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Welcome to UK-HMO
Open Enrollment 2008-2009
UK-HMO is committed to providing you and your family quality service delivered in a timely manner. At UK-HMO, every effort is made to provide you with the healthcare service you need. Open Enrollment Member Service Assistants are available to assist you with your questions and help you understand your benefits. You may reach them by calling (888) 393-6765.
This page is intended as a quick reference guide only. Your UK-HMO Certificate of Coverage will provide you with a more detailed explanation of your benefits.
How to Enroll
Current Member
If you are currently a UK-HMO Lexington Service Area (LSA) or Regional Service Area (RSA) member, you do not need to re-enroll at open enrollment. Your health coverage will continue automatically. However, if you wish to add or cancel a dependent, you must complete the 2008-09 Health Plan form sent to you in the open ernrollment packet from the UK Benefits office. You may also pick up a form at the UK Benefits office in 112 Scovell Hall or 321 Wethington Building, as well as 375 Peterson Service Building. These locations are in Lexington or you can download a form online at www.uky.edu/HR/benefits/enrollmentforms. You may also enroll online at https://myuk/uky.edu beginning April 21 through May 9 for open enrollment changes. More information is available in your Open Enrollment packet.
New Member
You must complete a health plan enrollment form provided to you in the benefits packet from the UK Benefits office. On this form, you will select a coverage level (i.e., employee only; employee + spouse or sponsored dependent; employee + child(ren); or employee + family). If you are covering dependents, you need to complete the section under "additional enrollment information" on the form.
You may also pick up a health plan enrollment form at the UK Employee Benefits Office in 112 Scovell Hall or 321 Wethington Building, both in Lexington, or download a form online at
www.uky.edu/HR/benefits/enrollmentforms.
Effective July 1, 2008
|
Medical Services |
Lexington Service Area Plan (LSA) |
Regional Service Area Plan (RSA) |
|
Choice of Physician |
UK-HMO LSA Participating Provider (Search for participating provider at www.mc.uky.edu/ukhmo) |
UK-HMO RSA Participating Provider in your county of residence or an immediately adjacent RSA county (Search for participating provider at www.mc.uky.edu/ukhmo) |
|
Physician (primary care) office visits for diagnosis and treatment |
100% covered, including routine, preventive care and well-child care (except allergy injections, see below) |
100% covered, including routine, preventive care and well-child care (except allergy injections, see below) |
|
Physician (specialist) office visits for diagnosis and treatment |
$10 co-pay |
$10 co-pay |
|
Allergy injections |
$5 co-pay |
$5 co-pay |
|
Annual gynecological exams, including pap smears, breast exam and pelvic exam with OB/GYN Physician |
100% covered |
100% covered |
|
Mammography |
100% covered |
100% covered |
|
Maternity care |
One $10 office visit co-pay due at initial prenatal visit only. Inpatient co-pay also applies |
One $10 office visit co-pay due at initial prenatal visit only. Inpatient co-pay also applies |
|
Prescription drugs |
Prescription drugs are covered under a separate plan through Express Scripts and UK Employee Benefits |
Prescription drugs are covered under a separate plan through Express Scripts and UK Employee Benefits |
|
Chiropractic; physical therapy services; acupuncture; pool therapy/exercise therapy.
Occupational Therapy (OT) and Cardiac Rehabilitation |
$15 co-pay. Prior plan approval required for pool therapy/exercise therapy. Certain limitations and exclusions apply.
100% covered 30 visits per plan year combined |
$15 co-pay. Prior plan approval required for pool therapy/exercise therapy. Certain limitations and exclusions apply.
