Financial Protection
for the Unexpected
Designed just for UC employees, three supplemental health insurance plans help to provide
a nancial safety net for the unexpected.
These plans oer exible nancial assistance that complements the protection of
your UC medical and disability coverage. When you have a covered accident, illness or
hospitalization, these plans pay a cash benet directly to you — not to a doctor or hospital.
The cash benet is yours to spend any way you like.
It’s protection that removes the worry of covering things like unpaid medical expenses, such
as deductibles, copays/coinsurance or other household and living expenses, so you can
focus on recovering, not nances.
Accident
Ease the Pain of
Unexpected Expenses
Your child gets hurt playing
soccer. You’re painting the
kitchen and the ladder slips.
If you receive medical
treatment for a covered
accident, you get a check
to help cover expenses.
Critical Illness
Serious Illness Can
Mean Serious Costs
Cancer, heart attack, stroke,
coronavirus: When a covered
critical illness strikes, this
plan sends a lump-sum
payment directly to you.
The plan also pays you for
getting a yearly preventive
health screening.
Hospital Indemnity
Hospital Stays Can
Catch You by Surprise
Some hospital stays are
planned. Others catch you
by surprise. This plan pays a
predetermined dollar amount
directly to you when you’re
admitted to the hospital
and pays a daily benet for
up to days.
UC Plus Supplemental Health Plans ucplus.com
How the Plans Work
The plans are administered by Prudential. In the event of medical treatment for a covered accident, covered illness
or hospitalization, you le a claim and get a check from Prudential. The cash benet is paid directly to you — in
addition to what your insurance plans pay.
You Choose How to Use Your Cash Benet
For medical
expenses not
covered by
your health
insurance
Everyday living
expenses — like
rent, mortgage
or car payments
Meal preparation
and/or delivery
Home health care; child,
elder and pet care
Housekeeping
Transportation to
doctor and therapy
appointments
What Have You Got to Save?
If you’ve considered moving to a lower-cost medical
plan but worry about the potential increase in out-of-
pocket costs in the event of a covered accident, critical
illness, or hospital stay, supplemental health insurance
might be your answer.
Consider all your benet options and costs — both
the premium you pay for coverage and what you pay
when you get care. A combination of a supplemental
health insurance plan plus a lower-premium medical
plan could save you money while helping to provide
nancial protection for a worst-case scenario.
Custom Plans, Group Rates,
Guaranteed Coverage
UC partners with Prudential to oer group coverage
designed especially for UC employees at group prices.
You pay the full cost of any coverage you choose
through convenient payroll deductions. Your premiums
are paid with after-tax dollars, which means you
generally don’t pay taxes on any benet payments you
receive from the plan(s). Enrollment is guaranteed.
Learn More
For a full list of
coverage and
benets, go to
ucplus.com.
UC Plus Supplemental Health Plans ucplus.com
Accident
What’s Covered
Examples of common accident-related services and benets:
SERVICES BENEFIT AMOUNT
Emergency room or urgent
care visit with X-ray
per accident
Ground ambulance
per trip
Physical therapy
per visit
Accident follow-up visit with physician
per visit
Leg braces, crutches, etc.
per appliance
Inpatient surgery
,
Treatment for fractures
Up to
,
Treatment for dislocations
Up to
,
Treatment for burns
to
,
Hospital admission
and connement
,
per connement
per day*
This listing does not reect each and every benet, exclusion or limitation which may
apply. For complete information, refer to the Certicate of Insurance at ucplus.com.
See page 11 for additional benets and coverage amounts.
* $200 per day connement benet begins on day two after admission
What You Pay
COVERAGE FOR MONTHLY RATE
Yourself only .
You and your spouse .
You and dependent
children
.
Your family .
UC Plus Supplemental Health Plans ucplus.com
Critical Illness
There are two coverage options: , and
,. The plan pays benets at ,
or of your coverage level.
What’s Covered
Examples of covered illnesses and benets:
SERVICES BENEFIT AMOUNT
• Cancer
• Heart attack
• Stroke
• Kidney failure
• Severe burn
• Benign brain tumor
• Major organ failure
(includes bone marrow/
stem cell transplant)
• Severe Coronary
Artery Disease
of coverage amount
• Non-invasive cancer
• Advanced Alzheimer’s
or Parkinson’s disease
of coverage amount
Annual preventive
health screening exam
per calendar year
Coronavirus-related
hospitalization of
ve or more days
of coverage amount
This listing does not reect each and every benet, exclusion or limitation
which may apply. For complete information, refer to the Certicate of
Insurance at ucplus.com.
