Trio Plan
Compare Medical Plans & Costs
Active employees and official retirees can use this tool to compare medical benefits, as well as plan costs.
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Trio is a comprehensive medical plan that covers only in-network providers and facilities within certain California counties, requiring you select a primary care doctor (PCP) who is responsible for the overall coordination of your care.
Trio uses a select Blue Shield of California network of doctors and hospitals (the Trio ACO HMO provider network). This network includes providers at UCSF, Dignity Health, Hills Physicians, and more. Access to a provider group, such as Hills Physicians, is based upon a reasonable distance from either your home or work ZIP code (except for services such as the Away From Home care program, which provides some benefits for students and family members living outside the service area). The Trio plan network excludes Palo Alto Medical Foundation and Stanford Health Care.
Trio is a plan with a copayment, which you make at the point of service and the university covers the remaining costs. If you choose to see a doctor or use a hospital outside the network, you pay the full cost of the care you receive.
Review 2022 plan information and resources for Trio, Blue Shield
| BASICS | |
|---|---|
|
Overview |
You must select a primary care physician (PCP) from the Trio network that is a reasonable distance from your home or work ZIP code. There is no benefit if you see a Non-Network provider, except for emergency or urgent care use for an emergency health issue. |
|
Pre-Authorization Requirement |
Pre-authorization required for all hospital stays and outpatient procedures by your Medical group. |
|
Office copays |
$30 copay primary/$50 copay specialist |
|
Deductible |
No deductible |
|
Out-of-Pocket Maximum |
$3,500 per individual/$7,000 family Combined Network or Non-Network. A single out-of-pocket maximum applies to all coverage under the plan, including medical and prescription drugs. (This will cover prescriptions and medical expenses at 100% once the out-of-pocket maximum is met.) |
| PREVENTATIVE CARE | |
|---|---|
|
Physical exams for adults |
100% |
|
Physical exams for children |
100% |
|
Pap smears |
100% |
|
Immunizations |
100% |
|
Well-woman visits |
100% |
| PRESCRIPTION DRUGS | |
|---|---|
|
Pharmacy (Retail) |
Up to a 30-day supply per prescription. Contraceptive drugs and devices: $0 Tier 1 drugs: $10/prescription Tier 2 drugs: $40/prescription Tier 3 drugs: $100/prescription Tier 4 drugs (excluding specialty drugs): 20% up to $200/prescription |
|
Mail order drug program |
Up to a 90-day supply per prescription. Contraceptive drugs and devices: $0 Tier 1 drugs: $20/prescription Tier 2 drugs: $80/prescription Tier 3 drugs: $200/prescription Tier 4 drugs (excluding specialty drugs): 20% up to $400/prescription Specialty drugs and oral anti-cancer drugs: 20% up to $200/prescription (per prescription, up to a 30-day supply)
|
|
Birth Control Pills |
Contraceptive drugs and devices: $0 |
Traveling Outside the U.S.
When you’re outside California or out of the country, you and your family can get urgent and emergency care through the BlueCard and Blue Shield Global Core programs. These programs offer access to doctors and hospitals almost everywhere in the U.S. and in 170 countries and territories around the world. To find a provider in the U.S., visit provider.bcbs.com, or call 800-810-BLUE. To find a provider outside the U.S., visit bcbsglobalcore.com, or call 804-673-1177 collect from outside the U.S.