100% covered 30 visits per plan year combined |
|
Outpatient speech therapy services |
100% covered, limit 16 visits per plan year |
100% covered, limit 16 visits per plan year |
|
Autism |
$500 maximum monthly benefit for children 2 to 21 years of age for therapeutic, respite and rehabilitative care |
$500 maximum monthly benefit for children 2 to 21 years of age for therapeutic, respite and rehabilitative care |
|
Outpatient mental/nervous care rendered by licensed psychiatrists and psychologist |
65% covered, 20 visits per plan year |
65% covered, 20 visits per plan year |
|
Outpatient substance abuse care rendered by licensed psychiatrists and psychologists |
65% covered, 20 visits per plan year |
65% covered, 20 visits per plan year |
|
Choice of hospital |
UK HealthCare Chandler Medical Center; Kentucky Children’s Hospital; and UK Healthcare Good Samaritan Hospital |
Specified UK-HMO network providers (see provider directory) specialized care not available in your area will be provided by UK Healthcare Chandler Medical Center; Kentucky Children’s Hospital; or UK Healthcare Good Samaritan Hospital. |
|
Hospital services, including semi-private room and board |
$100 co-pay per admission |
$100 co-pay per admission |
|
Emergency/accident (or urgent) care |
$50 co-payment per emergency department visit, waived if admitted to hospital
$15 co-payment at Twilight Children’s Clinic and Urgent Treatment Centers (Boardwalk, Park Hills, Dove Run, and Nicholasville) |
$50 co-payment per emergency department visit, waived if admitted to hospital
$15 co-payment at participating Urgent Treatment Centers; Twilight Children’s Clinic and Urgent Treatment Centers (Boardwalk, Park Hills, Dove Run, and Nicholasville) |
|
Outpatient diagnostic services, ambulatory hospital and outpatient surgery |
100% covered |
100% covered |
|
Inpatient mental/nervous care (acute care) |
100% covered after $100 co-pay, limited to 31 days |
100% covered after $100 co-pay, limited to 31 days |
|
Inpatient substance abuse care (acute care) |
80% covered after $100 co-pay, limited to 31 days |
80% covered after $100 co-pay, limited to 31 days |
|
Skilled nursing |
80% covered, 30-day limit |
80% covered, 30 day limit |
|
Home Health Services |
80% covered, 60 day visit limit |
80% covered, 60 day visit limit |
|
Durable Medical Equipment (DME), Prosthetics, Orthotics |
20% co-insurance ($400 maximum out-of-pocket per plan year for these services, then covered in full) |
20% co-insurance ($400 maximum out-of-pocket per plan year for these services, then covered in full) |
|
This is a partial listing and summary of benefits and services. For complete details of covered services, exclusions and benefit limitations, refer to the Certificate of Coverage booklet, which can be viewed at www.mc.uky.edu/ukhmo |
||
UK-HMO Lexington Service Area Plan
With this plan, all care is provided at UK Medical Center, UK HealthCare Good Samaritan Hospital, and by UKHMO participating providers, therefore, you are not required to obtain a referral from your UK primary care physician to see a UK specialist. If you and the dependents you intend to cover live within a 50 driving mile radius of the UK Chandler Medical Center or in the counties of Anderson, Bourbon, Clark, Fayette, Franklin, Jessamine, Madison, Mercer, Scott or Woodford you are eligible for this plan.
UK-HMO Regional Service Area Plan
If you and any dependents you intend to cover live in the counties of Adair, Ballard, Barren, Bath, Bell, Boone, Boyd, Boyle, Bracken, Breathitt, Bullitt, Butler, Caldwell, Calloway, Campbell, Carlisle, Carroll, Carter, Casey, Christian, Clay, Clinton, Crittenden, Cumberland, Edmonson, Elliott, Estill, Fleming, Floyd, Fulton, Gallatin, Garrard, Grant, Graves, Green, Greenup, Harlan, Harrison, Hart, Henry, Hickman, Hopkins, Jackson, Jefferson, Johnson, Kenton, Knott, Knox, Laurel, Lawrence, Lee, Leslie, Letcher, Lewis, Lincoln, Livingston, Logan, Lyon, Magoffin, Marion, Marshall, Martin, Mason, McCracken, Menifee, Metcalfe, Monroe, Montgomery, Morgan, Nicholas, Oldham, Owen, Owsley, Pendleton, Perry, Pike, Powell, Robertson, Rockcastle, Rowan, Russell, Shelby, Spencer, Taylor, Trigg, Trimble, Warren, Washington, Whitley or Wolfe you are eligible for this plan.
If you live in a Kentucky county not listed above, you may be eligible for the UK-HMO Regional Service Area Benefit Plan. Please call toll free (877) 855-9700 for more information.
