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Medical Plans for eligible UC retirees living in California
Health Maintenance Organizations
HMOs give you a list of doctors from which to choose a primary care physician
(PCP). A PCP coordinates your care, which means that generally you must contact
him or her to be referred to a specialist within your designated medical group.
If you belong to an HMO, the plan only covers the cost of charges for services
authorized by your PCP. HMOS only provide coverage for services outside of
your medical group in cases of emergencies.
Health Net
Kaiser
Permanente
Western
Health Advantage
For Medicare enrollees:
Health
Net/Seniority Plus
Kaiser/Senior
Advantage
WHA
Care+
Point-of-Service Plan
This plan combines characteristics of the HMO and the PPO. The in-network level
of this plan functions like an HMO and you must choose a primary care physician
who is responsible for all referrals within the POS network. If you choose
to go outside the network for healthcare, the plan functions more like a PPO.
Anthem Blue Cross PLUS
Preferred Provider Organization (PPO)
A PPO generally offers a broader network of doctors and hospitals than an HMO.
This plan model has arrangements with doctors, hospitals, and other providers
of care who have agreed to accept lower fees from the plan for their services
and participate in the network of physicians. If you need or want heath care
from outside the network you have access, but you should expect to pay a higher
copayment than if the provider were from within the PPO network.
Anthem Blue Cross PPO
Fee-for-Service Plan
This plan allows you to choose the doctor, the hospital, the clinic, or the behavioral
health provider and the insurance pays for part or all of the cost according
to the schedule laid out in the policy after you have met your plan's deductible.
Under this plan, you pay for services up front and submit a claim to the insurance
company, and if the service is covered in the policy, you receive reimbursement.
For Medicare Enrollees:
High
Option
Core
To learn more about the similarities and differences among HMOS, Point of
Service plans, PPOs and fee-for-service plans, see
the Medical Plan Comparison chart.
For a summary of plan benefits for most plans, see the Medical
Benefits Summary.
Medical Plans for eligible UC retirees living outside California
HMOs: Kaiser
Permanente Mid-Atlantic - for retirees living in the District of Columbia,
Maryland or Virginia;
For Medicare enrollees: Kaiser
Mid-Atlantic/Medicare Plus
PPOs: Anthem Blue Cross
PPO
Fee-for-service: Core
For Medicare Enrollees: High
Option, Core
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