High quality, affordable medical plan designed for USC employees. Offers access to Keck Medicine of USC and other high quality selected Anthem providers in the six counties in Southern California.

No out-of-network coverage (except for urgent care and emergencies).

You have access to Lyra Health for mental/emotional care and the Livongo diabetes program.

Learn more at employees.usc.edu/epo.

USC TrOjAN CAre ePO PL AN

USC TrOjAN CAre ePO PLAN

without incentives

withincentives

eMPLOYee

Salary $53,000 or less $142 $77*

$53,000.01–$104,000 $144 $79*

$104,000.01–$156,000 $147 $82*

$156,000.01–$250,000 $149 $84*

More than $250,000 $149 $84*

eMPLOYee + ADULT

Salary $53,000 or less $297 $232*

$53,000.01–$104,000 $300 $235*

$104,000.01–$156,000 $308 $243*

$156,000.01–$250,000 $311 $246*

More than $250,000 $312 $247*

eMPLOYee + CHILD(reN)

Salary $53,000 or less $244 $179*

$53,000.01–$104,000 $247 $182*

$104,000.01–$156,000 $253 $188*

$156,000.01–$250,000 $255 $190*

More than $250,000 $256 $191*

eMPLOYee + ADULT + CHILD(reN)

Salary $53,000 or less $378 $313*

$53,000.01–$104,000 $382 $317*

$104,000.01–$156,000 $392 $327*

$156,000.01–$250,000 $396 $331*

More than $250,000 $398 $333*

MeDICAL COverAge

Primary care physician (PCP) required?

No, but you can save by designating one

Out-of-network coverage? Urgent care and emergency only

Preventive care cost $0

Primary care visit cost $20 copay ($10 copay with designated PCP)

Deductible (individual/family) $100/$300

Out-of-pocket maximum (individual/family)

$1,000/$3,000

reTAIL PreSCrIPTION DrUg COverAge (30 day supply)

Generic $5 copay

Brand (no generic available) $25 copay

Brand (generic available) $70 copay

Specialty drug $125 copay

Participate in healthy choices incentives and save $780 on your medical plan premiums. Get started at USCwellness.cafewell.com.

ServICe PrOvIDerS

Complete in-person health screening

Complete online questionnaire

Verify you are tobacco free

annually (Excluding anthem MyChoice plan)

gympass.com866.642.7917

livehealthonline.com888.548.3432

deltadentalins.com888.335.8227

anthem.com/ca800.227.3771

hconline.healthcomp.com/uscprovidersearch.aspx855.727.5267

mp.medimpact.com/usc844.401.2054

lyrahealth.com844.495.7094

vsp.com800.877.7195

ucci.com800.937.6432

*Health Assessment and Tobacco Free Incentives

USC TrOjAN CAre ePO PrOvIDer NeTwOrK

Member Support800.945.4355

This plan offers the most provider choice, but highest cost.

Tier 1: Keck Medicine of USC providers

Tier 2: Anthem Blue Cross Prudent Buyer/BlueCard providers (nationwide and international providers)

Tier 3: Out-of-network (non-contracted providers)

You have access to Lyra Health for mental/emotional care and the Livongo diabetes program.

Learn more at employees.usc.edu/ppo

USC PPO PL An

USC PPO PLAnwithout incentives

withincentives

EMPLOYEE

Salary $53,000 or less $264 $199*

$53,000.01–$104,000 $267 $202*

$104,000.01–$156,000 $275 $210*

$156,000.01–$250,000 $280 $215*

More than $250,000 $286 $221*

EMPLOYEE + ADULT

Salary $53,000 or less $573 $508*

$53,000.01–$104,000 $579 $514*

$104,000.01–$156,000 $597 $532*

$156,000.01–$250,000 $609 $544*

More than $250,000 $621 $556*

EMPLOYEE + CHILD(REn)

Salary $53,000 or less $462 $397*

$53,000.01–$104,000 $466 $401*

$104,000.01–$156,000 $481 $416*

$156,000.01–$250,000 $490 $425*

More than $250,000 $500 $435*

EMPLOYEE + ADULT + CHILD(REn)

Salary $53,000 or less $742 $677*

$53,000.01–$104,000 $750 $685*

$104,000.01–$156,000 $773 $708*

$156,000.01–$250,000 $788 $723*

More than $250,000 $803 $738*

Participate in healthy choices incentives and save $780 on your medical plan premiums. Get started at USCwellness.cafewell.com.

