EXPERIENCE THE UC DIFFERENCE

No. Kaiser Permanente operates as a closed-network HMO, which means care is provided only through Kaiser doctors, clinics, and hospitals. UCR Health providers are not part of the Kaiser network, so visits to UCR Health are not covered under Kaiser HMO plans. 
The only exceptions are medical emergencies or services pre-approved by Kaiser through a special referral or authorization. 

No. Enrolling in a UC self-funded health plan (such as UC Care or UC Health Savings Plan) does not limit you to UCR Health doctors only. These plans give you flexibility to see providers both within and outside of the UC system! 

For example, if you want to seek medical treatment at the Ronald Reagan UCLA Medical Center, you can do so because UC self-funded health plans include all UC medical centers and UC Health providers within their network. 

An HMO — Health Maintenance Organization — is a type of health insurance that helps keep costs lower by using a network of doctors and hospitals. 

Here’s how it works: 

1. You choose a primary care doctor, also known as a PCP, who manages your care. 
2. If you need to see a specialist (like a dermatologist or cardiologist), you’ll need a referral from your PCP. 
3. You’re generally only covered for care within the HMO network, except in emergencies. 
4. Because the network is more limited, monthly premiums and out-of-pocket costs are usually lower than other plans.

In short: With an HMO, you save money but have to stay in-network and go through your primary doctor for most care. 

To learn more about the UC self-funded HMO plans offered this open enrollment season, please visit the UC Blue & Gold HMO page at UCnet or call a Health Net Navigator at (800) 539-4072 

A PPO — Preferred Provider Organization — plan is a type of health insurance that gives you more flexibility in choosing your doctors and hospitals. 

Here’s how it works, simply: 

1. You don’t need to choose a primary care doctor (PCP). 
2. You can see specialists directly—no referral needed. 
3. You’ll pay less when you use in-network providers, but you can still see out-of-network doctors (it just costs more). 
4. Monthly premiums and out-of-pocket costs are usually higher than an HMO, but you get more freedom in where you go for care.

In short: with a PPO, you pay more for flexibility and can see any doctor you want—no referral required. 

To learn more above the UC self-funded PPO plans offered this open enrollment season, please visit UCnet or call Accolade at (866) 406-1182 

When deciding between an HMO or PPO during open enrollment, it helps to think about your personal health needs, budget, and lifestyle. 

Here are a few main factors to consider: 

• Network Access:
  • HMO: Must use in-network doctors and hospitals (except emergencies) 
  • PPO: Can use any doctor; in-network costs less, but out-of-network still covered 
• Primary Care Provider:
  • HMO: Required — you must choose a PCP who manages your care 
  • PPO: Not required — you can see any provider directly 
• Referrals Needed?:
  • HMO: Yes — for specialists, you need a referral from your PCP 
  • PPO: No — you can schedule with specialists on your own 
• Flexibility:
  • HMO: Lower flexibility; network-based care 
  • PPO: High flexibility; wide provider access
• Monthly Premiums: 
  • HMO: Typically lower 
  • PPO: Typically higher
• Out-of-Pocket Costs:
  • HMO: Usually lower copays and deductibles
  • PPO:Usually higher copays and deductibles 
• Coverage Area:
  • HMO: Works best if you live and receive care within the plan’s service area 
  • PPO: Better for people who travel or live in multiple locations 
• Care Coordination:
  • HMO: Centralized through your PCP 
  • PPO: You manage your own care and appointments 
• Best For:
  • HMO: Those who want lower costs and don’t mind staying in-network 
  • PPO: Those who want flexibility to choose doctors or see specialists freely 
• UC Example Plans:
  • HMO: UC Blue & Gold HMO 
  • PPO: UC Care PPO, HealthSavings+ 

To speak more in-depth about the UC Blue & Gold HMO plan, please call the Health Net Navigators at (800) 539-4072. 

 To speak more in-depth about UC Care PPO or HealthSavings+, please call Accolade at (866) 406-1182. 

For more general questions about open enrollment, please call the UCR Health Blue and Gold Concieges Line at (855) 827-4264. 

In-network refers to doctors, hospitals, labs, and clinics that have a contract with your health insurance company. These providers agree to charge discounted rates, so your insurance covers a larger portion of the cost. You’ll pay less out of pocket (lower copays, coinsurance, and deductibles). 

Out-of-network providers do not have a contract with your insurance. They insurance company may cover less – or nothing at all – of the bill. You will likely pay higher out-of-pocket costs and may have to file the claim yourself. 

Example: You decide to enroll in UC Blue & Gold HMO plan and you visit your primary care physician at UCR Health. Our doctors are in-network with the UC Blue & Gold HMO plan and therefore, your copay will be $30* and the rest is billed to Health Net, the administrator for UC Blue & Gold HMO. If you visit someone outside of the UC Blue & Gold HMO network, however, you may have to pay the full cost of your visit and your insurance plan might reimburse only a small portion, if any of this out-of-network visit.  

*These prices are subject to change. Please refer to your plan for the most up-to-date costs and restrictions. 

UC Health Savings Plan members have seen unprecedented increases in their premiums over the last few years, while CORE members have missed out on the tax advantages of a health savings account (HSA). HealthSavings+ will be UC’s lowest premium medical plan, and it will be compatible with a health savings account (HSA). 

To help HealthSavings+ members start saving for their medical expenses, UC is increasing its annual HSA contribution from $500 to $750 for individuals and from $1,000 to $1,500 for families. 

UC contributes every year employees remain enrolled in the plan, and funds in the HSA carry over from year to year. The account belongs to the employee, whether they change jobs or medical plans or retire. 

The benefits of HealthSavings+, such as the deductibles and coinsurance, are different than for the current plans. 

To learn more on the HealthSavings+ plan, please visit HealthSavings+ page at UCnet. 

Beginning next year, UC is balancing premiums across comparable health plans. Monthly premiums for UC Care will be lower, and HealthSavings+ premiums will be lower than 2025 premiums for UC Health Savings Plan. 

See medical plan premiums for 2026. ALEX will be live on Oct. 29 with customized comparisons of medical plan premiums (including any caps or subsidies that may apply to your bargaining unit contract or location), out-of-pocket costs, and in-network providers. 

Some members moving from CORE to HealthSavings+ will see premiums that are up to $20 a month higher for single coverage and up to around $94 higher for family coverage. These premium increases will be offset by UC’s contribution to the Health Savings Account. 

Kaiser HMO members in the up to $73,000 salary range (as of Jan. 1, 2025) who pay for single coverage may see increases up to $36 a month, while those who pay for family coverage may see increases up to $169 a month. The effect of increases to Kaiser premiums for some represented employees will be mitigated by existing caps and subsidies. 

For answers about your benefits and coverage, call the UCR Health Concierge Line at 1-855-UCR-HBNG (827-4264).