Choosing Well
To find the right healthcare care for you and your family, take a look at the options USG offers.
To find the right healthcare care for you and your family, take a look at the options USG offers.
The University System of Georgia offers four comprehensive healthcare options. Regardless of the plan you choose, each plan protects you and your family’s health. The main differences between the plans come down to things like how much you pay when you get care, how much you pay each paycheck, how much flexibility you have in choosing providers, and where you can receive care.
The Consumer Choice HSA plan, offered through Anthem, is a high deductible plan with a lower monthly premium but higher deductible that must be met before the plan’s coinsurance kicks in, except for in-network preventative care. This plan uses the Open Access POS network that provides in- and out-of-network coverage and access to a pre-tax Health Savings Account (HSA), with an employer HSA match.
Benefit Description | Benefit Amount |
---|---|
Lifetime maximum benefit | Unlimited |
Network | Anthem Open Access POS |
Annual deductible If enrolled in the individual tier, once the individual deductible is met, the plan will start sharing in the cost of coverage. If enrolled in the family tier, the entire family deductible must be met, the plan will start sharing in the cost of coverage. In- and out-of-network deductibles are reached separately Both healthcare and pharmacy coinsurance amounts count toward the deductible. | In-Network Out-Of-Network |
Annual out-of-pocket maximum Both healthcare and pharmacy coinsurance amounts apply toward the out-of-pocket maximum. In- and out-of-network maximums are reached separately *No one family member will exceed $9,200 toward the in-network out-of-pocket maximum | In-Network Out-Out-Network |
Preventive Care Preventive care is not subject to the deductible. | In-network Out-of-Network |
Primary Care Office Visit | In-network Out-of-Network |
Specialist Visit | In-network Out-of-Network |
Prescription Drugs Provided under Caremark | Both medical and pharmacy coinsurance apply toward the deductible and OOP limit. See the Pharmacy page for details on prescription drug coverage. |
Telemedicine | Virtual care video visit: flat dollar before the deductible. Login through Sydney app. or the Anthem website for the fee schedule and visits. Virtual primary care of specialist doctors visits: Standard Office Visit coinsurance applies, after deductible
|
Hospital Inpatient & outpatient | In-network Out-of-Network |
Urgent Care | In-network Out-of-Network |
Emergency Care | In-network Out-of-Network |
The Comprehensive Care, offered through Anthem, is a traditional healthcare plan with deductibles, copays, and coinsurance. This plan also utilizes the Open Access POS network, with in-network and out-of-network coverage.
Benefit Description | Benefit Amount |
---|---|
Lifetime maximum benefit | Unlimited |
Network | Anthem Open Access POS |
Annual deductible If enrolled in the individual tier, once the individual deductible is met (even if enrolled in the family tier), the plan will start sharing in the cost of coverage. If enrolled in the family tier, each member is responsible for the single deductible, the OOP amount within the family deductible or OOP amount up to the maximum In- and out-of-network deductibles are reached separately
| In-Network Out-Out-Network |
Annual out-of-pocket maximum Member deductible, copays, and coinsurance apply toward the annual healthcare out-of-pocket maximum. Prescription benefits have a separate out-of-pocket maximum. In- and out-of-network maximums are reached separately | In-Network Out-Of-Network |
Preventive Care Preventive care is not subject to the deductible. | In-network Out-of-Network |
Primary Care Office Visit | In-network Out-of-Network |
Specialist Visit | In-network Out-of-Network |
Prescription Drugs annual out-of-pocket-maximum Provided under Caremark | Individual: $2,000 See the Pharmacy page for details on prescription drug coverage. |
Telemedicine | Virtual Care Video Visit: First 3 visits free, then $15 copay per visit. Log in through Sydney app or the Anthem website for visits.
|
Hospital Inpatient & outpatient | In-network Out-of-Network |
Urgent Care | In-network Out-of-Network |
Emergency Care | In-network Out-of-Network |
The BlueChoice HMO plan, offered through Anthem, has the highest premium but more predictable copayment costs when you use the plan. This plan does not have a deductible and offers in-network coverage only (except in the case of an emergency). Although costs are more predictable, it lacks the flexibility to see specialists and requires a primary care physician (PCP) and referrals for specialists.
