Retiree Health Plans, Benefits, Human Resources, University of Kentucky

Overview Age 65 and Over

Under Age 65

Eligibility FAQ

Retiree - Medicare Eligible Health Plan

Medicare Advantage Option Summary of Health Plan Benefits

2007	Major Plan Benefits	Plan Benefits for Covered Services
Out-of-Pocket Maximum	If you reach this maximum, no further out-of-pocket will be required of you for covered expenses during the year. Expenses for outpatient prescription drugs, Medicare-covered diabetic supplies, care during foreign travel, and plan premiums do not apply toward this maximum.	$2,500 per calendar year
Lifetime Maximum Benefit		Unlimited
Preventive Care	• Office visits in conjunction with an illness or injury • Allergy injections and serum • Diagnostic tests and X-rays • Medicare-approved lab services	100% after $5 copayment per visit to primary care doctor 100% after $15 copayment per visit to specialists.
Preventive Care	• Preventive care – Routine physical exams – Well-woman care – Immunizations	100% when no other services are provided during the visit. If other services are provided during the visit, you pay $5 to $50 per visit, based on where the services are received.
Hospital Services	• Inpatient hospital care (semiprivate room, ancillary services, physician visits)*	100% after $175 copayment per admission
	• Preadmission testing	100%
	• Outpatient hospital care	100% after $50 copayment per visit
	• Emergency Care (emergency room, emergency services)	100% after $50 copayment per visit
	• Ambulatory surgical center care	100% after $15 copayment per visit
Other Medical Services	• Physical therapy, respiratory, occupational, or speech therapy	100% after $15 copayment per visit
	• Home health services	100%
	• Durable medical equipment	100% after 20% coinsurance
	• Oxygen	100% after 20% coinsurance
	• Skilled nursing facility (limited to 100 days per benefit period) (no three day hospital stay required)	100% for days 1-20, 100% after $50 copayment per day (days 21-100)
	• Ambulance	100% after $50 copayment per date of service
	• Immediate care facility	100% after $15 copayment per visit
Mental and Nervous Disorder and Alcohol and Drug Abuse Services	• Inpatient hospital care (semiprivate room, ancillary services, physician visits) (190 day lifetime maximum in a psychiatric hospital)*	100% after $175 copayment per admission
	• Outpatient care	100% after $15 to $50 copayment per visit, based on where services are received
	• Partial hospitalization	100% after $15 copayment per date of service
*Inpatient hospital admissions do not require prior authorization. However, notification of hospital admissions is requested.