Retiree - UK-HMO
At a glance: offers quality care through UK HealthCare facilities and physicians, lowest monthly premium, lowest out-of-pocket costs. No deductible. No out-of-network coverage. Click here for full plan details on the UK-HMO LSA and click here for full plan details on the UK-HMO RSA. Click here to view map of Regional Service Area. (Coverage is provided for emergency care at a non-participating facility only if your condition is an Emergency Medical Condition as determined by the plan. To find out if a provider is a participation provider, visit our Web site at www.mc.uky.edu/ukhmo).
UK-HMO Summary of Health Plan Benefits
The UK-HMO offers excellent value for your premium dollar. There are no deductibles to meet and no copayments for routine physicals or well child care when services are provided by a network primary care physician.
UK-HMO Factors to Consider:
- Lexington Service Area network consists of UK HealthCare facilities (including Chandler Hospital, Good Samaritan Hospital, and Kentucky Clinics) and UK HealthCare physicians.
- Regional Service Area network includes the UK HealthCare facilities, UK HealthCare physicians and select Humana/ChoiceCare providers (use the UKHMO RSA provider link on the Humana page).
- No referrals are required for specialty care services provided within the network.
- No deductibles to meet.
- No coverage for out-of-network services unless it is a true emergency.
- Covered transplants include kidney, liver, pancreas, kidney/pancreas, heart, lung, heart/lung, bone marrow and cornea transplants.
Prior authorization is required for the following services:
Durable medical equipment (over $750), home health care and hospice services, and other services as listed in the certificate of coverage. Available urgent care options include: Urgent Treatment Centers in Lexington (Dove Run Road, Custer Drive, and Boardwalk Street), Nicholasville (Bellaire Drive) as well as the UK Children's Twilight Clinic.
UK-HMO (Lexington Service Area and Regional Service Area) Summary of Health Plan Benefits
2009-2010
|
Major Plan Benefits
|
Benefits for Covered Services Provided at Participating Providers |
Lifetime Maximum Benefit |
|
Unlimited |
| Copayment Limits | Individual and Family | N/A |
Preventive Care
|
Routine Pap smears, mammograms, PSA, screening colonoscopy and sigmoidoscopy |
100% |
Physician Services
|
Office visits (excludes certain diagnostic lab and X-ray) |
100% after $10 copayment for primary care physician, |
Lab tests and X-rays |
100% |
|
Allergy injections |
100% after $5 copayment |
|
Inpatient services |
100% |
|
Hospital Services
|
Inpatient care (semi-private room and board, nursing care, ICU) |
100% after $150 copayment per admission |
Organ transplants |
100% |
|
Outpatient surgery |
100% after $50 copayment |
|
Emergent/Urgent Services |
Emergency Room |
100% after $75 copayment (waived if admitted) |
Other Medical Services
|
Skilled nursing facility (up to 30 days per plan year); |
100% |
| Home health care (up to 60 visits per plan year) | 80% | |
| Durable medical equipment, orthotics, and prosthetics | 80%, maximum member responsibility of $400/plan year for all services combined | |
Hearing Aids |
$1,400 benefit every 36 months for children under 18 |
|
Speech therapy, pulmonary rehab therapy, physical, occupational therapy, cardiac rehab, manipulative therapy, hydrotherapy and acupuncture therapy (limited to 45 visits per plan year, combined)
|
100% after $15 copayment per visit for all therapies |
|
Mental Health and Substance Abuse |
Inpatient mental health or substance abuse (up to 60 days/plan year) |
100% after $150 copayment |
Outpatient mental health or substance abuse (up to 20 visits/plan year) |
100% after $20 copayment |
