Menu

Healthcare Coverage Options

Choosing Well

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.

  • Anthem Consumer Choice HSA

    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. 

    2021 Consumer Choice HSA Plan

    Benefit DescriptionBenefit Amount
    Lifetime maximum benefitUnlimited
    NetworkAnthem 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
    Individual: $2,200
    Family: $4,440

    Out-Out-Network
    Individual: $4,400
    Family: $8,800

    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

    In-Network
    Individual: $3,700
    Family: $7,400

    Out-Out-Network
    Individual: $7,400
    Family: $14,800

    Preventive Care

    Preventive care is not subject to the deductible.

    In-network
    100% covered, not subject to the deductible

    Out-of-Network
    60% covered, not subject to deductible

    Primary Care Office Visit 

    In-network
    80% covered after the deductible

    Out-of-Network
    60% covered after the deductible

    Specialist Visit

    In-network
    80% covered after the deductible

    Out-of-Network
    60% covered after the deductible

    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

    Live Health Online (LHO): flat dollar before the deductible  

    For virtual doctors visits: Standard Office Visit coinsurance applies, after deductible

     

    Hospital 

    Inpatient & outpatient

    In-network
    80% covered after the deductible

    Out-of-Network
    60% covered after the deductible

     Urgent Care

    In-network
    80% covered after the deductible

    Out-of-Network
    60% covered after the deductible

     Emergency Care

    In-network
    80% covered after the deductible

    Out-of-Network
    60% covered after the deductible

  • Anthem Comprehensive Care

    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. 

    2021 Comprehensive Care Plan

    Benefit DescriptionBenefit Amount
    Lifetime maximum benefitUnlimted
    NetworkAnthem 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
    Individual: $750
    Employee + 1: $1,500
    Family: $2,250

    Out-Out-Network
    Individual:  $2,250
    Employee + 1: $4,500
    Family: $6,750

    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
    Individual: $1,750
    Employee + 1: $3,500
    Family: $3,500

    Out-Out-Network
    Individual:  $5,250
    Employee + 1: $10,500
    Family: $10,500

    Preventive Care

    Preventive care is not subject to the deductible.

    In-network
    100% covered, not subject to the deductible

    Out-of-Network
    Not Covered

    Primary Care Office Visit 

    In-network
    $20 copay,  not subject to the deductible

    Out-of-Network
    60% covered after the deductible

    Specialist Visit

    In-network
    $35 copay,  not subject to the deductible

    Out-of-Network
    60% covered after the deductible

    Prescription Drugs annual out-of-pocket-maximum

    Provided under Caremark

    Individual: $1,500
    Employee + 1: $3,000
    Family: $4,500

    See the Pharmacy  page for details on prescription drug coverage.

    Telemedicine

    Live Health Online (LHO): First 3 visits free

    Doctor's virtual visit: Standard office visit copay/coinsurance 

     

    Hospital 

    Inpatient & outpatient

    In-network
    90% covered after the deductible

    Out-of-Network
    60% covered after the deductible

     Urgent Care

    In-network
    $35 copay,  not subject to the deductible

    Out-of-Network
    60% covered after the deductible

     Emergency Care

    In-network
    90% covered after a $250 copay per visit, subject to the deductible. copay. copay waived if admitted within 24 hours

    Out-of-Network
    60% covered after the deductible

  • Anthem Blue Choice HMO

    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.

    2021 Blue Choice HMO

    Benefit DescriptionBenefit Amount
    Lifetime maximum benefitUnlimited

    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
    Individual: $5,500
    Family: $9,900

    Out-Out-Network
    Not Covered

    Preventive Care

    Preventive care is not subject to the deductible.

    In-network
    100% covered

    Out-of-Network
    Not Covered

    Primary Care Office Visit 

    In-network
    $35 copay

    Out-of-Network
    Not Covered

    Specialist Visit

    In-network
    $70 copay

    Out-of-Network
    Not Covered

    Prescription Drugs annual out-of-pocket-maximum

    Provided under Caremark

    Individual: $1,500
    Employee + 1: $3,000
    Family: $4,500

    See the Pharmacy page for details on prescription drug coverage.

    Telemedicine

    Live Health Online (LHO): First 3 visits free

    Doctor's virtual visit: Standard office visit copay/coinsurance 

     

    Hospital 

    Inpatient & outpatient

    In-network
    Inpatient: $500 copay
    Outpatient: $250 copay

    Out-of-Network
    Not Covered

     Urgent Care

    In-network
    $70 copay

    Out-of-Network
    Not Covered

     Emergency Care

    In-network
    $300 copay

    Out-of-Network
    Not Covered, except in case of Emergency

    Out-of-network services are not covered 
  • Kaiser Permanente HMO

    The Kaiser Permanente HMO is a plan that offers in-network coverage only, through Kaiser Permanente facilities (except in the case of emergency). There is no deductible and 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.

    2021 Kaiser Permanente HMO Plan (In-network only)

    Benefit DescriptionBenefit Amount
    Lifetime maximum benefitUnlimited 
    NetworkKaiser Permanente network
    Deductible None

    Out-of-pocket maximum 

     

    Individual: $6,350
    Employee + 1 or more: $12,700
    Wellness/preventive care100% covered
    Primary care office visits $20 copay
    Specialist visits$35 copay

    Prescription drugs

    Annual out-of-pocket maximum

    $1,500 per covered person

    See the Pharmacy page for details on prescription drug coverage.

    E-visits (telemedicine)100% covered
    Hospital (inpatient)$250 copay
    Hospital (outpatient)$100 copay
    Urgent care$30 copay
    Emergency care$250 copay

    Out-of-network services are not covered

     

    See the Pharmacy page for details on prescription drug coverage.

Eligibility

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::

  • Your legal spouse
  • Your natural, adopted or stepchildren, up to age 26
  • Your disabled child(ren), over the age of 26 with proof of disability

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 Benefits for a complete list of requirements. 

Certificates and surcharges 

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 user. You will be charged an additional $100 per month for each covered family member who uses tobacco products. Additionally, you must re-certify your tobacco user status each annual enrollment period. 

Learn more about the tobacco use certification and surcharge

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 $100 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.

 

Coverage costs

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, click Manage Benefits. For additional detail about how coverage works for specific services, see your plan documents.

The Preventive Care Advantage

Here’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.