UK-PPO

Factors to Consider

  • Lower copayments when using UK Healthcare providers for certain procedures.
  • 80% benefit after meeting your deductible (when applicable) when using an in-network provider.
  • 50% benefit after meeting your deductible when using an out-of-network providers
  • Deductible does not apply to in-network preventive services.
  • 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

Summary of Plan Benefits

2014-2015 Major Plan Benefits UK Healthcare Providers In-Network Benefits Out-of-Network Benefits

Lifetime Maximum Benefit

 

Unlimited

Unlimited

Unlimited

Out-of-pocket Amount

Annual Deductible

Out-of-pocket max (includes deductible, copay and coinsurance. Excludes prescription coinsurance)

$250/member; $500/family
$2,500/member; $5,000/family

$500/member; $1,000/family
$2,750/member; $5,500/family

$1,500/member; $3,000/family
$7,500/member; $15,000/family

Preventive Care

 

 

 

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

100%

100%

 

 

50% after deductible

Physician Services

 

 

 

 

 

 

Office visits (excludes 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

50% after deductible

Lab tests, X-rays and diagnostic tests

100% after office visit copay

100% after office visit copay

50% after deductible

Allergy injections

100% after $10 copay per visit

100% after $10 copay per visit

50% after deductible

Inpatient services 
Outpatient surgery and diagnostic tests

80% after deductible

80% after deductible

50% after deductible

Physician visits to emergency room

80%

80%

50% after deductible

Hospital Services

 

 

 

 

Inpatient care (semi-private room and board, nursing care, ICU)
Outpatient surgery
Outpatient nonsurgical care
Outpatient tests, lab and X-ray
Ancillary services
Organ transplants

80% after deductible

80% after deductible

50% after deductible

Emergency Room
 

80% after $100 copay per visit (waived if admitted)

80% after $100 copay per visit (waived if admitted)

50% after deductible

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

Other Medical Services

 

 

 

 

Skilled nursing facility (up to 100 days per plan year)
Home health care (up to 100 visits per plan year)
Durable medical equipment
Hospice services

80% after deductible

80% after deductible

50% after deductible

Ambulance

80% after deductible

80% after deductible

80% after deductible

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

 

100% after $20 copay per visit

100% after $30 copay per visit

50% after deductible

Mental Health and Substance Abuse

Inpatient

80% after deductible

80% after deductible

50% after deductible

Outpatient 100% after $40 copay per visit 100% after $50 copay per visit 50% after deductible