UC Care

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

This plan is administered by Blue Shield of California. Prescription drug coverage is also included through Navitus.

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

• UC Select Tier 1: 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 Tier 1 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 level. Provider and service types not available through UC Select Tier 1 are likely available through Blue Shield PPO Tier 2 providers at the Tier 2 coverage level.
• Blue Shield PPO Tier 2: 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.
• Out-of-network tier 3: 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. For help filing claims, log on to the Accolade member portal or call Accolade at (866) 406-1182.

Preventive care, including services such as screenings, immunizations and exams for you and all covered family members is covered at 100% when you see an in-network provider. (Out-of-network preventive care is covered at 50% after the out-of-network deductible.) Learn more about covered preventive care services.

Deductible

• UC Select Tier 1 providers: $0
• Blue Shield PPO Tier 2 providers: $500 (for self-only coverage) or $1,000 (for family coverage)
• Out-of-network provider: $750 (for self-only coverage) or $1,750 (for family coverage)
• Covered medical and pharmacy expenses count toward the deductible

Cost of care:¹

• UC Select Tier 1 providers: $30 copay for most office visits and other outpatient services
• Blue Shield PPO Tier 2 providers: After your deductible of $500, you pay 30% of the cost of most covered services; there is no deductible for preventive care. Your provider sends a claim to Blue Shield of California. Blue Shield sends an Explanation of Benefits to you showing the full cost and the amount you're responsible for paying. (In-network providers charge lower rates.) Your doctor will send you a bill for your portion.
• Out-of-network provider: After your deductible and copayment, the plan pays 50% of the allowed amount and you are responsible for the rest, including any billed charge that exceeds the amount allowed for services. These additional amounts do not count toward the out-of-pocket maximum

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 Blue Shield of California pays 100% for most covered medical services and Navitus pays for 100% of most prescription drugs, for the rest of the year.

• UC Select Tier 1 providers: $6,100 (for self-only coverage) or $9,700 (for family coverage)
• Blue Shield PPO Tier 2 providers: $7,600 (for self-only coverage) or $14,200 (for family coverage)
• Out-of-network providers: $9,600 (for self-only 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 Tier 1/ Blue Shield PPO Tier 2 (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 / Blue Shield PPO (in-network) out-of-pocket max or the Blue Shield PPO deductible.

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.

All UC PPO plans offer a range of comprehensive clinical resources for every stage of a woman’s life, including no-cost preventive care, family planning and midlife health. Learn more about women’s health services.

Provider-ordered PCR testing is covered based on your plan’s benefits. You pay 20% of the cost after the Blue Shield PPO Tier 2 deductible. Over-the-counter tests are not covered.

The UC faculty/staff 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 Blue Shield of California 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.

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.

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 Accolade 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 Blue Shield of California.

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.

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 member portal.

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

Blue Shield of California is the claims administrator for UC faculty/staff PPO Plans. Blue Shield of California processes and reviews the medical and behavioral health claims submitted under the PPO plans. 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. The content on this website provides highlights of your benefits under the UC non-Medicare PPO plans. The official plan documents and administrative practices will govern in any and all cases.