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Benefits

UK-RHP

Factors to Consider

  • UK-RHP offers lowest premiums and out-of-pocket costs, but you must select UK-RHP network providers for primary or routine care and for surgery/diagnostic care, one of three regional UK-RHP hospital/facility networks based on your county of residence. UK-RHP members may also utilize UK HealthCare facilities and physicians. 
  • UK-RHP Physician/Provider Network: UK-RHP is available in every Kentucky county except those covered by the UK-HMO plan. View detailed UK-RHP provider directory listings for all counties in Kentucky.
  • Regional Health Plan Area network includes the UK HealthCare facilities, UK HealthCare physicians and Anthem BlueCross and BlueShield providers (use the UKHMO RSA provider link on the Anthem 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 life or limb threatening.

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 Benefits

2014-15

 

Major Plan Benefits

 

Benefits for Covered Services Provided at Participating Providers

Lifetime Maximum Benefit

Out-of-Pocket Amount

 

Unlimited

 

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

Copayment Limits

Individual and Family

N/A

Preventive Care

*Coverage under preventative care category depends on age, symptoms, and diagnosis

 

 

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

100%

 

 

Physician Services

 

 

 

 

 

 

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

100% after $10 copayment for primary care physician,
100% after $30 copayment for specialist,

Lab tests, X-rays and diagnostic tests

100%

Allergy injections

100% after $10 copayment

Inpatient services
Outpatient surgery and diagnostics
Physician visits to emergency room

100%

Hospital Services

 

 

 

 

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

100% after $200 copayment per admission

Organ transplants
Outpatient nonsurgical care
Outpatient tests, lab and X-ray, and other diagnostic tests
Ancillary services

100%

Outpatient surgery
Outpatient diagnostic testing (high costs - MRI, MRA, CT and PET scans)

100% after $75 copayment

Emergent/Urgent Services

Emergency Room
 

 

Urgent Treatment Center

 

UK Children's Twilight Clinic

100% after $100 copayment (waived if admitted)

100% after $25 copayment

100% after $15 copayment

Other Medical Services

 

 

 

 

Skilled nursing facility (up to 30 days per plan year) & Hospice Services

Ambulance

100%

100% after $75 copayment

Home health care (up to 60 visits per plan year)

80%

Durable medical equipment, orthotics and prosthetics

80%, maximum member responsibility of $500/plan year for all services combined

Hearing aids

80% for children under 18

Speech therapy, music therapy, pulmonary rehab therapy, physical therapy, 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

100% after $200 copayment per admission

Outpatient mental health or substance abuse

100% after $30 copayment