Important Information

Monthly Employee Contributions for 2014

USC Network Medical Plan

Employee: $130.00
Employee + Adult: $366.00
Employee + Child(ren): $228.00
Employee + Adult + Child(ren): $366.00

Keck Medical Center of USC — UPC

Covered Persons under the USC Network Medical Plan can now access care from Keck Medicine of USC doctors at the Engemann Student Health Center, fourth floor on the University Park Campus. Please call (213) 821-6500 to make an appointment with a Keck Medicine of USC doctor at this location.

Tier 2 Participating Providers – Nationwide Coverage

You have access to participating providers nationwide. What this means to you is that you are able to access a larger network of contracted physicians and hospitals within the state of California and across the United States (with the exception of vision and dental providers) and have benefits calculated at a negotiated contract rate.

You may look up participating providers at the Anthem website at www.anthem.com/ca for providers within California. You can also call Anthem Blue Cross for assistance at (800) 888-8288, 24 hours a day, seven days a week. For providers outside of California, you can search the Anthem BlueCard program at www.bcbs.com/bluecardworldwide or call them at (800) 810-2583. When making an appointment with any participating provider, you must verify with their office that the provider continues to participate either in Prudent Buyer or BlueCard program. Otherwise, benefits will be calculated at the out-of-Network rate if the provider no longer participates.

Network Referral to Non-Network Provider

If your Network Physician refers you to another physician or health care provider, it is your responsibility to verify that the physician or other provider is also a Network provider. If the physician or other provider is not a Network provider, benefits will be paid at the out-of-Network rate.

CVS Caremark

Pharmacy benefits for the USC Network Medical Plan are managed by CVS Caremark.

Prescription Copay Information

The retail Copayment for prescription drugs filled at a Network pharmacy for each 30 day supply is:

Generics – $10 CopayBrand with no Generic available - 20% of the cost, with a minimum Copay of $30.00. Maximum Copay of $125 per prescription.

Brand with Generic available – 50% of the cost with a minimum Copay of $30.00 – No Maximum Copay.

Specialty Drugs – $200 Copay (for a current list of Specialty Drugs, click here)

The Plan has a mandatory Step Therapy in place for Proton Pump Inhibitors (PPI) and Antihistamines. What this means is that you must first fill a generic/over the counter (OTC) medication at a $0 Copay before a Brand name prescription under these two categories will be covered by the Plan. The following is a list of the generic/OTC medications that are covered at $0 copay with a written prescription from your doctor:

PPIs: omeprazole, omeprazole OTC, omeprazole-sodium bicarbonate, pantoprazole, lansoprazole, lansoprazole ODT, Prevacid OTC, Prilosec OTC, and Zegerid OTC

Antihistamines: cetirizine, cetirizine OTC, fexofenadine-pseudoephedrine, levocetirizine, loratadine OTC, Alavert, Alavert-D, Claritin OTC, Claritin-D 12 HR, and Zyrtec OTC.

For maintenance medications dispensed in excess of a one month’s supply at a retail pharmacy, multiple copayments will be charged.

A Mail Service is available for maintenance drugs through which you can obtain up to a 90 day supply of medication, as long as your physician has written the prescription for a 90 day supply. The above retail Copay also applies to each 30 day supply of medication purchased through mail order.

For more information about Mail Service, please see www.caremark.com or call CVS Caremark at (877)889-3402.

CVS Caremark Pharmacies: USC Health Center Pharmacy, USC Pharmacy, USC Medical Plaza Pharmacy, Verdugo Professional Pharmacy, Verdugo Medical Pharmacy, CVS, Rite Aid, Ralph’s, Wal-Mart, Vons, Walgreens, Albertsons, Payless Drugs, Costco, and other small independent pharmacies. Please call (877)807-7341 to verify the participation of a pharmacy.

If you have any questions regarding pharmacies or outstanding prescription claims previously submitted by you, please call CVS Caremark at (877)807-7341.

For prescriptions filled at a non-Network pharmacy, the Plan will reimburse 50% of the Plan’s CVS Caremark contracted rate (not 50% of cost). Prescriptions filled at a non-Network pharmacy must be paid in full by the Covered Person at the time of service. The Covered Person must then submit a prescription claim form to CVS Caremark within 60 days of the fill to get reimbursed 50% of the Plan’s contracted rate.

If you have prescription claims that need to be submitted for reimbursement, please forward them within 60 days of the fill to:

Commercial Paper Claims
CVS Caremark
P.O. Box 53992
Phoenix, AZ, 85072-3992

Medical Claims Information

All inquiries regarding Explanation of Benefit correspondence or any medical bill in question should be directed to HealthComp at (855) 727-5267, Monday-Friday, 6:00 a.m. — 4:30 p.m  (PST). You can also view your paid claims information on HealthComp’s website at www.healthcomp.com. You must first register on their site as a member before you will be allowed to view your information.

All medical claim forms, bills and receipts that require reimbursement to the Patient should be forwarded to:

HealthComp Administrators
P.O. Box 45018
Fresno, CA 93718-5018

Medical claim forms for submission to HealthComp can be downloaded at www.healthcomp.com.

ID Cards

USC Network Medical Plan ID cards are issued and mailed by HealthComp. ID cards are mailed to your home address in a USC envelope with “USC Network Medical Plan ID Card Enclosed” in bold letters. HealthComp automatically sends a maximum of two (2) ID cards to subscribers with family coverage. If you have family coverage and need an extra ID card, you may request an additional card by logging into the HealthComp website at www.healthcomp.com or you can call HealthComp at (855) 727-5267 for assistance. It may take up to two (2) weeks from the day you place your request to receive the ID card.

Mental Health

You have access to a network of mental health and substance abuse treatment providers. Anthem Blue Cross Prudent Buyer mental health providers in California and Anthem BlueCard providers in all other states will be providing services to all our participants at the Tier 2 benefit level. You can search for providers at www.anthem.com/ca in California and at www.bcbs.com/bluecardworldwide outside of California. You can access Tier 1 providers from Keck Medicine of USC. You can search for these providers at keckmedicine.org.

Inpatient admissions, partial hospital (day treatment), residential treatment center and intensive outpatient visits require prior authorization and Anthem Blue Cross should be contacted at (800) 274-7767.

For benefit questions or concerns, please call HealthComp at (855) 727-5267.

Vision Service Plan

Employees enrolled in the USC Network Medical Plan are automatically enrolled in Vision Service Plan (VSP) Choice Network. You can verify your eligibility, plan coverage and other information by accessing the VSP website at www.vsp.com. You must enter your USC Network Medical Plan Subscriber ID number (which can be located on the front of your Plan ID card) on their web site instead of your social security number to view your coverage. You can also call VSP at (800) 877-7195 for assistance.