USC Verdugo Hills PPO medical plan

The USC Verdugo Hills medical insurance plan is administered by HealthComp.

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 & 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 & 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 & 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