UC Care

See the plan comparison chart [PDF] for more coverage details.

Three tiers of coverage: Your cost for care is based on where you receive services.

• Tier 1: UC Select. Available only in California. Features no deductible and set copays for most covered services when you get care from UC physicians and health centers and some other select providers. Every campus — even those without a UC health center — has access to UC Select providers. Tier 1 is focused on primary care and hospital services, and some specialty care. Not all services and provider types are available at the Tier 1 benefit. Provider and service types not available through Tier 1 are likely covered through the Tier 2 (Anthem Preferred) benefit.
• Tier 2: Anthem Preferred. Offers a wider range of providers and facilities, with access to more than 62,000 providers statewide. You must meet an annual deductible, and then the plan pays most of the cost of services received.
• Tier 3: Out-of-network. You can also choose to receive care from out-of-network providers. However, your costs will be significantly higher, and you’ll have to file claims. See the plan comparison chart [PDF] for more details about your cost for out-of-network care.

You can also choose to receive care from out-of-network providers. However, your costs will be significantly higher, and you’ll have to file claims. See the plan comparison chart [PDF] for more details about your cost for out-of-network care.

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Preventive care, including services such as screenings, immunizations and exams for you and all covered family members when you see an in-network provider. (Out-of-network preventive care covered at 50% after the out-of-network deductible.) Learn more about covered preventive care services.

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Deductible

• UC Select providers: $0
• Anthem Preferred providers: $500 (for individual coverage) or $1,000 (for family coverage)
• Out-of-network provider: $750 (for individual coverage) or $1,750 (for family coverage)

Cost of care:¹

• UC Select providers: $30 copay for most office visits and other outpatient services. 
• Anthem Preferred providers: After your deductible of $500, you pay 30% of the cost of most covered services; there is no deductible for preventive care
• Out-of-network provider: After your deductible, you pay 50% of the cost of most covered services

Out-of-pocket maximum

This limits the amount you’ll pay for covered services during the year. After you meet the out-of-pocket maximum,¹ Anthem pays 100% for most covered medical services and Navitus pays for 100% of most prescription drugs, for the rest of the year.

• UC Select providers: $6,100 (for individual coverage) or $9,700 (for family coverage)
• Anthem Preferred providers: $7,600 (for individual coverage) or $14,200 (for family coverage)
• Out-of-network providers: $9,600 (for individual coverage) or $20,200 (for family coverage)

See the plan comparison chart [PDF] for more coverage details.

1. Out-of-pocket costs for UC Select / Anthem Preferred (in-network) services cross-accumulate (i.e., they count toward each other). Out-of-pocket costs for out-of-network services do not count toward the UC Select / Anthem Preferred (in-network) out-of-pocket max or the Anthem Preferred deductible.

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You and your covered family members can use behavioral health benefits for sessions with counselors, psychologists or psychiatrists for mental health services and substance use treatment. If you need help finding a provider and booking and appointment, call Accolade at (866) 406-1182 Monday–Friday, 5 a.m.–8 p.m. PT. You can also speak to a therapist or psychologist virtually through Accolade Care Telehealth and Virtual Visits.

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The journey to parenthood is not always easy. If you are struggling to conceive, WINFertility is here to help.

UC families enrolled in the Anthem UC Care, HSP, and CORE medical plans are provided a 2-cycle lifetime maximum benefit toward eligible expenses related to fertility treatment and related fertility medications. Coverage includes IVF, GIFT, and ZIFT coverage with 50% coinsurance (after deductible), up to a combined limit of two treatment cycles per lifetime, per member.

The benefit also includes artificial/intrauterine insemination (IUI) cycles, assisted reproductive technologies (ART), and related services as well as infertility specialty medications (also subject to coverage maximums). It does not cover expenses for surrogacy, fees associated with surrogacy or expenses for procuring donated oocytes or sperm.

All fertility services are subject to medical necessity and prior authorization by WINfertility, which will also provide a range of support services.

What you can expect

WIN will help you better understand your options so you can maximize your benefit and choose the best course of treatment. More importantly, WIN knows this can be an extremely stressful and emotional time in your life, and is here to support you through your fertility journey.

• 24/7 access to WIN’s Nurse Care Managers for emotional guidance and support
• Assistance in selecting a high-quality, in-network provider based on your individual treatment needs
• Expertise in understanding complex information and decisions regarding infertility causes, testing and treatment option success rates and risk
• Guidance to help increase the efficient use of hormonal medications to avoid wastage and over-stimulation
• Education on your pharmacy dosing usage, storage, and medication side effects and also assistance in maximizing your infertility medication benefit

WINFertility will assist you in selecting the right provider and navigating the system, your care and benefits. Working together with your health plan network of doctors and pharmacies, WIN provides you with total support and coordination of care.

