlan pays 100% aftermember 250 copay/admissionPlan pays 100%Outpatient - facilityPlan pays 100% aftermember pays 200 copay/admissionPlan pays 100% aftermember pays 200 copay/admissionPlan pays 100%Plan pays 100% aftermember pays 200 copay/admissionPlan pays 50% of UCR**not to exceed 2,700 aftermember pays 600 copay/admission plus remainderof all chargesPlan pays 100%Plan pays 100%Outpatient professionalPlan pays 100% aftermember pays 20 copay( 10 copay withdesignated PCP)Plan pays 100% aftermember pays 20 copay( 10 copay withdesignated PCP)Plan pays 100% aftermember pays 25 copay/visit ( 15 copay withdesignated PCP)Plan pays 100% aftermember pays 40 copay/visit ( 30 copay withdesignated PCP)Plan pays 50% of UCR**after deductible; memberpays deductible andbalance of chargesPlan pays 100% aftermember pays 20 copay/admissionPlan pays 100% aftermember pays 25 copay/admissionEmergency onlyNoYesYesEmergency onlyEmergency onlyO T H E R H E A LT H S E R V I C E SCoverage in foreigncountriesEmergency only* EPO Network Anthem Prudent Buyer/BlueCard (for dependents residing out of state & in No. Calif counties).** Usual and customary rate. Refers to the rate generally charged for a specific service by doctors or other providers in the same geographic area.This is a summary only and does not include all the details, exclusions, or limitations about covered services. For more details about coverage or costs, contact the HR Service Center at uschr@usc.edu or (213) 821-8100.
NO N- U NION2021 Financial Incentives/Surcharges to Medical PlansPAG EEMPLOYEE COST IMPACTI N C E N T I V E /S U R C H A R G E D E S C R I P T I O NAFFEC TED PL ANM O N T H LYA N N UA LHealth assessment creditAll plansSubtract 40Subtract 480PCP selection discountUSC Trojan Care EPO, USC EPO Plus and USC PPO Plansonly 10 off PCP office visit copayNot applicableWorking spouse surchargeAll medical plansAdd 100Add 1,2002021 VisionVSP CHOICE PLANBENEFITIN-NET WORKU S C R O S K I P R OV I D E RIN-NET WORKV S P P R OV I D E RO U T- O F - N E T W O R KP R OV I D E RWell vision exam (one exam/year) 0 copay 15 copay 15 copay up to 45Frames 25 copay* up to 170(every other calendar year) 25 copay* up to 170(every other calendar year) 25 copay* up to 55(every other calendar year)Single vision, lined bifocal, lined trifocal, lenticular 25 copay*(every calendar year) 25 copay*(every calendar year) 25 copay* up to 45- 125(every calendar year)Progressive 55– 175 copay(every calendar year) 55– 175 copay(every calendar year) 25 copay up to 85 allowance(every calendar year)Contacts (in lieu of glasses)Up to 150 allowance(every calendar year)Up to 150 allowance(every calendar year)Up to 150 allowance(every calendar year)LENSES* Only one copay applies when lenses and frames are purchased.This is a summary only and does not include all the details, exclusions, or limitations about covered services. For more details about coverage or costs, contact the HR Service Center at uschr@usc.edu or (213) 821-8100.5
NO N- U NION2021 DentalPAG EDELTA DENTAL PPO PLAN6UNITED CONCORDIA DHMO PLANServices at the USC Schoolof DentistryIn-NetworkOut-of-NetworkPrimary Dental Office (PDO) 1,500/person 1,500/person 1,500/personNot applicableIndividual 50 50 75 0Per family 150 150 225 0100%, no deductible90%, no deductible80%, after deductible 0 copay100%, after deductible80%, after deductible70%, after deductible 0– 140 copay100%, after deductible60%, after deductible50%, after deductibleCrowns: 25– 75 copay*Bridges: 70– 90 copay*Dentures: 100– 120 copayComprehensive orthodontic treatment50%50%50% 1,500– 2,000 copayLifetime maximum 1,500 1,500 1,500Not applicable. Orthodontic benefits areavailable once per lifetime per member.Eligibility for orthodontiaCovers both children and adultsCovers both children and adultsCovers both children and adultsCovers both children and adultsImplant rider50%50%50%Not coveredImplants lifetime maximum 1,500 1,500 1,500Not applicableBENEFITO U T- O F - P O C K E T M A X I M U MOut-of-pocket maximum (combined)DEDUC TIBLEP R E V E N T I V E A N D D I AG N O S T I CCleaning, exams, x-rayBASIC SERVICESRoutine extractions, fillings, root canal therapy, osseous surgery, oral surgeryMA JOR SERVICESCrowns, bridges, denturesORTHODONTIAIMPL ANTS* Charges for the use of precious (high noble) or semiprecious (noble) metal are not included in the copayment for crowns, bridges, pontics, inlays and onlays. The decision to use these materials is a cooperative effort between the provider and the patient, based onthe professional advice of the provider. Providers are expected to charge no more than an additional 125 for these materials.This is a summary only and does not include all the details, exclusions, or limitations about covered services. For more details about coverage or costs, contact the HR Service Center at uschr@usc.edu or (213) 821-8100.