UK-HMO Open Enrollment 2008-09
The UK Health Benefit Open Enrollment period that allows UK employees to sign up or switch their health benefits will be held April 21, 2008 through May 9, 2008. Changes made during the Open Enrollment period will go into effect July 1, 2008.
If you have any questions regarding your plan, contact the following numbers:
UK-HMO Open Enrollment Customer Service (888) 393-6765 (tell them you need UK-HMO benefits)
UK Human Resources Benefit Office: (859) 257-9519, Chose option 3 , then chose option 1
2008-2009 Benefits Open House Information
|
Building |
Location |
Date |
Time |
|
Kentucky Clinic |
3rd Floor, Wing D |
Monday, April 21st |
11:00 a.m. -2:00 p.m. |
|
North Lobby in Hospital |
(in front of Hospital Administration) |
Tuesday, April 22nd |
6:30 a.m.– 8:30 a.m. and 10:30 p.m. – 11:30 p.m. |
|
Human Resources Satellite Office |
321 Wethington Building |
Tuesday, April 22nd
|
9:00 a.m. - 11:30 a.m.
|
|
Service Building |
Loading Dock |
Wednesday, April 23rd |
7:30 a.m. – 11:00 a.m. and 10:00 p.m. – 10:30 p.m. |
|
Good Samaritan Hospital |
Conference Room |
Friday, April 25th |
7:00 a.m. – 9:00 a.m. |
|
Main Administration Building |
Lexmark Public Room |
Tuesday, April 29th |
10:00 a.m. - 1:00 p.m. |
|
Hospital/Medical Center |
Room H133 |
Thursday, May 1st |
10:00 a.m. – 1:30 p.m. |
|
Kentucky Clinic |
Hall of Fame/Big Blue Deli |
Monday, May 5th |
6:30 a.m. – 9:00 a.m. |
|
Good Samaritan Hospital |
Conference Room |
Tuesday, May 6th |
11:00 a.m. – 2:00 p.m. |
|
Scovell Hall |
Outside front lawn (weather permitting) or inside first floor hallway |
Friday, May 9th |
11:00 a.m. – 2:00 p.m. |
Primary Care Physician
Neither of the plans above require members to designate a specific primary care physician. UK-HMO strongly encourages members to choose a primary care provider for each family member to provide your medical care and coordinate your care with other participating physicians, however you are free to see any participating physician. If you require the care of a specialist, your primary care physician can arrange this appointment for you or you may contact the specialist directly to schedule an appointment. As always, should you require care that can not be provided in your local UK-HMO Network, you will need to access the UK Chandler Medical Center, Good Samaritan Hospital and participating UK-HMO physicians.
|
UK-HMO Monthly Rates 2008-09 |
Coverage Levels |
|||
|
Employee Only |
Employee + Child(ren) |
Employee + Spouse |
Employee + Family [Spouse & Child(ren)] |
|
|
Regular Full-time Employee Eligible for University Contribution |
$26 |
$130 |
$253 |
$373 |
|
Employee NOT Eligible for University Contribution |
$401 |
$602 |
$802 |
$1003 |
|
Retirees Under Age 65 Eligible for University Contribution* |
$58 |
$359 |
$659 |
$960 |
*Retired or Eligible to Retire as of July 1, 2007 (see UK Benefits website for other retiree rates at www.uky.edu/hr/benefits)
Click here to view a map of the UK-HMO Service Area map.
To view the 2008-09 LSA Provider Directory click here.
To view the 2008-09 RSA Provider Directory click here.
To view the 2008-09 LSA Certificate of Coverage click here
To view the 2008-09 RSA Certificate of Coverage click here
For a 2008-09 UK-HMO Enrollment Form click here.
To Link to the UKHR Open Enrollment website click here
Express Scripts (UK Pharmacy Benefit Manager)
| UK-HMO is a benefit structure and provider
network available to University of Kentucky employees and their family members through the
University's self-insured program. As a self-insured product, it is not a licensed HMO.
This brochure is not a contract. It is a partial listing and summary of benefits and services. For complete details on covered services, exclusions and benefit limitations, refer to the Certificate of Coverage Booklet. All services, with exception of life-threatening, emergent care, must be provided within the UK-HMO network. |