Benefit Description | Benefit Amount |
---|---|
Lifetime maximum benefit | Unlimited |
Annual deductible
| None |
Annual out-of-pocket maximum Member copays and coinsurance apply toward the annual healthcare out-of-pocket maximum. Prescription benefits have a separate out-of-pocket maximum.
| In-Network Out-Out-Network |
Preventive Care Preventive care is not subject to the deductible. | In-network Out-of-Network |
Primary Care Office Visit | In-network Out-of-Network |
Specialist Visit | In-network Out-of-Network |
Prescription Drugs annual out-of-pocket-maximum Provided under Caremark | Individual: $2,000 See the Pharmacy page for details on prescription drug coverage. |
Telemedicine | Virtual Care Video Visit: First 3 visits free. Login through Sydney app or the Anthem website for visits
|
Hospital Inpatient & outpatient | In-network Out-of-Network |
Urgent Care | In-network Out-of-Network |
Emergency Care | In-network Out-of-Network |
Out-of-network services are not covered |
The Kaiser Permanente HMO is a plan that offers in-network coverage only (except in the case of emergency), with care generally located within Kaiser Permanente facilities. There is no deductible for most services; you pay a flat copay at the time of service. While this plan lacks the flexibility to see providers outside of the network, all of your care is coordinated by your Kaiser primary care physician (PCP), and most of the services you need like specialty, lab, and pharmacy are all under one roof. Like a traditional HMO, referrals are required for specialists.
Click here for an informational video about Kaiser Permanente plans.
Benefit Description | Benefit Amount |
---|---|
Lifetime maximum benefit | Unlimited |
Network | Kaiser Permanente network |
Deductible | Individual: $100 Employee + 1: $200 Family: $200 |
Out-of-pocket maximum
| Individual: $6,350 Employee + 1 or more: $12,700 |
Wellness/preventive care | 100% covered Out-of-Network |
Primary care office visits | $40 copay Out-of-Network |
Specialist visits | $75 copay Out-of-Network |
Prescription drugs Annual out-of-pocket maximum | Individual: $1,750 See the Pharmacy page for details on prescription drug coverage. |
E-visits (telemedicine) | 100% covered Out-of-Network |
Hospital (inpatient) | $600 copay after deductible Out-of-Network |
Hospital (outpatient) | $400 copay after deductible Out-of-Network |
Urgent care | $75 copay Out-of-Network |
Emergency care | $400 copay after deductible Out-of-Network |
See the Pharmacy page for details on prescription drug coverage.
Active employees who work 30 hours or more per week are eligible for USG Healthcare plans. When you elect coverage for yourself, you may also cover your eligible dependents, which include::
Documentation is required to add dependents to your coverage. Common examples include a marriage certificate, birth certificate, income tax return, and/or joint utility. Visit oneusgconnect.usg.edu and select Manage My Benefits for a complete list of requirements.
Tobacco Use
When you enroll in USG healthcare coverage, you'll need to indicate if you or your covered family members age 18 or older are a tobacco-use. You will be charged an additional $150 per month for yourself, spouse, and children age 18+r who uses tobacco products or is defaulted by not taking completing the certification during enrollment. Additionally, you must re-certify your tobacco use status each annual enrollment period.
Learn more about the tobacco use certification and surcharge.
Planning to Quit: Tobacco Cessation Resources
We know it’s not easy to quit, but we’ll give you the support you need. Tobacco cessation programs are available at no cost to you and your dependents. Please review the Tobacco Cessation options on the USG Well-being website.
Once you complete a cessation program or become tobacco-free, you must update your tobacco user status with OneUSG Connect - Benefits at 844-587-4236. Your surcharge will be removed on the first day of the month following the change to your status.
Working Spouse
If you enroll your spouse in USG healthcare coverage, you will also need to indicate whether your spouse has coverage available through an employer outside of USG. If so, a monthly working spouse surcharge of $150 will apply. The working spouse surcharge does not apply to retirees.
Learn more about the working spouse certification and surcharge.
When you certify your tobacco use or working spouse status, you are attesting that the information is true and correct to the best of your knowledge. USG expects employees to uphold the highest standards of intellectual honesty and integrity, in compliance with the USG Ethics policy. Therefore, you should respond honestly in regard to your status. If you knowingly and willfully make a false or fraudulent statement to the University System of Georgia regarding your insurance coverage, you may be subject to criminal prosecution.
Find the monthly rates for all plans on the Employee Premiums and Surcharges pages. Access your benefits enrollment and premiums for plans you’re enrolled in, by logging onto OneUSG Connect- Benefits, click Manage Benefits. For additional detail about how coverage works for specific services, see your plan documents.
There’s a great reason to stay up to date on your preventive care, which is covered at 100%. In most cases, the plan will pay for these services and won’t count the total cost towards your deductible. This helps you save on care now so you might not have to pay for expensive medical care later.