USC TROJAN ; CARE EPO USC EPO PLUS; USC PPO ANTHEM HMO; Kaiser HMO; BENEFIT; EPO Network EPO Plus Network* Tier 1: Keck Medicine; Tier 2: Anthem Prudent ; Buyer Tier 3: Out-of-Network Anthem CaliforniaCare ; Network Kaiser Network; AMBULANCE Emergency ground ; transportation (non-emergency t
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07_Displaying and Comparing Quantitative Data.notebook October 08, 2019 Comparing Box and Whisker Plots Example: The box plots below show the heights (in centimeters) of the players on the University of Maryland women's basketball and field hockey teams. Displaying and Comparing Quantitative Data
Aetna Better Health of Michigan Meridian Health Plan . Pre-Paid Inpatient Health Plan Southwest Michigan Behavioral Health . Molina Healthcare . Pre-Paid Inpatient Health Plan Detroit-Wayne Mental Health Authority . 11 . Region 9 - Macomb County . MI Health Link health plan options Aetna Better Health of Michigan .
Retiree Health Plan Marathon Petroleum Company LP (Company) sponsors and maintains the Marathon Petroleum Retiree Health Plan (the "Plan" or "Retiree Health Plan"). This document amends and restates the Plan effective as of January 1, 2022. This document serves both as the plan document and the Summary Plan Description (SPD) for the Plan.
SCHOOL EMPLOYEES RETIREMENT SYSTEM OF OHIO : Aetna Choice POS II - HCPII Coverage Period: 01/01/2021-12/31/2021 . Coverage for: Individual Family Plan Type: POS. The Summary of Benefits and Coverage (SBC) document will help you choose a health . plan. The SBC shows you how you and the plan would share the cost for covered health care .File Size: 1MBPage Count: 11Explore furtherAetna Choice POS II - Discontinued as of Jan 1, 2021 .postdocbenefits.stanford.eduAetna Choice POS II Summary of Benefitswww.aetna.comAetna Choice POS II Medical Plan - Marine Corps Communityusmc-mccs.orgPrescription Drug List (Formulary), Coverage . - Aetnawww.aetna.comBENEFIT PLAN What Your Plan Covers and How - Aetnawww.aetna.comRecommended to you b
This Aboriginal Health Plan 2018–2022 builds on the successes of the former Sydney South West Area Health Service Aboriginal Health Plan 2010–2014, and aligns with the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, NSW Aboriginal Health Plan 2013–2023, and the Sydney Local Health District Strategic Plan.
2021/SOM1/SCE‐COW/019 EPWG Work Plan 2021/SOM1/SCE‐COW/020 PPSTI Work Plan 2021/SOM1/SCE‐COW/021 EGILAT Work Plan 2021/SOM1/SCE‐COW/022 SMEWG Work Plan 2021/SOM1/SCE‐COW/023 TELWG Work Plan 2021/SOM1/SCE‐COW/024 TWG Work Plan 18. The SCE approved the document classification list as amended.
2017 Resolution Plan Northern Trust's 2017 165(d) resolution plan 2021 Resolution Plan Northern Trust's 2021 165(d) resolution plan 2021 Targeted Plan Northern Trust's 2021 Targeted Resolution Plan ADI Authorized deposit-taking institutions Adverse Scenario The DFAST Adverse Scenario Agencies The Federal Reserve and the FDIC, collectively