See page 16 for additional benets and coverage
amounts.
What You Pay
Rates are based on age. Monthly costs shown are for
one adult. Rates for you and your spouse may dier
depending on your ages. Coverage for eligible children
is free when you enroll.
AGE
MONTHLY RATE
,
Coverage Option
,
Coverage Option
. .
. .
. .
. .
. .
. .
. .
. .
. .
. .
UC Plus Supplemental Health Plans ucplus.com
Hospital
Indemnity
What’s Covered
Examples of common hospital-related services and benets:
SERVICES BENEFIT AMOUNT
Hospital admission
,
Hospital connement
per day*
Hospital intensive care
per day*
This listing does not reect each and every benet, exclusion or limitation which may
apply. For complete information, refer to the Certicate of Insurance at ucplus.com.
See page 18 for additional benets and coverage amounts.
* $200 per day connement benet begins on day two after admission
What You Pay
COVERAGE FOR MONTHLY RATE
Yourself only .
You and your spouse .
You and dependent
children
.
Your family .
UC Plus Supplemental Health Plans ucplus.com
Filing Claims
When you have a covered accident, illness or hospitalization, you le a claim with
Prudential— either electronically or by paper. Keep all bills and paperwork, as you may
needthem to le claims. Your treating doctor may also need to ll out some paperwork.
Create an online Prudential account at www.prudential.com/mybenets to le
claims electronically and check the status of existing claims. First-time users will need
to select “Register Now” and enter the control number 97000. Call Prudential at
, 8 a.m.–6 p.m. Monday–Friday, Pacic, if you need help.
Protection
for You and
Your Family
You can cover yourself and
your eligible dependents.
UC Plus Supplemental Health Plans ucplus.com
UC Plus
Group Accident Plan
COVERED ACCIDENT BENEFIT BENEFIT AMOUNT
Initial Treatment
Once per accident, within 96 hours after the accident. Not payable for telemedicine services.
Payable when an insured receives initial treatment for a covered accidental injury.
· Hospital emergency room
with X-ray
without X-ray
· Urgent care facility
with X-ray
without X-ray
· Doctor’s oce or facility (other than a hospital emergency room or urgent care)
with X-ray
without X-ray
Non-Emergency Initial Care
Once per accident, more than 96 hours but less than 90 days after the accident occurs.
$75
Ambulance
Within days after the accident. Payable when an insured receives transportation by a professional
ambulance service due to a covered accidental injury.
ground ambulance
, air ambulance
Advanced Diagnostic Testing
Once per accident, within 90 days after the accident. Payable when an insured requires one of the
following exams: computerized tomography (CT/CAT scan), magnetic resonance imaging (MRI),
electroencephalography (EEG) due to a covered accidental injury, ultrasound, nerve conduction
velocity test (NCV), positron emission tomography (PET), or single-photon emission computed
tomography (SPECT Scan).
Blood Plasma and Platelets
Once per accident, within 90 days after the accident.
Pain Management
Once per accident, within 180 days after the accident. Payable when an insured sustains an
accidental injury and receives epidural anesthesia to manage pain from the injury. The epidural
anesthesia must be prescribed by a physician.
Concussion
Payable when an insured is diagnosed by a doctor with a concussion due to a covered accident
within 48 hours after the concussion occurs.
Coma
Coma must begin within 90 days after the covered accident and last for seven consecutive days. The
benet is not payable for medically induced coma.
,
Emergency Dental Work
One crown, lling and extraction per accident. Dental services must begin within 90 days after the
covered accident or covered injury occurs.
for extraction
repair with a crown
for repair with a lling
Eye Injuries
Payable for eye injuries that require surgery or the removal of a foreign object by a physician within
90 days after the accident occurs.
surgery
removal of
foreign object
UC Plus Supplemental Health Plans ucplus.com
COVERED ACCIDENT BENEFIT BENEFIT AMOUNT
Lacerations
Once per accident, within 96 hours after the accident. Payable when an insured receives a laceration
in a covered accident, and the laceration is repaired by a doctor. For multiple lacerations, the
amount paid will be based on the total length of all lacerations received that are repaired with
stitches.
· Lacerations requiring stitches, including liquid skin adhesive
- Over centimeters
- – centimeters
- Under centimeters
· Lacerations not requiring stitches
Burns
Once per accident. Payable when an insured is burned in a covered accident and is treated by
a doctor within 48 hours after the covered accident or covered injury occurs. The plan will pay
according to the percentage of the body surface burned. First-degree burns are not covered.