Complete in-person health screening

Complete online questionnaire

Verify you are tobacco free

Annually (Excluding Anthem MyChoice Plan)

*Health Assessment and Tobacco Free Incentives

SERvICE PROvIDERS

gympass.com866.642.7917

livehealthonline.com888.548.3432

deltadentalins.com888.335.8227

anthem.com/ca800.227.3771

hconline.healthcomp.com/uscprovidersearch.aspx855.727.5267

mp.medimpact.com/usc844.401.2054

Member Support800.945.4355

lyrahealth.com844.495.7094

vsp.com800.877.7195

ucci.com800.937.6432

USC PPO PROvIDER nETwORK

TIER 1 TIER 2 TIER 3

Prudent Buyer PPO and International

Coverage

Other

MEDICAL COvERAgE

Primary care physician (PCP) required?

No, but you can save by designating one

Out-of-network coverage? Yes

Preventive care cost Tier 1: $0 Tier 2: $0 Tier 3: 50%+*

Primary care visit cost Tier 1: $20 ($10 copay with designated PCP)

Tier 2: $30 copay ($20 copay with designated PCP)

Tier 3: 50%+*Deductible (individual/family) Tier 1: $100/$300

Tier 2: $250/$750 Tier 3: $600/$1,800

Out-of-pocket maximum (individual/family)

Tier 1: $1,500/$4,500 Tier 2: $2,500/$7,500 Tier 3: $12,500/$37,500

RETAIL PRESCRIPTIOn DRUg COvERAgE (30 dAy suPPly)

Generic $5 copay

Brand (no generic available) $25 copay

Brand (generic available) $70 copay

Specialty drug $125 copay

*If you use a Tier 3 (out-of-network) provider, you pay deductible and all charges above 50% of “usual and customary” fees.

WAGEWORKS FITNESS INCENTIVE PROGR AM

USC’s Fitness Incentive program is designed to encourage and support your healthy lifestyle. This program reimburses you up to $220 per year for eligible wellness activities including gym membership fees, fi tness classes and much more.

WageWorks makes it easy to submit receipts and track reimbursements online at www.wageworks.com.

LEARN MORE AND JOIN AT WAGEWORKS.COM

A healthier lifestyle pays off . Get up to $220 reimbursement for eligible wellness activities through WageWorks.

· The $220 incentive reimbursement is subject to taxes, including all federal and state withholding and employment taxes (FICA-OASDI, Medicare, Additional Medicare, Disability).

· Enrollment is open to all benefi ts-eligible employees (except for VHH, Local 11 and Las Vegas groups, which have diff erent benefi ts).

• Your reimbursement for approved claims will be added to your paycheck, typically one to two payroll cycles after approval. Check your reimbursement status anytime online at the WageWorks site.

• All 2020 expenses can be submitted to WageWorks beginning on January 1, 2020. Current WageWorks users will be able to access all benefi ts using their existing username and password. New users need to register by selecting “Login/Register” from the upper right-hand corner of the homepage at www.wageworks.com.

Submitting your claim is simple:

Go to www.wageworks.com. If you have an existing account through WageWorks you may submit your claim. If you are new to WageWorks you may register and create an account where you can view a com-plete list of eligible expenses.

Use EZ Receipts Mobile App. You can also submit Fitness “Pay Me Back” claims using the EZ Receipts Mobile App. To learn more about the EZ Receipts App, go to www.wageworks.com/myezreceipts.

Required supporting documents to process a claim:Documentation may be a scanned receipt, credit card/bank statement, document on fi tness club letterhead, or other offi cial documentation providing it has: 1. Employee’s name, 2. name of the service provider, 3. description of service, 4. payment amount (cost), and 5. service date/period.

