Health Insurance
PPO
Low-deductible health insurance with more provider options
Consider if: You or your family need flexibility to see different health care providers.
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.
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 PPO.
$15
UK HEALTHCARE PRIMARY CARE CO-PAY
$25
ANTHEM PRIMARY CARE CO-PAY
$40
UK HEALTHCARE SPECIALIST CO-PAY
$50
ANTHEM SPECIALIST CO-PAY
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 | $4,000/member; $8,000/family | N/A | |
| Prescription out-of-pocket maximum | $5,000/member; $10,000/family | $5,000/member; $10,000/family | $5,000/member; $10,000/family |
Employee monthly rates
| Coverage level | Total monthly cost* | UK pays | You pay |
|---|---|---|---|
| Employee only | $810 | $736 | $74 |
| Employee + children | $1,208 | $986 | $222 |
| Employee + spouse | $1,592 | $1,216 | $376 |
| Employee + family | $1,974 | $1,442 | $532 |
* 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
| 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 |
UK HealthCare
PPO plan members have access to the expertise of UK HealthCare providers.