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 UC medical plan will receive 50 percent office visit co-pay reduction and co-insurance savings 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.
Medical coverage pays benefits for eligible medical expenses. The university offers employees the opportunity to choose between two 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:
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), Anthem 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.
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.
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 the plan, 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.