Eligibility review. Your fi tness incentive will be reviewed for eligibility. Payment for approved claims will appear on the next paycheck, which is typically one to two payroll cycles after approval.

How do I receive reimbursement?Complete the claim form and submit online (or via fax or mail) as indicated on the form, along with appropriate documentation of payment. (See “Required supporting documents to process a claim” in the left column below.)

When can I submit a claim form?You have 60 days after the end of the calendar year the expense was incurred to submit a reimbursement request for eligible expenses.

What if my claim is for dates of service which cross the calendar year?For claims that cross over into 2021, participants must resubmit a claim form.

Q&A

GYMPASS

Enjoy your benefitUSC offers memberships priced up to 70% less than market value

Flexible locations40,000 gyms in 14 countries+6,000 gyms in the US+800 different activities

Easy to useSimple and quick access through our website or app For more information go to help.me@gympass.com

or call 866.642.7917

CHOOSE YOUR PLAN. UP TO 70% OFF!

No lock-ins. Cancel your membership right in your app.

1

2

3

THREE STEPS TO START TRAINING:

REGISTER—CREATE YOUR FREE ACCOUNTCREATE YOUR FREE ACCOUNTRegister with your primary work email address at gympass.com/us/usc-us. You will also need your 7-digit employee ID number. Download the app to see nearby locations.

CHOOSE YOUR PLAN SEARCH FOR GYMSTo select the plan that fits you best, search for options that interest you.

Check which plan includes these gyms/venues. Once you choose and acti-vate your plan, all gym partners available to you will be displayed on the app or web page when you are logged in.

ACTIVATE YOUR UNLIMITED PLANClick on Activate My Package

ACCESS THE GYM CHECK IN AT THE GYM’S FRONT DESKClick on the Check-in icon in your app. Select the gym partner you would like to Check-in. Click on Check-in for the classes/workout you want to do. If you make a mistake, click on Cancel Check-in.

YOU CAN ACCESS A DIFFERENT GYM EACH DAY!

How do I sign up my dependents?Once you activate your plan, you will see the option to add your dependent on your homepage. Click ‘Add a Dependent’, then enter their information, and they will receive a welcome email from Gympass.

My favorite gym isn’t part of the network. Can you add it? We take referrals! Our Gym Partnerships team is constantly working to expand our growing network. Submit your referral via your Gympass account. Whether on the Gympass app or website, click on ‘Profile’ and click ‘Refer a gym’. Fill out the required fields, and we will update you if it is added to the Gympass network.

How do I change or cancel my plan? Is there a charge?There is no enrollment fee or minimum contract length. You can make changes to your plan at any time by logging into your account. Select Profile > My Plan > Change or Cancel Plan. If you need assistance or have questions, contact help.me@gympass.com. The active plan at the time of cancellation will continue through the end of the monthly billing cycle. Please be sure to make any changes to your plan prior to this date.

Q&A

Starter $40 $9.99

Basic $70 $24.99

Bronze $100 $39.99

Silver $150 $69.99

Gold $250 $119.99

Premium $350 $179.99

Diamond $450 $239.99

Get a single membership that lets you access hundreds of activities to find one you love.

PLAN NORMAL PRICE/MO. YOU PAY/MO.

HEALTH ASSESSMENT INCENTIVE

USC is here to support you on your journey to better health. Whether you want to eat healthier foods, boost your activity or manage your stress—we are committed to helping you build healthy habits by offering programs and resources designed to help you reach your health goals.

Get a “snapshot” of your health. Complete two steps to qualify for up to $480 incentive on your medical plan.

employees.usc.edu 213.821.8100 uschr@usc.eduLEARN MORE, TAKE ACTION.

Know your health and save! The Health Assessment Incentive process remains the same.

STEP ONE: The confidential online health questionnaire helps you and your doctor identify lifestyle and health habits you can address to improve or maintain your health; it contains questions covering health history, habits, diet, exercise, stress and mood. You can complete it anywhere with internet access in about 15 minutes (you can save your answers and log back in to finish later).

