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Medical Plans

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 Credit Waiver Form and provide proof of coverage through another plan. 

Medical Plan Comparisons:

2019 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 with Dependent(s) None None None $2,700 / $5,200
Family None None None $4,000 / $8,000
Annual Out of Pocket Maximum        
Individual & Individual with Dependent(s) $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 90% / 70%
Specialist Office Visit $20 copay $20 copay $40 copay
$20 with PCP referral
90% / 70%
Basic X-ray and Laboratory No charge No charge No charge 90% / 70%
Inpatient Hospital $250 copay per admission $250 copay per admission $250 copay per admission 90% / 70%
Emergency Room $50 copay $100 copay $100 copay 90% / 90%
Urgent Care $20 copay $20 copay $20 copay 90% / 70%
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
90% / 70%
Hearing Aid $2,500 per device, 2 devices every 3 years $2,000 every 2 years $2,000 every 2 years 80% / 80%
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%
Monthly Employee Contribution    
Employee Only $51.32 $11.12 $77.81 $113.92
Employee + 1 $301.63 $152.20 $351.93 $421.64
Employee + Family $455.80 $290.94 $536.13 $677.60

2020 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 $2,700 / $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 90% / 70%
Specialist Office Visit $20 copay $20 copay with PCP Referral $40 copay
$20 with PCP referral
90% / 70%
Basic X-ray and Laboratory No charge No charge No charge 90% / 70%
Inpatient Hospital $250 copay per admission $250 copay per admission $250 copay per admission 90% / 70% upt to $1,000/day
Emergency Room $50 copay $100 copay $100 copay 90% / 90%
Urgent Care $20 copay $20 copay $20 copay  
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
90% / 70%
Hearing Aid $2,500 per device, 2 devices every 3 years $2,000 every 2 years $2,000 every 2 years 80% / 80%
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 $200 copay
Monthly Employee Contribution    
Employee Only $57.86 $16.10 $97.36 $158.44
Employee + 1 $322.52 $170.26 $413.54 $538.66
Employee + Family $486.50 $321.08 $627.78 $854.50