The University offers employees a wide array of medical plans from which to choose including 2 Health Maintenance Organizations (HMO), 1 Point of Service (POS), 2 Preferred Provider Organizations (PPO) and 1 Catastrophic Coverage Plan (Indemnity). UC-sponsored medical plans are not subject to pre-existing condition exclusions. Additionally, the University offers 2 Carve out plans: United Behavioral Health (UBH) and StayWell that supplement most of the medical plans. Following are the plan names with a very brief description:
|Medical Plans ||Details |
|Kaiser Permanente ||HMO - $20 Office Visit co-pay; small Rx co-pays, Hospitalization & Outpatient Services |
|Health Net HMO ||HMO - $20 Office Visit co-pay; small Rx co-pays, Hospitalization & Outpatient Services |
|Blue & Gold ||Same benefits as Health Net HMO but must use custom network of providers |
|Anthem* PLUS ||POS - In-Network: $25 Office Visit co-pay; small Rx co-pays, Hospitalization & Outpatient Services, Limited Behavioral Health Benefits; Out-of-Network: 70%/30%, Deductible Applies |
|Anthem* PPO ||PPO - In-Network: 80%/20%; Out-of-Network: 60%/40%, Deductible Applies |
|Anthem* Lumenos ||PPO w/HRA - In-Network: 80%/20%; Out-of-Network: 60%/40%, Deductible Applies; Out-of-pocket maximum does not include deductible; unused HRA rolls over to next calendar year; HRA is prorated for mid-year participants; drugs at full cost |
|CORE ||Indemnity - Catastrophic Coverage, In-Network: $3,000 Deductible, 80%/20% Reimbursement, Deductible Applies, Excludes UBH Carve Out benefit |
|Optum (formerly United Behavioral Health) ||UBH is the behavioral health benefits provider for all the medical plans excluding CORE and the Medicare advantage plans. Kaiser members can use both Kaiser and UBH services. First 3 office visits are free otherwise the office visits are $20 for network providers |
|StayWell ||A program that offers lifestyle action plans to address health risks such as smoking, weight management, blood pressure, and stress. Not available to Kaiser members. No charge to access services. Eligibility of bargaining unit members is subject to Union Ratification (see related links) |
*Out of Network (Ambulatory) Out Patient Surgery is limited to $350 benefit from Anthem. Prior authorization is required.
HMO, Health Maintenance Organization, is a plan in which the participant chooses a Primary Care Physician (PCP) who coordinates all medical care, including specialist referrals. (Kaiser Permanente does not have PCPs; instead participants use a Kaiser facility for care.) There is a co-payment at the time of service and plan networks are limited. HMOs have the lowest premiums but offer the lowest flexibility.
POS, Point-of-Service, is comprised of in-network (HMO) and out-of-network (PPO) aspects. When a participant uses the in-network portion of the plan, it operates similar to an HMO; services are provided by an Anthem PCP, co-payment is due at the time of service, limited plan networks, etc. When a participant uses the out-of-network portion of the plan, it’s similar to the Anthem PPO; deductibles and co-insurances apply, self-referral is allowed. POS is a more flexible plan than an HMO plan, but it also has a higher premium.
PPO, Preferred Provider Organization, has in-network and out-of-network aspects; in-network refers to participating Anthem PPO doctors while out-of-network refers to non-participating network doctors and pharmacies. The PPO plans offer the broadest network of doctors and specialists; it is one of the most flexible plans offered, but it has the highest premiums. Under the Lumenos plan, members pay for the drugs at full cost (first deducted from the Health Reimbursement Account, HRA) until the deductible is met, then the insurance will subsidize at co-insurance levels until out-of-pocket maximums are met.
IMPORTANT NOTE REGARDING UCLA MEDICAL GROUP ASSIGNMENT: As a UCLA employee, you are not automatically assigned to a UCLA Primary Care Physician (PCP) and the UCLA Medical Group under your HMO health plan benefits. Under Anthem PLUS and Health Net, you can select a UCLA PCP or you can select a PCP from another medical group when you enroll in your health plan benefits. There are many different medical groups in Southern California that you can choose from. You must live or work within 30 miles of the medical group and the PCP you select, and the PCP you choose must be open and accepting new patients. You and your covered dependents must be in the same health plan, but you can be assigned to different medical groups.
To find an open UCLA PCP, you can call 1-800-UCLA-MD-1. If you want to find a PCP who is not in the UCLA Medical Group, you can call your health plan or use the provider finder feature on your health plan's website (see Contacts - Medical Plan Carriers under Related Information).
Important note: If you do not select a PCP when you enroll in your health plan benefits, your health plan will automatically assign you to an open PCP near your home. If you are not assigned to the UCLA Medical Group when you first enroll in your health plan benefits, you may be prohibited from changing into the UCLA Medical Group at a later time. The UCLA Medical Group declines enrollments of health plan members assigned to other medical groups who are in the middle of a course of care or pregnant. If you would like to select the UCLA Medical Group, you should do so at your time of initial enrollment in your health plan benefits. You should also check your health plan ID card when it arrives to make sure that the health plan has assigned you to the correct PCP. If there is an error on your health plan ID card, you should call your health plan's member services department (number listed on ID card).
Tax Savings On Insurance Premiums (TIP) This program allows you to pay your monthly health plan costs on a pretax, salary reduction basis. If you have an employee monthly cost for your health plan, you are automatically enrolled in TIP; this arrangement continues unless you cancel your participation in TIP.
For Conversion Options, please see Health Plans section, Conversion Privileges
HMO Transfer Plan This UC policy allows monthly transfers between UC-sponsored HMO medical plans due to major provider disruptions, i.e., the member's medical group severs its contract as a provider. The termination of a single provider, i.e., PCP (Primary Care Physician), would not be considered a major provider disruption and generally will not be allowed. Effective coverage dates are subject to payroll deadlines. For assistance, contact the person in your department who handles benefits.