• Eligible dependents include:

  ·   your spouse

  ·   your unmarried dependent children up to age 25 who are dependent on you for support

  ·   your mentally or physically disabled children of any age who were or became disabled before the age limit and who were already covered by your plan

  ·   your sponsored dependent

  ·   sponsored dependent up to age 25 and who resides in the employee's household

  
  
  

• The age limit is 25 years of age as long as the child is the member's dependent. Coverage ends at the end of the month in which the child reaches their 25th birthday. 
  
  

• Eligibility will continue past the age limit for Dependents who are totally disabled and who are Covered Persons upon reaching the age limit. The Dependent must have been totally disabled before reaching the age limit. A Physician must certify that the Dependent is totally disabled. We may require proof of the disability from time to time. A total disability is a condition that results when any physical handicap or mental retardation prevents a Dependent from engaging in substantial gainful activity. 
  
  The disability must be expected to result in death or be of continuous or indefinite duration. We are the final authority for determining whether a Dependent is totally disabled.
  
  
  

• No - Your parent is not considered to be an eligible dependent for health coverage.
  
  

• Yes
  
  

• No- Unless you are awarded legal guardianship of the child.
  
  

• Yes - If you are by court-order financially responsible for them and if they reside within the UK-HMO Lexington Service Area.
  
  

• If your Dependent attends school outside the Service Area, all Plan Delivery System Rules apply. Routine services must be received from a UK-HMO LSA Participating Provider. Unmarried, full-time students are eligible for coverage until age 25.
  

• Please refer to the UK-HMO website provider search to determine if your physician is a participating provider. If you choose UK-HMO, benefits are payable only if network providers are used.  There are no out of network benefits.
  
  

• No - The UK-HMO Lexington Service Area Plan does not require that you choose a Primary Care Provider and obtain referrals for specialty care. However, we encourage you to establish a relationship with a Primary Care Physician. Doing so will enable the physician to better serve your health care needs should you become ill or injured. 
  
  

• Your Primary Care Physician is responsible to coordinate your care. However, you can choose any provider at the UK Medical Center.
  
  

• Yes - You may see another doctor in the KY Clinic as well as Urgent Treatment Centers for illness or injury.
  
  You will pay a $15 co-payment at Urgent Treatment Centers or in the UK Pediatrics Twilight Clinic..
  
  

• Any specialty care that is not available at UK Hospital must be pre-authorized prior to obtaining the service to determine if that would be allowed.  Work through your UK participating physician for direction.
  

• This cost changes yearly.  Please refer to the UK Benefits to determine this cost by calling 257-9519 and choosing 3 for benefits and then 1 to speak with a customer service representative.  You may also find this on the UK Benefits website at www.uky.edu/HR/benefits.
  

• You must live in the following counties or within a 50 driving mile radius of the University of Kentucky Chandler Medical Center to participate in UK-HMO Lexington Service Area Plan: Anderson, Bourbon, Clark, Fayette, Franklin, Jessamine, Madison, Mercer, Scott or Woodford.
  
  

• The live or work option is only available to persons who have the UK Indemnity plan option which is offered to those members who live out of state.  So if you live in Indiana, but work in Louisville, you may choose the plans that are available in Jefferson County where you work or in Indiana where you live. 
  
  

• Yes - if both are being covered by your health care plan.  If your spouse has their own separate UK-HMO plan, they could potentially be participating in the RSA plan if they do not live with you.
  
  

MY CHILD IS A FULL TIME STUDENT AT A UNIVERSITY OUTSIDE THE REGIONAL SERVICE AREA. HOW WILL HE/SHE BE COVERED?

• If your Dependent attends school outside the Service Area, all Plan Delivery System Rules apply. Routine services must be received from a UK-HMO LSA Participating Provider.  Unmarried, full-time students are eligible for coverage until age 25.

IF I AM TRAVELING AND GET SICK, WHAT SHOULD I DO? WILL TREATMENT BE COVERED BY UK-HMO?

• If you feel you have an Emergency Medical Condition, you should go to the UK Emergency Room. If your condition makes travel to the UK Emergency Room unsafe or if you are out of the Service Area, go to the nearest emergency medical facility. If necessary, call 911. It is recommended that you notify your personal physician within 24 hours or as soon as reasonably possible. Follow-up care is not considered emergency care.

DO YOU COVER EMERGENCIES OUT OF THE COUNTRY?

• Yes – When you are traveling out of the Service Area, you are covered for urgent or emergent care only.  Most countries outside the United States may require that you pay for these services and get reimbursement when you return.  Be sure to obtain copies of your medical records and the bill in US currency.  Medical Records also need to be translated prior to submission if they are in a foreign language.

I’M DIVORCED AND MY CHILD LIVES WITH THEIR CUSTODIAL PARENT OUTSIDE OF THE REGIONAL SERVICE AREA. CAN THEY BE COVERED BY THE UK-HMO REGIONAL SERVICE AREA?

• No - Both the member and their dependents must reside within the same UK-HMO Service Area in order to be eligible for coverage.
  

• Yes - Your doctor must be a UK-HMO participating provider. Your newborn will be covered automatically for the first 5 days of newborn nursery regardless of whether the child is placed on the UK-HMO Plan. However, you must add the baby within 30 days in order to have the baby covered from the date of birth for any other services.  You would submit a "Health Benefits Enrollment Form" to the UK Employee Benefits Office, 112 Scovell Hall, Lexington, KY 40506-0064.  You must also submit a copy of the baby’s footprint certificate from the hospital or the birth certificate with this enrollment form..  If on a single or employee plus one (spouse) plan, you will need to change to either employee plus children or family coverage. You will not be able to add the baby after the 30 days have lapsed until the next open enrollment period. 

• The duration of routine inpatient maternity care for a mother is determined by her physician based upon medical necessity.

• No - One global fee shall be charged for all maternity care and is covered by the plan. There is a $10 one-time office visit co-payment for the physician services and a $100 inpatient co-pay when you are admitted for the delivery.

• Coverage will begin with the adoption date of the child. You must complete a change form obtained from Employee Benefits and return it to them within 30 days in order to have the child covered.  You must also submit the adoption papers with this form to add the child to your plan.

• Yes - When performed by a participating provider. If you obtain your pap smear from an OB/GYN, for your annual exam only, you will not have a co-payment as this visit is considered the same as a PCP visit.

• No coverage is provided for infertility services. No coverage is provided for reversal or any attempted reversal of a previously performed sterilization.

• Yes - up to age 6 with annual check-ups thereafter.

• Yes

• Yes - Your doctor must be a UK-HMO participating provider and the delivery must occur at the UK Hospital. There is a $10 specialty co-payment on the initial visit only for pregnancy and a $100 co-payment for the inpatient admission.