What it costs

After any applicable deductible, you pay 50% coinsurance for each treatment cycle. (Maximum of two combined cycles per lifetime for each covered member.) Your costs do not count toward the plan’s out-of-pocket maximum.

Get started

For benefit details and eligibility, contact WINFertility at (877) 451-3077, or visit managed.winfertility.com/universityofcalifornia. Service team members are available Monday–Friday 6 a.m.–4:30 p.m. PT. And download the WINFertility Companion app from Google Play or the App Store to take advantage of your benefits on the go. (App code: UCA23.)

For more details, see the WINFertility flyer [PDF] and detailed coverage information [PDF].

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Provider-ordered tests: PCR testing is covered based on your plan’s benefits. You pay 20% of the cost after the $1,650 (individual)/$3,300 (family) in-network deductible.

Over-the-counter (OTC) tests: Effective Jan. 1, 2025, OTC tests are no longer covered. You have one year from the date of purchase to submit a claim form for reimbursement for any tests purchased in 2024. Complete sections 1 and 2 of the form and sign where indicated.  Mail the claim form and your receipts for the OTC COVID tests purchased to Anthem Blue Cross, PO Box 60007, Los Angeles, CA 90060-0007. (Do not submit claims through the Anthem member portal or Sydney app.) Claim processing can take up to 45 days. If you do not receive your reimbursement after 45 days or have any questions about your submission, contact Accolade at (866) 406-1182 for help.

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The UC PPO plans give you a range of options to get care when you need it—from in person to virtual care (telehealth), and urgent care and emergency services through University of California Health Providers, the Anthem provider network, and Accolade Virtual Care and 2nd.MD. (Your primary care doctor and specialists may also offer virtual appointment options. Contact their office for more information.) You’re even covered when you’re traveling out of state or out of the country. Find the right care for your need.

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Some specialists — and specialty treatment centers (like nephrology or infusion) — may require a referral from your primary care doctor or prior authorization from Accolade before you can make an appointment. When scheduling an appointment, call Accolade at (866) 406-1182, Monday–Friday, 5 a.m.–8 p.m. PT to ask if a preservice review or precertification is required prior to your initial visit.

Certain services, such as a planned surgery with an overnight hospital stay, require prior authorization from Accolade. If you have a procedure scheduled or a condition that will require treatment, you may need a preservice review. For assistance, call Accolade at (866) 406-1182, Monday–Friday, 5 a.m.–8 p.m. PT.

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Medical and behavioral health

When you see in-network providers, there are no claim forms to fill out. Your provider handles all the paperwork.

If you see an out-of-network provider for medical or behavioral health services or use an out-of-network pharmacy, it's up to you to submit a claim for reimbursement for services received or prescriptions.

The easiest way to file an out-of-network claim is to start with Accolade. Call (866) 406-1182 (Monday–Friday, 5 a.m.–8 p.m. PT) or visit the digital member portal. Accolade will direct you to the correct forms and answer any questions you have.

If you prefer, you can file out-of-network medical and behavioral health claims directly with Anthem through the Anthem member portal or the Sydney Health app. Download it through the App Store or Google Play.

Pharmacy

When you fill prescriptions at Navitus network pharmacies, there are no claim forms to fill out. Your pharmacy handles all the paperwork. If you use an out-of-network pharmacy, it's up to you to submit a claim for reimbursement for services received or prescriptions. The easiest way to file an out-of-network claim is through the Navitus member portal.

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For questions about medical coverage, claims, finding providers and more, start with Accolade. Call (866) 406-1182 (Monday–Friday, 5 a.m.–8 p.m. PT) or visit the Accolade website.

For questions about prescription drug coverage and costs, call Navitus Customer Care at (833) 837-4308 or visit the Navitus member portal.

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Anthem Blue Cross Life and Health Insurance Company is the claims administrator for UC PPO Plans. On behalf of Anthem Blue Cross Life and Health Insurance Company, Anthem Blue Cross processes and reviews the medical, pharmacy and behavioral health claims submitted under the PPO plans. Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Navitus is an independent company providing pharmacy benefit management services on behalf of the University of California for the PPO plans. Accolade is an independent company providing benefits advocacy services on behalf of the University of California for the PPO plans. Health Net is the claims administrator for the UC Blue & Gold HMO. Health Net processes and reviews the medical, pharmacy and behavioral health claims submitted under the UC Blue & Gold HMO. All plan benefits are provided by the Regents of the University of California. The content on this website provides highlights of your benefits under the UC non-Medicare PPO Plans plans and the Blue & Gold HMO. The official plan documents and administrative practices will govern in any and all cases.