~Dual Comp Staff Provider Onboarding Binder 06.26.20

University of Cincinnati Medical Plan Summary and Comparison Non AAUP - Effective January 1- December 31, 2020

Covered Service

Health Saving Account/HDHP In network

Health Saving Account/HDHP Out-of-network

PPO Traditional Plan In network

PPO Traditional Plan Out-of-network

Annual Deductible

$1,700 individual $3,400 family

$3,400 per person $6,800 family

$500 individual $1,000 family

$1,000 individual $2,000 family

Annual Health Savings Account Funding (UC)

Varies by Annual Base Pay as of 1/1/20

Varies by Annual Base Pay as of 1/1/20

Not applicable

Not applicable

Copayment/co- insurance

As specified

As specified

As specified

As specified

Annual Out-of-Pocket Maximum*

$3,400 individual $6,800 family (includes in network medical and pharmacy expenses) $3,400 individual $6,800 family (non-embedded deductible) (includes in network medical and pharmacy expenses)

$6,800 individual $13,600 family (includes out of network medical and pharmacy expenses)

$1,700 individual $3,400 family (Medical services only, excludes office visit and Rx copays) $8,150 individual $16,300 family (includes copays – medical and pharmacy)

$3,400 individual $6,800 family (Medical services, excludes copays)

Plan Maximum Out-of Pocket (per calendar year)**

$6,800 individual $13,600 family

Not applicable (no limit on your out- of- pocket expenses)

(includes in network medical and pharmacy expenses) No maximum, except as specified

Maximum Lifetime Benefit

No maximum, except as specified

No maximum, except as specified

No maximum, except as specified

Acupuncture

Based on setting where services received.

Based on setting where services received.

Based on setting where services received.

Based on setting where services received.

Allergy Testing and Treatment/Serum

85% after deductible

70% after deductible

80% after deductible

65% after deductible

Ambulance

85% after deductible

70% after deductible

80% after deductible

65% after deductible

Anesthesia

85% after deductible

70% after deductible

80% after deductible

65% after deductible

Medical Insurance 6

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