· Second-degree burns
- Less than
- At least but less than
- At least but less than
- or more ,
· Third-degree burns
- Less than ,
- At least but less than ,
- At least but less than ,
or more
,
· Skin graft
of burn benet
Fractures
Once per accident, within days after the accident. Payable when an insured fractures a bone
because of a covered accident and is treated by a doctor. If the fracture requires open reduction,
of the benet is payable for that bone. If more than one fracture to the same bone occurs
as a result of the same accident, only one fracture benet is payable. For multiple fractures to
dierent bones in the same accident, the plan will pay a maximum of of the benet amount
for the bone fractured that has the highest dollar amount. For a chip fracture (a piece of bone that is
completely broken o near a joint), the plan will pay of the amount for the aected bone.
Employee/Spouse/Child
Open
Reduction
Closed
Reduction
· Hip/Thigh , ,
· Vertebral body (except processes) , ,
· Pelvis (except coccyx) , ,
UC Plus Supplemental Health Plans ucplus.com
COVERED ACCIDENT BENEFIT BENEFIT AMOUNT
Fractures, continued:
Open
Reduction
Closed
Reduction
· Skull (depressed) , ,
· Leg , ,
· Forearm/Hand/Wrist , ,
· Foot/Ankle/Kneecap , ,
· Shoulder Blade/Collarbone , ,
· Lower Jaw (mandible) , ,
· Skull (non-depressed) , ,
· Upper Arm/Upper Jaw , ,
· Facial Bones (except teeth) , ,
· Vertebral Processes ,
· Coccyx (tailbone)/Rib/Finger/Toe
· Sternum (breast bone) , ,
· Pelvis , ,
Dislocations
Once per accident, within days after the accident. Payable when an insured dislocates a joint
because of a covered accident and is treated by a doctor. If the dislocation requires open reduction,
of the benet for that joint is payable. The plan will pay benets only for the rst dislocation
of a joint. The plan will not pay for recurring dislocations of the same joint. For multiple dislocations
(more than one dislocated joint in one accident), the plan will pay a maximum of of the
benet amount for the joint dislocated that has the highest dollar amount. For a partial dislocation
(joint is not completely separated, including subluxation), the plan will pay of the amount for
the aected joint.
Open
Reduction
Closed
Reduction
· Hip , ,
· Knee (not kneecap) , ,
· Shoulder , ,
· Foot/Ankle , ,
· Hand , ,
· Lower Jaw , ,
· Wrist , ,
· Elbow ,
· Spine ,
· Finger/Toe
· Collarbone
· Rib
UC Plus Supplemental Health Plans ucplus.com
COVERED ACCIDENT BENEFIT BENEFIT AMOUNT
Outpatient Surgery
Maximum of one surgery per accident when treated by a physician in an outpatient surgery facility
within 180 days after accident. General anesthesia must be administered within 90 days after the
accident occurs, during surgery to treat the injury, and must be administered by a physician. Benets
will be paid no more than one time per covered person, per accident, up to three times per covered
person, per calendar year. If another covered surgery is performed at the same time, the plan will
pay the benet with the highest amount.
outpatient surgery
Inpatient Surgery
Maximum of one surgery per accident within 180 days after the accident. The surgery must be
performed while the insured is conned to a hospital as an inpatient. If more than one surgery is
performed or if outpatient surgery is performed at the same time, the plan will pay the benet with
the highest amount. General anesthesia must be administered within 90 days after the accident
occurs, during surgery to treat the injury, and must be administered by a physician.
,
Transportation Benets (ground, water or plane)
For transportation greater than 50 miles from insured’s residence for treatment prescribed by a
doctor not available within 50 miles of residence where ground or air ambulance is not payable
for the trip.
Surgical procedures may include, but are not limited to, surgical repair of ruptured disc, tendons/ligaments, hernia, rotator cu, torn knee
cartilage, skin grafts, joint replacement, internal injuries requiring open abdominal or thoracic surgery, exploratory surgery (with or without
repair), etc., unless otherwise noted due to an accidental injury.
AFTERCARE BENEFITS BENEFIT AMOUNT
Appliances
Within 90 days after the accident. Payable if, as a result of an injury received in a covered accident, a doctor
advises the insured to use a listed medical appliance as an aid in personal locomotion: cane, brace for neck,
back or leg, walking boot that extends above the ankle, walker, crutches, wheelchair or motorized scooter for
medical purposes, or any other medical device used for mobility.
Accident Follow-Up Treatment
Treatment must begin within 90 days after the accident occurs and must be provided within 180 days after
the accident occurs. Treatment must not be for preventative testing or payable under the therapy services
benet, emergency or non-emergency care benets.
