SCU offers five medical plan options, allowing you to choose the plan that’s best for you and your family. A brief description of each plan is included below.
If you opt to waive medical coverage, Santa Clara University offers an incentive payment of $150 per month. You must fill out the Health Insurance Waiver and provide proof of coverage through another plan.
|
2022 MEDICAL PLANS |
Kaiser HMO |
Blue Shield Trio Network HMO |
Blue Shield Access+ Network HMO |
Blue Shield HDHP PPO HSA PPO/Non-PPO |
| Annual Deductible | ||||
| Individual | None | None | None | $2,000 / $4,000 |
| Individual within Family | None | None | None | $2,800 / $5,200 |
| Family | None | None | None | $4,000 / $8,000 |
| Annual Out of Pocket Maximum | ||||
| Individual | $1,500 | $2,000 | $2,000 | $3,425 / $12,000 |
| Family | $3,000 | $4,000 | $4,000 | $6,850 / $24,000 |
|
Medical Services |
||||
| Primary Care Visit | $20 copay | $20 copay | $20 copay | 10% / 30% |
| Specialist Office Visit | $20 copay | $20 copay with PCP Referral | $40 copay $20 with PCP referral |
10% / 30% |
| Basic X-ray and Laboratory | No charge | No charge | No charge | 10% / 30% |
| Inpatient Hospital | $250 copay per admission | $250 copay per admission | $250 copay per admission | 10% / 30% |
| Emergency Room | $50 copay | $100 copay | $100 copay | 10% / 10% |
| Urgent Care | $20 copay | $20 copay | $20 copay | 10%/30% |
| Chiropractic | $15 copay per visit to 30 visits per year |
$15 copay per visit to 20 visits per year |
$15 copay per visit to 20 visits per year |
10% / 30% |
| Hearing Aid | $2,500 per device, 2 devices every 3 years | 20% with $4,000 benefit maximum every 2 year | 20% with $4,000 benefit maximum every 2 year | 20% / 20% |
| Prescription Drugs | After Deductible | |||
| Generic / Tier 1 | $10 copay | $10 copay | $10 copay | $10 copay / $10+25% |
| Formulary / Tier 2 | $25 copay | $25 copay | $25 copay | $40 copay / $40+25% |
| Non-Formulary / Tier 3 | $25 copay | $50 copay | $50 copay | $60 copay / $60+25% |
| Speciality/ Tier 4 | None | 20% up to $200 Copay | 20% up to $200 Copay | 25% of purchase price+ 30% up to $250 copay |
| Monthly Employee Contribution | ||||
| Employee Only | $60.14 | $16.10 | $108.96 | $164.78 |
| Employee + 1 | $335.28 | $170.26 | $462.74 | $560.20 |
| Employee + Family | $505.72 | $321.08 | $702.50 | $888.68 |