HEALTH INSURANCE
HMO
No-deductible health insurance for Central Kentuckians who use UK HealthCare
Consider if: You don’t need medical care outside of Central Kentucky and like the convenience of using UK HealthCare.
The HMO health plan is available to employees and retirees living in 10 Central Kentucky counties. Plan members have the UK HealthCare provider network available to them.
For the 2023-24 plan year, WINFertility benefits are not available on the UK-HMO plan. WINFertility benefits will be available on the HMO plan beginning July 1, 2024, for the 2024-25 plan year.
Anderson, Bourbon, Clark, Fayette, Franklin, Jessamine, Madison, Mercer, Scott or Woodford
Service coverage and costs
All employee health insurance plans provide one annual preventive care visit with your primary care provider at $0 co-pay within specified networks.
For other common visits, this is what you’ll pay with UK-HMO.
$10
Primary care co-pay
$30
specialist co-pay
$25
urgent care co-pay
Coverage highlights
| HMO health plan | Maximums | UK HealthCare |
|---|---|---|
| Lifetime Maximum Benefit | Unlimited | |
| Out-of-Pocket Amount | Annual deductible | $0/member; $0/family |
| Medical out-of-pocket maximum | $3,000/member; $6,000/family | |
| Prescription out-of-pocket maximum | $5,000/member; $10,000/family |
Employee monthly rates
| Coverage level | Total monthly cost* | UK pays | You pay |
|---|---|---|---|
| Employee only | $654 | $614 | $40 |
| Employee + children | $980 | $823 | $157 |
| Employee + spouse | $1,297 | $1,015 | $282 |
| Employee + family | $1,613 | $1,203 | $410 |
| Coverage level | Total monthly cost* | UK pays | You pay |
|---|---|---|---|
| Employee only | $781 | $736 | $45 |
| Employee + children | $1,152 | $986 | $166 |
| Employee + spouse | $1,512 | $1,216 | $296 |
| Employee + family | $1,872 | $1,442 | $430 |
* 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 for common services
| HMO health plan | Service | UK HealthCare |
|---|---|---|
| Preventive Care (Coverage under preventive care category depends on age, symptoms, and diagnosis) | Routine Pap smears, mammograms, PSA, screening colonoscopy, and sigmoidoscopy | $0 |
| Routine child care and immunizations (through age 18) | $0 | |
| Routine adult physical exam (19 years and above, one per plan year) | $0 | |
| Physician Services | Primary care office visits (excludes certain diagnostic lab and X-ray) | $10 co-payment for primary care physician |
| Specialist office visits (excludes certain diagnostic lab and X-ray) | $30 co-payment for specialist | |
| Lab tests, X-rays and diagnostic tests | $0 | |
| Allergy injections | $10 co-payment | |
| Inpatient services | $0 | |
| Outpatient surgery and diagnostics | $0 | |
| Physician visits to emergency room | $0 | |
| Hospital Services | Inpatient care (semi-private room and board, nursing care, ICU) | $200 co-payment per admission |
| Hospital observation stay | $100 co-payment | |
| Organ transplants | $0 | |
| Outpatient nonsurgical care | $0 | |
| Outpatient tests, lab, X-ray and other diagnostic tests | $0 | |
| Ancillary services | $0 | |
| Outpatient surgery | $75 co-payment | |
| Outpatient diagnostic testing (high costs - MRI, MRA, CT and PET scans) | $75 co-payment | |
| Emergent/Urgent Services | Emergency room | $100 co-payment, then 10% co-insurance (waived if admitted) |
| Urgent treatment center | $25 co-payment | |
| UK Children's Twilight Clinic | $15 co-payment | |
| Ambulance | $75 co-payment | |
| Other Medical Services | Skilled nursing facility (up to 30 per plan year) and hospice services | $0 |
| Home health care (up to 60 visits per plan year) | 20% co-insurance | |
| Durable medical equipment, orthotics, and prosthetics | 20% co-insurance up to $500 member cost per year | |
| Hearing aids | 20% co-insurance for children under 18 | |
| Speech, music, physical, occupational, manipulative, hydrotherapy, acupuncture, pulmonary rehab, and cardiac rehab therapy (limited to 45 visits per plan year, combined) | $15 co-payment per visit for all therapies | |
| Mental Health and Substance Abuse | Inpatient mental health or substance abuse | $200 co-pay per admission |
PROVIDER NETWORK
UK HealthCare
HMO plan members have access to the expertise of UK HealthCare providers.
Eligibility and enrollment
Welcome to UK! You can sign up for benefits depending on your FTE. Enroll in your benefits quickly in myUK.
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.
Our Benefits Open Enrollment happens every year so you can make changes. Changes can be made in myUK, or with paper forms.
Please use the Retiree Benefits Enrollment form and return to Mandrell Hall.
How to change your benefits
Signing up as a new employee or making changes during Benefits Open Enrollment can be done in myUK, or with paper forms.
Making changes at other times of the year due to a qualifying event are completed using our Benefits Enrollment Form.
Paper forms can be emailed, faxed or brought to Mandrell Hall.