STEP TWO: Sign up for an in-person health screening event, get your lab work with your doctor, or select a LabCorp location. Tests include: Body mass index, cholesterol, triglycerides, blood sugar, blood pressure, and waist to hip ratio measurement. While not absolutely necessary, accuracy of your blood sugar results is increased if you fast (water only) for 12 hours before your screening.

THE CONFIDENTIAL RESULTS—your “health numbers”—will then be sent to HealthFitness to populate your personal feedback report, which you can share with your doctor and use to help improve and maintain your health.

What’s in my feedback report?

The feedback report combines your responses and results to return an overall “wellness score” and brief summary of what that means along with your responses, risk factors, and suggestions for ways to improve and maintain your health. The report also includes links to more information and resources, plus a printable lab report and doctor discussion guide.

Is my privacy protected?

Your privacy is protected—always. Combined results from all participating employees provide USC with “big picture” trends to create benefits to help all employees improve and maintain their health. No one at USC who is not involved in your clinical care sees any of your individual results. Your individual results will not affect your eligibility for health care coverage or the amount you pay for your coverage (other than the $40/month credit for completing the assessment).

FAQ

A new tool and wellness partner for 2020

Our new wellness partner, HealthFitness, can be found at uscwellness.cafewell.com. This new platform is designed to inspire healthy changes and guide you to resources for better health. As you become a frequent user, be on the lookout for wellness opportunities throughout the year.

IMPORTANT DATES: Onsite Screening Events at USC: September 16 to November 15, 2019

2020 Program Period: August 19, 2019 through July 31, 2020

If both the questionnaire and the in-person screening are completed within the program year, you will receive up to $40 per month reduction in paycheck contributions for your medical plan in 2020. Complete both steps by December 31, 2019, and credits will begin January 2020. Complete steps after December 31, 2019, and credits will be applied to the following pay period once information is received. Note: No retroactive credits provided for periods missed. This credit is not available for covered dependents.

Powered by CafewellFor login support for the HealthFitness website, contact customer service at 1-877-417-3361 or email: CustomerService@hfit.com

lyr a health

Getting Started is easy

Connect with top therapists and coaches quickly, easily, and at no cost to

you. It’s essential to take care of all the important parts of you—especially

your mental and emotional well-being. Whatever you’re going through, lyra

can connect you to the right support, right away.

Get Started at usc.lyrahealth.com or 844.495.7094.

A healthy you from head to toe. Lyra is your go-to for mental and emotional well-being.

What’s Included:Short-term, evidence-Based CareLyra covers short-term, evidence-based care provided by licensed clinical therapists and

mental health coaches who work with Lyra. Lyra providers practice specific methods of

therapy that have been proven to be effective at relieving symptoms within a short period

of time.

access to available Providers and digital Care toolsIn addition to vetting all our providers for quality and expertise, we also check their availability.

Providers we recommended are available to see you in the next two weeks so you can get

started quickly. For support on-the-go, you can also

meet via video or tap into digital care tools for an

emotional boost anytime, anywhere.

No Cost to youNo copays, no claims to file. USC covers the cost

of benefit-eligible care, up to 25 sessions, for

USC PPO and USC Trojan Care EPO Plans enrolled

employees and their dependents. Quick Scheduling

Schedule an appointment online or by calling the provider directly.

Convenient OptionsChoose from therapy, coaching,

or self-care apps.

Coaching Anytime and AnywhereTell us about yourself and we’ll offer

options, personalized to you.

Easy Sign-UpCreate an account using our secure,

confidential online tool.

Traveling? You’ll be happy to know your benefits are with you across the country and around the world.

USC PPO Pl an

employees.usc.edu 213.821.8100 uschr@usc.edulearn MOre, Take aCTiOn.

if YOU’re inSide The U.S. and need Care:

Call 911 or go straight to the nearest hospital in an emergency.*

Go to anthem.com/ca and use the find a doctor tool. Enter your Plan ID number prefix “TRJ” in the available field to search for a BlueCard® program doctor or hospital.