Inpatient Rehabilitation
Maximum of days per accident, no more than days total per calendar year for each insured. Payable
for each day that, due to a covered accidental injury, an insured received treatment as an inpatient at a
rehabilitation facility. For this benet to be payable, the insured must be transferred to the rehabilitation
facility for treatment following an inpatient connement. The plan will not pay the rehabilitation facility
benet for the same days that the hospital connement benet is paid. The plan willpay the highest
eligible benet.
per day
Therapy Services (Physical, Occupational, Cognative, Speech Therapy)
Maximum of per accident, beginning within days after the accident. Payable if, because of injuries
received in a covered accident, an insured has doctor-prescribed therapy treatment in one of the following
categories: physical therapy, occupational therapy, speech therapy, or cognitive behavioral therapy, and
therapy is received on an outpatient basis. Not payable on the same day for which inpatient rehabilitation
is paid.
UC Plus Supplemental Health Plans ucplus.com
HOSPITALIZATION BENEFITS BENEFIT AMOUNT
Hospital Admission
Once per covered person per accident, within 90 days after the accident. Payable when an insured is
admitted to a hospital and conned as an inpatient because of a covered accidental injury. This benet is
not payable for connement to an observation unit of less than 20 hours, for emergency room treatment
or for outpatient treatment.
, per connement
Hospital Connement
Maximum of days per accident, beginning within 90 days after the accident. Payable for each day that
an insured is conned to a hospital as an inpatient for 24 hours because of a covered accidental injury.
If the plan pays benets for connement and the insured is conned again within 90 days because of
the same accidental injury, the plan will treat this connement as the same period of connement. This
benet is payable for only one hospital connement at a time even if caused by more than one covered
accidental injury. This benet is not payable for a day in which the hospital admission benet is payable.
If a covered person has a non-ICU hospital connement and an intensive care connement on the same
day, only the intensive care connement benet will be paid.
per day
Hospital Intensive Care
Maximum of days per accident, beginning within 90 days after the accident. Payable for each day an
insured is conned in a hospital intensive care unit for 24 hours because of a covered accidental injury.
The plan will pay benets for only one connement in a hospital intensive care unit at a time even if
caused by more than one covered accidental injury. If the plan pays benets for connement in a hospital
intensive care unit and an insured becomes conned to a hospital intensive care unit again within nine
months because of the same accidental injury, the plan will treat this connement as the same period
of connement.
per day
Lodging Benet
Greater than 50 miles from the insured’s residence, maximum of 30 days per accident and 30 days per
year. Payable for each night’s lodging in a motel/hotel/rental property for a companion who accompanies
the covered person while the covered person is conned.
per day
LIFECHANGING EVENT BENEFITS BENEFIT AMOUNT
Paralysis
Once per accident, diagnosed by a doctor within 90 days after the accident.
· Monoplegia ,
· Paraplegia ,
· Triplegia ,
· Quadriplegia ,
Prosthesis
Must be received within 365 days after the accident occurs. No benet will be payable for replacement of
a device.
,
Residence/Vehicle Modication
Once per accident, within 180 days after the accident. Payable if the modication is necessary to help
enable the covered person to live in his or her primary residence or travel in his or her primary vehicle.
,
LIMITATIONS AND EXCLUSIONS
The benets outlined in this document are a brief description of coverage, designed to help you with the selection
process. This summary does not reect each and every benet, exclusion and limitation which may apply to the
coverage. For more details, important limitations and exclusions, refer to the Group Accidental Injury Insurance
Policy, which can be found on the ucplus.com website. If there is a dierence between this summary and the
Group Accidental Injury Insurance Policy, the Group Accidental Injury Insurance Policy will prevail.
UC Plus Supplemental Health Plans ucplus.com
UC Plus
Group Critical Illness Plan
COVERED CRITICAL ILLNESS BENEFIT BENEFIT AMOUNT
Paid as a percentage of
coverage amount elected
($10,000 or $30,000)
Cancer (Internal or Invasive)
Heart Attack (Myocardial Infarction)
Sudden Cardiac Arrest
Stroke (Ischemic or Hemorrhagic)
Kidney Failure (End-Stage Renal Failure)
Bone Marrow Transplant (Stem Cell Transplant)
Severe Burn
Paralysis of Limbs
Coma
Severe Coronary Artery Disease
Loss of Speech/Blindness/Deafness
Benign Brain Tumor
Non-Invasive Cancer
Advanced Alzheimer’s Disease
Advanced Parkinson’s Disease
Human Coronavirus Requiring Hospitalization of Five Days
Childhood Conditions
Cystic Fibrosis
Cerebral Palsy
Cleft Lip or Cleft Palate
Down Syndrome
Spina Bida
UC Plus Supplemental Health Plans ucplus.com
Additional Occurance
The plan will pay benets for the diagnosis of a separate covered condition.
