Health insurance PPO Low-deductible health insurance with more provider options
Employee health insurance
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.
Coverage highlights
| 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 | $663 | $614 | $49 |
| Employee + children | $995 | $823 | $172 |
| Employee + spouse | $1,316 | $1,015 | $301 |
| Employee + family | $1,635 | $1,203 | $432 |
* 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.
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 Scovell 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 Scovell Hall.
