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
2008-2009
|
Major Plan Benefits
|
Benefits for Covered Services Provided at Participating Providers |
Copayment Limits |
Individual and Family |
N/A |
Lifetime Maximum Benefit |
|
Unlimited |
Preventive Care
|
Routine immunizations (through age 18) |
100% when provided by primary care physician and |
Physician Services
|
Office visits (excludes certain diagnostic lab and X-ray) |
100% 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 $100 copayment per admission |
Outpatient surgery |
100% |
|
Emergency room |
100% after $50 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 | |
Speech therapy, occupational therapy, and cardiac rehabilitation Physical therapy, manipulative therapy, hydrotherapy and acupuncture therapy (limited to 30 visits per plan year combined) Note: Speech therapy has a separate limit of 16 visits per plan year and pulmonary rehabilitation has a separate limit of 36 visits per plan year.
|
100%
100% after $15 copayment per visit |
|
Mental Health and Substance Abuse (mental disorders, chemical and/or alcohol dependence) |
Inpatient mental health (up to 31 days per plan year) |
100% after $100 copayment |
Inpatient substance abuse (up to 31 days per plan year) |
80% after $100 copayment |
|
Outpatient mental health (up to 20 visits per plan year) |
65%
|
