Health plan PPO
Low-deductible health insurance with provider options
This plan offers greater flexibility to choose providers from UK HealthCare, Anthem network or out-of-network. UK HealthCare facilities and physicians still offer excellent value with lower co-pays and co-insurance.
PPO vs HMO
PPO plan is available at the same monthly cost as HMO and offers greater flexibility to choose a doctor or health care facility. What you pay per month, called the monthly premium, is the same as the HMO plan. Members of the PPO plan pay for this extra flexibility through deductibles, co-insurance and higher co-pays for certain services.
Employee monthly rates
| Coverage | Cost * | UK pays | You pay |
|---|---|---|---|
| Employee only | $575 | $542 | $33 |
| Employee + children | $862 | $719 | $143 |
| Employee + spouse | $1,150 | $885 | $265 |
| Family | $1,437 | $1,046 | $391 |
* Regular part-time and temporary employees (less than 0.75 FTE or work less than an average of 30 hours per week in a 12 month measurement period), who are not eligible for the UK credit toward the costs of coverage, pay this rate.
Coverage highlights
Deductibles and out-of-pocket maximums vary based on who you see for care.
| PPO plan design | UK HealthCare | Anthem | Out-of-network | |
|---|---|---|---|---|
| Lifetime Maximum Benefit | Unlimited | Unlimited | Unlimited | |
| Out-of-Pocket Amount | Annual deductible | $100/member; $200/family | $500/member, $1,000/family | $1,500/member; $3,000/family |
| Medical out-of-pocket maximum | $3,000/member; $6,000/family | $3,000/member; $6,000/family | N/A | |
| Prescription out-of-pocket maximum | $4,900/member; $9,800/family | $4,900/member, $9,800/family | $4,900/member, $9,800/family |
Costs for common services
| PPO plan design | UK HealthCare | Anthem | Out-of-network | |
|---|---|---|---|---|
| Preventive Care (Coverage under preventive care category depends on age, symptoms and diagnosis) | Routine mammogram and Pap smears | $0 | $0 | 50% after deductible |
| Routine child care and immunizations (through age 18) | $0 | $0 | 50% after deductible | |
| Routine adult physical exam (19 years and above) | $0 | $0 | 50% after deductible | |
| Routine outpatient lab tests and X-rays | $0 | $0 | 50% after deductible | |
| Physician Services | Primary care office visits (excludes certain diagnostic lab and X-ray) | $15 co-pay per visit | $25 co-pay per visit | 50% after deductible |
| Specialist office visits (excludes certain diagnostic lab and X-ray) | $40 co-pay per visit | $50 co-pay per visit | 50% after deductible | |
| Lab tests and X-rays | Same as office visit co-pay | Same as office visit co-pay | 50% after deductible | |
| Allergy injections | $10 co-pay per visit | $10 co-pay per visit | 50% after deductible | |
| Inpatient services | $300 co-pay per visit | 20% after deductible | 50% after deductible | |
| Outpatient surgery | $100 co-pay per visit | 20% after deductible | 50% after deductible | |
| Diagnostic tests (high costs - MRI, MRA, CT, and PET scans) | $75 co-pay per visit | 20% after deductible | 50% after deductible | |
| Hospital Services | Inpatient care (semi-private room and board, nursing care, ICU) | $300 co-pay per visit | 20% after deductible | 50% after deductible |
| Outpatient surgery | $100 co-pay per visit | 20% after deductible | 50% after deductible | |
| Diagnostic tests (high costs - MRI, MRA, CT, and PET scans) | $75 co-pay per visit | 20% after deductible | 50% after deductible | |
| Outpatient nonsurgical care | $100 co-pay per visit | 20% after deductible | 50% after deductible | |
| Outpatient tests, lab and X-ray | $0 | 20% after deductible | 50% after deductible | |
| Ancillary services | $0 | 20% after deductible | 50% after deductible | |
| Organ transplants | $0 | 20% after deductible | 50% after deductible | |
| Emergency room | 20% after $100 co-pay per visit (waived if admitted) | 20% after $100 co-pay per visit (waived if admitted) | 20% after $100 co-pay per visit (waived if admitted) | |
| Other Medical Services | Urgent treatment center | $50 co-pay per visit | 100% after $50 co-pay per visit | 50% after deductible |
| Skilled nursing facility (up to 100 days/plan year) | 20% after deductible | 20% after deductible | 50% after deductible | |
| Home health care (up to 100 visits/plan year) and hospice services | 20% after deductible | 20% after deductible | 50% after deductible | |
| Durable medical equipment | 20% after deductible | 20% after deductible | 50% after deductible | |
| Ambulance | 20% after deductible | 20% after deductible | 50% after deductible | |
| Chiropractic care*, physical, speech, music, hydrotherapy, occupational and acupuncture therapy (limited to 45 visits per plan year, combined) *Maximum 20 visits for chiropractic care | $20 co-pay/visit | $30 co-pay/visit | 50% after deductible | |
| Mental Health and Substance Abuse | Inpatient | $300 co-pay per visit | 20% after deductible | 50% after deductible |
| Outpatient | $40 co-pay/visit | $50 co-pay/visit | 50% after deductible |
Making changes
Your first 30 days
Welcome to UK! You can sign up for benefits depending on your FTE. Enroll in your benefits quickly in myUK.
Qualifying events
If you experience a major life change outside of open enrollment you can also make changes to your insurance. This is known as a qualifying event. You'll need to fill out and submit a form within 30 days.
Benefits Open Enrollment
Our Benefits Open Enrollment happens every year so that you can make changes. Changes can be made in myUK, or with paper forms.
Retirees
Please use the Retiree Benefits Enrollment form and return to Scovell Hall.