Frequently Asked Questions about UC Health Plans for Employees
The following are answers to ‘recent’ frequently asked questions (FAQs) regarding UC sponsored health plans.* You may also review UCOP’s At Your Service for an extended list of FAQs and general information regarding your UC benefits. I hope these FAQs are helpful.
Blue Cross Plus, PPO, High Option 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 your UCSF benefits office. Campus 476-1400, Medical Center 353-4545.
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 an other source?” What should I do?
A: Do not be alarmed! Blue Cross sends an EOB of this type once a year to each member. Complete the form as requested and mail back to Blue Cross. Once processed you will receive an updated EOB.
Q: Does my Blue Cross health plan cover medical services when I am traveling outside of California?
A: Yes, Blue Cross Plus, PPO, 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. Visit the Blue Cross website for details, www.bluecrossca.com/uc, or call Blue Cross, (888) 209-7975.
Q: How can I find information about the Blue Cross mail order pharmacy benefit?
A: Review the Blue Cross website, www.bluecrossca.com/uc or contact Blue Cross, (888) 209-7975.
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.
Health Net , PacifiCare and Blue Cross Plus ?In-Network? Plans
Q: Can I change my primary care physician (PCP) 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.http://atyourservice.ucop.edu/contact/medical_plan.html. 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 (PCP)?
A: Yes.
Q: How do I find out if a specialist is covered under my insurance plan?
A: Search the carrier website under ‘specialist type?. http://atyourservice.ucop.edu/contact/medical_plan.html. Your may also call the health plan member services department and ask if the specialist is in their plan. 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. http://atyourservice.ucop.edu/contact/medical_plan.html 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. If there is no other HMO available to you to keep your current doctor or medical group, review the plan website 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.
*FAQs regarding the Kaiser plan have not been included because generally there have been very few inquires regarding this plan.