UC Health and UC Physicians Partnership
Applicable to all employees covered under a UC medical plan
UC Health and University of Cincinnati Physicians (UCP) are pleased to announce a partnership with the University of Cincinnati (UC) and its employees. UC employees and their dependents enrolled in a Humana medical plan will receive 50 percent office visit co-pay reduction when seeing UCP physicians. Billing questions should be directed to UC Health Customer Service at (513) 585-7600.
UCP is the Cincinnati area’s largest group of board-certified physicians with over 700 physicians practicing in every medical and surgical specialty.
A listing of UCP physicians eligible for the co-pay reduction is available on www.UCPhysicians.com.
- Go to www.UCPhysicians.com
- Click on the Faculty/Staff heading in the upper right of the home page
- Click on University of Cincinnati listing
Medical coverage pays benefits for eligible medical expenses. The university offers employees the opportunity to choose between several medical plans, giving them flexibility to tailor a benefit package to their individual or family's needs.
The Medical Coverage Comparison Chart summarizes the benefits available under each medical plan. Note that medical plan availability varies by employee group. Review the plan information carefully before choosing a medical plan.
Medical Comparison Charts:
- 2013 - AAUP Represented Faculty
- 2013 - Unrep, SEIU, FOP-LE, FOP-SO
- 2013 - AFSCME, ONA, IUOE, FOP-DIS
If an employee, spouse, domestic partner, or dependent is covered under the university medical plan in addition to any other medical coverage (including other university coverage), Humana may require information about the other coverage for coordinating benefits.
If the Health Care Flexible Spending Account is elected, it can be used to reimburse deductibles, copayments, and other eligible expenses not paid by the medical plan.
Information about eligibility for UC's medical plans can be found on the Human Resources website.
Health Care Reform - Adult Children
Both the federal goverment (through the Affordable Care Act) and the Ohio state government have passed legislation allowing older age children ("adult children") to remain covered under their parents' health insurance coverage.
Click on the appropriate link below to view a sample identification card for your medical plan
Children's Health Insurance Program (CHIP)
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage.
Women's Health and Cancer Rights Act
This act requires the medical plan to provide mastectomy benefits to cover the following procedures:
- reconstruction of the breast on which the mastectomy was performed,
- reconstructive surgery of the other breast to present a symmetrical appearance, and
- prosthesis and coverage for physical complications at all stages of the mastectomy procedure, including swelling associated with the removal of lymph nodes.
This change only affects the procedures in connection with mastectomy procedures. It does not extend treatment for surgeries which are deemed to be cosmetic in nature, such as breast augmentation.
Newborns' and Mothers' Health Protection Act
This act requires the medical plan to provide hospital stays in connection with childbirth of no less than 48 hours for vaginal deliveries and no less than 96 hours for deliveries by Caesarean section. Any exceptions to these minimum stay requirements must be made by the attending physician in consultation with the mother (or the newborn's authorized representative).
All copayments, deductibles, co-insurance, and precertification requirements are still applicable according to the medical plan's guidelines.
Effective January 1, 2014, this plan is not available to all employee groups.
The First 1000 Plan is a Point of Service (POS) plan which uses the Humana network of health care providers. A provider directory may be accessed by logging on to the Humana website.
First 1000 is a consumer-driven medical plan for those employees who generally experience few medical expenses and are willing to pay out-of-pocket for medical expenses within the plan limits in return for no premium.
The plan provides:
- coverage for catastrophic medical expenses,
- $500 annual benefit allowance per person to cover physician, hospital and laboratory services, xrays, preventative and wellness care.
Additional details can be found in the Summary Plan Description document:
The insured is responsible for:
- copays which are not covered by the benefit allowance,
- eligible expenses until the deductible and out-of-pocket limits are met.
The First 1000 option should be chosen only after careful consideration. Please refer to the Medical Coverage Comparison Chart.
To receive the highest level of benefits under this plan, the insured must use the provider network; however he/she does not need to choose a primary care physician.
An insured may use providers outside the POS network; however, he/she will pay a greater share of eligible medical expenses. In a true emergency, care by an out-of-network provider for a life-threatening illness or accidental injury will be covered at network benefit levels, provided the plan is notified within 24-48 hours.
No matter which health care provider the insured uses, he/she must follow specific plan guidelines.
Effective January 1, 2014, this plan is not available to all employee groups.
The Humana Premier HMO also uses the Humana network of health care providers and covers a wide range of services. A provider directory may be accessed at the Humana website.
- The insured does not need to choose a primary care physician.
- The insured may use HMO specialists without a referral.
- If the insured uses a physician or facility that is not a participating provider in the Humana HMO network, benefits will not be paid.
- In the event of a true emergency, care for a life-threatening illness or accidental injury out of the service is covered, provided the plan is notified within 48 hours.
- Check with the physician(s) to ensure the drugs prescribed are listed on the formulary. All prescriptions must be written by a participating physician.
- For additional details refer to the Summary Plan Description document:
The Humana National Point of Service (POS) plan uses the Humana network of health care providers. A provider directory may be accessed by logging on to the network provider (Humana.com). To receive the highest level of benefits under the POS Plan, an insured must use the provider network; however, he/she does not need to choose a primary care physician.
The insured may use providers outside the POS network; however, he/she will pay a greater share of eligible medical expenses. In a true emergency, care by an out-of-network provider for a life-threatening illness or accidental injury will be covered at network benefit levels, provided the plan is notified within 48 hours.
For additional details, refer to the Summary Plan Description documents:
No matter which health care provider the insured uses, he/she must follow specific guidelines for elective hospitalization and surgery.
This plan is not available to all employee groups. Read more about this plan.
For additional details, refer to the Summary Plan Description document:
All of the medical plans have certain limits and exclusions that apply to the services they cover. Limitations that the plans have in common include:
- A medically appropriate length of stay will be authorized whenever the insured member is admitted to the hospital.
- During each hospital stay, the plan will periodically review the need for continued inpatient care to avoid unnecessary hospitalization.
- Special rules apply if the insured is hospitalized when new coverage begins. Contact the Human Resources department for more information.
- Some prescriptions drugs may require pre-authorization.
- Limits that are unique to a plan are summarized on the Medical Coverage Comparison Chart. If an insured needs emergency care outside the area serviced by POS, HMO, or First 1000, keep in mind that benefits for this care may be limited.
An employee can waive medical coverage. The employee does not have to certify that he/she has other medical coverage in order to choose the waiver of medical insurance; however, the Medical Waiver option should be chosen only after careful consideration. Even though the employee may choose to waive coverage, if he/she is not covered by another medical plan he/she runs the risk of potentially catastrophic medical expenses in the event of serious illness or injury. If the employee chooses to waive coverage, he/she may not enroll in medical coverage during the calendar year unless he/she has a qualified status change (QSC) and the change of coverage is consistent with the QSC. If the employee chooses to waive medical coverage and he/she is eligible for the Medical Plan Credit, it will appear as a taxable addition to the employee's paycheck.