Reoccurrence
The plan will pay benets for a recurrence of the same critical illness. Recurrence means positive diagnosis of a critical illness or
procedure for which a benet was paid, and the date of diagnosis of recurrence is more than 180 Days after prior benet payment.
Cancer Diagnosis and Recurrence
The plan will pay benets for a recurrence or new diagnosis of cancer for which a benet was paid, and the date of diagnosis of
recurrence is more than 180 days after prior benet payment.
Skin Cancer Benet
The plan will pay for the diagnosis of skin cancer. It will pay this benet once per calendar year.
Wellness Benet
The Wellness Benet is a $100 benet which is payable once per calendar year if the covered person receives approved health screening
tests while not conned in a hospital (mammography, lab tests for cholesterol or triglycerides, diabetes screenings, colonoscopy, etc.).
LIMITATIONS AND EXCLUSIONS
The benets outlined in this document are a brief description of coverage, designed to help you with the selection
process. This summary does not reect each and every benet, exclusion and limitation which may apply to the
coverage. For more details, important limitations and exclusions, refer to the Group Critical Illness Insurance
Policy, which can be found on the ucplus.com website. If there is a dierence between this summary and the
Group Critical Illness Insurance Policy, the Group Critical Illness Insurance Policy will prevail.
UC Plus Supplemental Health Plans ucplus.com
UC Plus
Group Hospital Indemnity Plan
HOSPITAL BENEFIT BENEFIT AMOUNT
Hospital Admission Benet
Payable once per covered sickness or accident, no more than ve times per covered person, per calendar
year. The admission must occur within 180 days after the covered accident, covered injury or covered
illness occurs.
,
per connement
Hospital Connement
Maximum of 30 days per connement for each covered sickness or accident for each insured. Payable no
more than three times per covered person, per calendar year. The initial hospital connement must begin
within 180 days after the covered accident, covered injury or covered illness occurs.
per day
Hospital Intensive Care Benet
Maximum of 30 days per connement for each covered sickness or accident for each insured. Payable for
each day when an insured is conned in a hospital intensive care unit because of a covered accidental
injury or covered sickness. Connement must begin within 180 days after the covered accident, covered
injury or covered illness occurs. Once benets are paid, if an insured becomes conned to a hospital’s
intensive care unit again within six months because of the same or a related condition, the plan will treat
this connement as the same period of connement.
per day
LIMITATIONS AND EXCLUSIONS
The benets outlined in this document are a brief description of coverage, designed to help you with the selection
process. This summary does not reect each and every benet, exclusion and limitation which may apply to
the coverage. For more details, important limitations and exclusions, refer to the Group Supplemental Hospital
Indemnity Policy, which can be found on the ucplus.com website. If there is a dierence between this summary and
the Group Supplemental Hospital Indemnity Policy, the Group Supplemental Hospital Indemnity Policy will prevail.
UC Plus Supplemental Health Plans ucplus.com
Contacts and Resources
ucplus.com
Find complete plan information, including Certicates of Insurance and answers to frequently asked questions.
www.prudential.com/mybenefits
Create an online account with Prudential to le claims electronically and check the status of existing claims.
UCPath
To enroll in a Supplemental Health Plan, visit ucpath.universityofcalifornia.edu. Contact a member of
the UCPath team with enrollment-related questions at (855) 982-7284. Business hours are 8 a.m. to 5 p.m. PT,
Monday through Friday, excluding UC holidays.
UCnet
For more information about all of the UC benet plan options, go to UCnet.
The University of California intends to continue the benets described here indenitely; however, the benets of all employees, retirees and plan
beneciaries are subject to change or termination at the time of contract renewal or at any other time by the university or other governing authorities.
If you belong to an exclusively represented bargaining unit, some of your benets may dier from those described here. This document is a summary.
If there is any conict between this summary and the governing plan booklets or agreements, the governing plan documents will control.
UC Plus Supplemental Health Plans ucplus.com
January
The Prudential coverage described in this booklet is subject to plan limitations, exclusions, denitions, and provisions. For detailed information, please see the
plan certicate or reference the brochure, which can be found on ucplus.com, as this booklet is intended to provide a general summary of the coverage. This
overview is subject to the terms, conditions and limitations of the plan.
ucp-evgrngd24-508
