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Benefits

UK-EPO

Factors to Consider

  • High premiums, for largest selection pool of providers and facilities
  • Large provider network includes UK HealthCare facilities & physicians, and the Anthem BlueCross and BlueShield networks.
  • No referrals required for specialty care services.
  • No coverage for out-of-network services, unless it is a life- or limb-threatening emergency.
  • No deductibles to meet.
  • ​Available in every Kentucky county, as well as in all 50 states.

Continue below for an overview of benefits or click here for a full plan description.

Click here for instructions on finding a participating provider. 

Summary of Plan Benefits

2014-2015

Major Plan Benefits

 

UK HealthCare Providers

Benefits for Covered Services Provided at Participating Providers

Lifetime Maximum Benefit

Out-of-Pocket Amount

 

Unlimited

$6,350/member; $12,700/family

Unlimited

$6,350/member; $12,700/family

Copayment Limits

Individual and Family

N/A

N/A

Preventive Care

 

 

 

Routine immunizations (through age 18)
Routine Pap smears and mammograms
Routine child care (through age 18)
Routine adult physical exam (19 years and above, one per plan year)

100%

100%

 

 

Physician Services

 

 

 

 

 

 

Office visits (excludes certain diagnostic lab and X-ray)

100% after $15 copay per primary care visit or $40 copay per specialist visit

100% after $25 copay per primary care visit or $50 copay per specialist visit

Lab tests, X-rays and diagnostic tests

100% after office visit copay

100% after office visit copay

Allergy injections

100% after $10 copay per visit

100% after $10 copayment

Inpatient services
Outpatient surgery and diagnostics
Physician visits to emergency room

100%

100%

Hospital Services

 

 

 

 

 

Inpatient care (semi-private room and board, nursing care, ICU)

100% after $300 copay per admission (limited to two copays per plan year)

100% after $500 copay per admission (limited to two copays per plan year)

Outpatient surgery

100% after $100 copay per procedure

100% after $150 copay per procedure

Outpatient nonsurgical care
Outpatient tests, lab and X-ray
Ancillary services

100%

100%

Emergency Room

100% after $100 copay (waived if admitted)

100% after $100 copay (waived if admitted)

Urgent Treatment Center N/A 100% after $50 copay per visit

Organ transplant

100%

100%

Other Medical Services

 

 

 

 

Skilled nursing facility (up to 100 days per plan year)
Home health care (up to 100 visits per plan year)
Ambulance (100% after $100 copay)
Hospice

100%

100%

Durable medical equipment

80% up to $500 member cost per year

80% up to $500 member cost per year

Physical, speech, hydrotherapy, occupational music, and acupuncture therapy (limited to 45 visits per plan year, combined)

Chiropractic Care

100% after $20 copay per visit

 

100% after $50 copay

100% after $30 copay per visit

 

100% after $50 copay

Mental Health and Substance Abuse

Inpatient

100% after $300 copay per admission

100% after $500 copay per admission

Outpatient

100% after $40 copay per admission

100% after $50 copay per admission