Frequently Asked Questions about UC Health Plans for Annuitants
The following are answers to frequently asked questions (FAQs) regarding UC sponsored health plans. You may also review UCOP’s At Your Serivce for Annuitantsfor an extended list of FAQs and general information regarding your UC benefits.
Blue Cross Plus, PPO, High Option Supplement to Medicare and Core Plans
Q: What is my membership I.D. number?
A: Your membership I.D. is alpha-numeric and listed on the front of your card beginning with the letter ‘U’ followed by several zeros then numbers. Please note that there are 3 letters preceding the ‘U’ but the letters are not part of your I.D.
Q: I called the Blue Cross member services department and the representative couldn’t verify my eligibility, how can I resolve this?
A: Contact the University Office of the President customer service department, 1-800-888-8267.
Q: What if the I.D. cards for myself and my family do not list the PCP/Medical group I selected?
A: Contact Blue Cross Member services ‘immediately’ and request the desired PCP/medical group assignments for each family member, (888) 209-7975.
Q: My primary care provider (PCP) is under the Brown and Toland (B&T) Medical Group. However, B&T does not have a record of my enrollment. What should I do?
A: Check your Blue Cross member I.D. and verify that your correct PCP/Medical Group is listed on the card. If there is an error call Blue Cross with the correct information, then follow the next step.
Call B&T customer service, (415) 553-6588, let the representative know that you are a member under B&T. Request that your eligibility be updated in their database.
Q: I just received an explanation of benefits (EOB) statement from Blue Cross that states paid amount is ‘zero’ and a detail message asking, "Are group health insurance benefits for these expenses available form another source?" Why are they asking this and what should I do
A: Do not be alarmed! Blue Cross sends an EOB of this type to members once every year. It is their way of obtaining other insurance information in addition to Medicare. Please complete the form as requested and mail back to Blue Cross. Once processed you will receive an updated EOB.
A: Yes, Blue Cross Plus, PPO, High Option Supplement to Medicare and Core all provide inpatient/outpatient services when you are traveling outside of California. In fact coverage is available worldwide. Members have national and international access to prescription drug benefits as well. Your benefit level is subject to the plan design and in coordination with Medicare as applicable. Please note that members with Medicare that are traveling/living abroad are subject to the non-Medicare benefit level of their Blue Cross plan because Medicare does not provide coverage outside of the U.S.
Q: Has the High Option Supplement to Medicare Plan pharmacy benefit changed?
A: Yes, on January 1, 2003 the High Option Supplement to Medicare pharmacy benefit changed to a three tier co-pay plan, administered by Blue Cross/WellPoint pharmacy. If you have questions you may call the Blue Cross Well Point pharmacy program at (800) 700-2541. You may also view Blue Cross Well Point pharmacy information on-line,http://www.bluecrossca.com/.
Please note the addition of a $1000 out-of-pocket maximum on prescription drugs (co-pays for non-formulary drugs and expenses incurred when using a non-network pharmacy do not apply).
Q: Can I have prescriptions refilled by mail if they are on the regulated drug list?
A: Typically ‘no’. For a list of drugs available through mail order contact Blue Cross at (800) 700-2541 or review information on-line at https://www.precisionrx.com/wpx/index.jsp
Q: Will the formulary (the health plan’s list of drugs) change during the year?
A: Yes, the plan’s formulary is subject to change. An example of a typical change is a drug that was only available under a brand name becomes available as a generic.
Q: How does Blue Cross Medicare Crossover work?
A: The Medicare Crossover feature is available for all the Blue Cross plans, including Blue Cross Plus, Blue Cross PPO, High Option Supplement to Medicare and Core. The Crossover feature allows Blue Cross to access your explanation of benefits (EOBs) directly from Medicare so that you (or your provider) do not need to re-submit a claim with Blue Cross after filing a claim with Medicare. You can activate this feature by calling Blue Cross and providing your Medicare number, (888) 209-7975.
Q: Is the Blue Cross Medicare Crossover a one-time registration?
A: Yes.
Q: If Medicare does not cover the service provided, will my insurance plan cover it?
A: There may be some services not covered by Medicare that are covered by your insurance plan. Always check with your health plan to determine your benefit level before receiving services in question.
Health Net, PacifiCare and Blue Cross Plus “In-Network” Plans
Q: Can I change my primary care physician outside of Open Enrollment?
A: Yes, you may change your PCP and provider group outside of open enrollment. Most plans allow you to make a change once a month. Typically if you request the change before the 15th of the month, the change is effective the first of the following month. Contact your health plan regarding the administrative processes required to make the change. Click on the following link to view a list of UC sponsored health plan phone numbers and web links, Health Plan Contacts. Please note that if you are under care for an escaled healthcare issue, your movement between medical groups may be restricted.
Q: Can I and my family members each have a different primary care physician?
A: Yes.
Q: How do I find out if a specialist is covered under my insurance plan?
A: Call the health plan member services department and ask if the specialist is in their plan. You may also look-up the information on the carrier website by searching under ‘specialist type’ Health Plan Contacts . Generally an HMO member must be referred by his/her primary care physician (PCP) to a specialist in the medical group network in order for the services to be covered. (A referral to an out-of-network specialist requires special authorization by the medical group.)
Q: My PCP is contracted with Brown & Toland (B&T). What type of authorization do I need to see a specialist?
A: All members may self-refer to a B&T contracted ob/gyn for female-related services. A patient needs a VERBAL okay from their PCP to see a contracted podiatrist (DPM), or contracted ophthalmologist (MD). A Blue Cross Plus member may also self-refer to network ENT specialist, Dermatologist and Immunologist through the Direct Access Program. For most other types of medical specialists, a patient needs a WRITTEN referral from the assigned PCP.
Q: If I receive a letter from my Primary Care Provider (PCP) stating that he/she will no longer accept my insurance because he/she no longer has a contract with the insurance plan (provider disruption) what are my options?
A: Call your doctor or medical group and ask them if they have a contract with another UC HMO in your service area. If they do and you would like to stay with your current doctor and/or medical group ask them whether or not they will take you as a patient under the other HMO. Then apply for an HMO transfer under UC, by contacting UC Customer Service at (800) 888-8267. If there is no other HMO available to you to keep your current doctor or medical group, call the plan to find out what other doctors or medical groups are available to your in the area. They can advise you and assist you in making the change to a new primary care physician. If you are not satisfied with the solutions outlined above call your Health Care Facilitator.
Q: PacifiCare Secure Horizons and Health Net Seniority Plus have an annual prescription drug co-pay maximum of $2000 per person. What does this mean?
A: This means that once an individual member has paid $2000 in prescription co-pays in a plan year, the member’s eligible prescriptions will be paid at 100% for the rest of the plan year.
*FAQs regarding the Kaiser plan have not been included because generally there have been very few inquires regarding this plan.