Use the anthem anywhere app to search for a BlueCard® program doctor or hospital. Get turn-by-turn directions to the nearest doctor, urgent care center or hospital.

Call Member Services at the number on your Plan ID card. They can help you find a doctor or hospital.

if YOU’re OUTSide The U.S. and need Care:

Go straight to the nearest hospital in an emergency*

Go to bcbsglobalcore.com to search for a doctor or hospital. Accept the “Terms and Conditions” and enter your Plan ID number prefix “TRJ” and click on “Go”.

Use the Blue Cross Global Core app to find a doctor or hospital.

Call the Blue Cross Blue Shield Global® Core Service Center 24/7 at 1-800-810-2583 (Blue) or call collect at 1-804-673-1177. They can help you set up a doctor visit or hospital stay.

* You or a family member need to call the Member Services number on your Plan ID card within 24 hours after going to the hospital or as soon as you can.

WhaT YOU need TO knOW BefOre YOU Tr avel

• Before leaving the country, ask Member Services if your international benefits are different.

• Ask for approval before getting care. This is “precertification” and helps you find care covered by your plan. Call Member Services at the number on your ID card to see if you need precertification.

• Save money by seeing a Blue Cross Blue Shield Global® Core program doctor or hospital. You only pay your usual out-of-pocket amounts (deductible, percentage of costs or copay). You’ll need to pay the entire bill up front when using a doctor or hospital outside of the program.

• Show your USC PPO Plan ID card so they can check your benefits and send your claim for processing.

WhaT if YOUr dOC TOr Or hOSPiTal iS nOT Par T Of The BlUe CrOS S BlUe Shield GlOBal® COre PrOGr aM?

1. You will need to pay up front, in full for your care.

2. Download an international claim form at bcbsglobalcore.com or get a form by calling Member Services at the number on your Plan ID card.

3. Fill out the claim form and send it with the original bills to the Blue Cross Blue Shield Global® Core Service Center.

how to access care wherever you are.

The BlueCard® and Blue Cross Blue Shield Global® Core Programs provide peace of mind near and farWhat happens if you’re away from home and you need care right away? as a USC PPO Plan member, you have access to care across the country through the BlueCard® network. if you’re outside the U.S. you can use the Blue Cross Blue Shield Global® Core program. it gives you access to doctors and hospitals in nearly 190 countries and territories around the world.

accessing nationwide andinternational Providers

LIVONGO DIABETES MANAGEMENT

Key Benefi ts of the Livongo for Diabetes Program

More than a Standard Meter

Your meter is connected and automatically uploads your blood glucose readings, as well as providing real-time tips.

Coaching Anytime and Anywhere

Our coaches are Certifi ed Diabetes Educators who are available anytime via phone, text, or mobile app to give you guidance on your nutrition and lifestyle questions.

Unlimited Strips at No Cost to YouGet as many strips and lancets as you need, all shipped right to your door, with no hidden costs.

Livongo for Diabetes is a new kind of Diabetes Management Tool. It off ers personalized, relevant and timely support using a combination of connected technology, digitally delivered health signals, and live, expert coaching.

Livongo users receive actionable insights to help maintain their health and can see real, measurable clinical improvements in terms of reduced A1c levels and hypoglycemia.

The program is comprehensive, holistic and available to USC Trojan Care EPO and USC PPO Plan members, completely free of charge.

REGISTER AT JOIN.LIVONGO.COM/USCTROJANS/HI OR CALL (800) 945-4355 WITH CODE: USCTROJANS

Living with Diabetes?

An advanced technology management tool is now available at no charge.

• A connected glucose meter ($200 value)

• Unlimited strips

• Lancing device, lancets, and carrying case

• Personalized insights with each reading

• 24/7 access to Certifi ed Diabetes Educators

• Free diabetes medicines for those enrolled in the USC Trojan Care EPO and USC PPO Plans

Enroll today and you’ll receive:

Member Support (800) 945-4355

employees.usc.edu 213.821.8100 uschr@usc.eduLEARN MORE, TAKE ACTION.