~Dual Comp Staff Provider Onboarding Binder 06.26.20

MEDICAL INSURANCE

MEDICAL PLAN INFORMATION

65%+ FTE FACULTY 75%+ FTE STAFF

ELIGIBILITY

PLAN INFORMATION (TWO AVAILABLE)

PPO

HDHP

IN NETWORK

OUT OF NETWORK

IN NETWORK

OUT OF NETWORK

ANNUAL DEDUCTIBLE

$500 INDIVIDUAL $1,000 FAMILY

$1,000 INDIVIDUAL $2,000 FAMILY

$1,700 INDIVIDUAL $3,400 FAMILY

$3,400 PER PERSON $6,800 FAMILY

ANNUAL HEALTH SAVINGS ACCOUNT FUNDING (UC)

$325 – $825 EE $650 - $1,650 FAMILY *

$320 – $825 EE $650 - $1,650 FAMILY*

NOT APPLICABLE

NOT APPLICABLE

65% AFTER DEDUCTIBLE

COVERED 100%

COVERED 100%

70% AFTER DEDUCTIBLE

PREVENTIVE CARE**

COVERED SERVICES

80% AFTER DEDUCTIBLE

65% AFTER DEDUCTIBLE

85% AFTER DEDUCTIBLE

70% AFTER DEDUCTIBLE

TIER 1 (GREATEST VALUE): $20 TIER 2 (BRAND): $40 TIER 3 (HIGHER COST BRAND): $55 TIER 4 (SPECIALTY): 25% CO-INS, $250 MAX

85% AFTER DEDUCTIBLE

RETAIL PHARMACY

MAIL ORDER 90 DAY SUPPLY (MANDATORY FOR

TIER 1: $40 TIER 2: $80 TIER 3 : $110

85% AFTER DEDUCTIBLE

MAINTENANCE MEDICATIONS)

RATES VARY BASED ON PLAN SELECTION AND ANNUAL BASE PAY* https://www.uc.edu/hr/benefits/employee-contributions.html (CHOOSE 2020 Non-AAUP)

EMPLOYEE CONTRIBUTION PLAN ADMINISTRATOR

ANTHEM

Medical Insurance 2

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