The University of Southern California Postdoctoral Scholar Benefit Program offers the choice of either a medical HMO plan or a medical POS plan through Aetna, a well-known international insurance company. Please find a brief description of both types of plans below to assist you in choosing the right plan for you and your family.
Once you have reviewed the descriptions of the plan types, please click on Aetna Plans for access to benefit plan summaries with specific plan information.
Please click on the Prescription Information link to review information regarding certain prescription precertification requirements and access to the mail order prescription information.
Provider Directory Information
Detailed provider directory usage instructions are available for both the Aetna medical HMO and POS plans when you click on Provider Directory Information.
Summary Plan Descriptions
Detailed information regarding the medical plans is presented in the Evidence of Coverage Booklets, as well as the Summary Plan Description Wrap Document. Please visit the Summary Plan Descriptions page for access to this important information.
Information Regarding Seeking Services In- and Out-of-Network
It’s important to seek services in-network whenever possible to save you money on out-of-pocket costs, as well as to maintain the premium costs of the medical insurance for all enrollees. Please click on Seeking Medical Services OON for important information.
Women’s Preventive Health Benefits
Beginning August 1st, 2012, due to the Patient Protection and Affordable Care Act (PPACA) of 2010, certain preventive care, pharmacy benefits and physician visits for pre-natal maternity will be covered at 100%. The pharmacy benefit includes formulary, generic FDA-approved women’s contraceptives. Please click on Women’s Preventive Health HMO and Women’s Preventive Health POS for further details.
Authorization for Release of Protected Health Information (PHI)
There may be instances when you will need a representative from Garnett-Powers & Associates to assist you with claims or billing inquiries for you or your enrolled dependents. In order for a representative to intercede on your behalf with an insurance carrier or health care provider, you must complete an Authorization for Release of Protected Health Information. Due to the Health Insurance Portability and Accountability Act of 1996, we are not allowed to assist you unless you have completed the form. If you do require assistance, please click on the link, complete the form, and either e-mail it to USCPBP@garnett-powers.com or fax to 949-583-2929.
Aetna Navigator is a secure member web site where you may perform a number of functions, as well as gather important information. You can print a temporary ID card, order a new card, look up a claim to see what your doctor billed and how much the insurance plan paid as well as check to see what a procedure may cost in your area. Please click on Aetna Navigator to access more detailed information. Once you reach the Aetna Navigator site, you will need to register. When registering, please use the first 9 digits of your University ID number. That is the number that is used by Aetna to recognize you in their system.
In addition to your medical insurance benefits, Aetna offers many valuable supplemental programs to their members. Please click on Wellness Benefits to learn about many of those programs available to you.
What is an HMO Plan?
- The Health Maintenance Organization (HMO) plan offers a broad spectrum of benefit coverage with a higher degree of managed care.
- Under the HMO model, you and your enrolling family members will choose a Primary Care Physician (PCP) contracted with the HMO plan at the time of enrollment.
- The PCP becomes the gatekeeper of your healthcare needs.
- If you are in need of treatment from a Specialist or in need of an In-Patient or Out-Patient procedure, you must obtain a referral from the PCP prior to any type of consultation or treatment. If the referral is not obtained, no benefits will be paid.
- There is no out-of-network benefit.
- In the event of a life/limb-threatening emergency, you should dial 911 and all medical care will be covered. Once you condition is stabilized, the HMO will require that you be transferred to an In-Network facility.
- HMO premiums as well as the out-of-pocket expenses (i.e. deductibles, co-payments, etc.) tend to be lower than their indemnity, POS or PPO counterpart due to the contractual element of capitation. Capitation means that the PCP is compensated by the HMO plan in the form of a monthly capitation fee for each member that signs up with him/her at the time of enrollment. The PCP has agreed to provide all primary care, as well as the cost for most labs and x-rays for that capitated fee. Additionally, in the event that the PCP provides a referral to a Specialist, the PCP will pay the Specialist from that same capitation. There are some hospital charges and lab/x-ray procedures that do fall outside of captitation.
What is a Point of Service Plan (POS)?
- The Point of Service (POS) plan offers much more flexibility and choice than the HMO plan because there is an ‘In-Network’ and ‘Out-of-Network’ choice at the time you seek service from a provider.
- The Aetna POS plan offers you the choice of choosing a Primary Care Physician if you so desire. You are not obligated to choose one.
- The In-Network benefits (copays, coinsurance, etc.) will be greater than the Out-of-Network benefits. You will pay less when you seek your care In-Network. For example, many POS plans offer a copay of $10 for a physician office visit In-Network; that same office visit Out-of-Network can be as much as 50%.
- At the time of service, the member has the ability to seek care from a Specialist, without having to obtain a referral from a Primary Care Physician.
- The contractual agreement between the POS Plan and the Provider is on a "discounted fee for service" basis. This means that the provider who participates in the network has agreed to provide their service on an agreed upon discounted fee. The Provider who is not in the network will not agree to that discounted fee and will typically charge a "Reasonable and Customary" fee.
- There is no capitation in a POS contract.
- POS premiums tend to be higher than the HMO premiums due to the method of reimbursement and contractual agreements with the providers.
Garnett-Powers & Associates, Inc. is pleased to offer a University of Southern California PBP Customer Service Representative, dedicated to this program. Please address benefit and enrollment questions to:
Garnett-Powers & Associates, Inc.
23361 Madero, Suite 240
Mission Viejo, CA 92691
Or call us Monday - Friday, 8 am - 5 pm Pacific Time
Toll free at 1-800-319-9557
Contact USC-PBP Program Services
We thank you for the opportunity to be of service to you and your family.
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Program and benefit information contained on this site has been deemed reliable, but can change without notice.