University of Cincinnati Medical Plan Summary and Comparison AAUP - Effective January 1- December 31, 2022
Additional Information •
Searching for an Anthem provider? Visit www.Anthem.com. www.Anthem.com. Click on the “Find Care” link. Then choose “Guest”. Fill in the fields for “Select Type of Care”, “Select a state”, “Select type of plan” (chose Medical Employer-sponsored), and “Select plan/network” (choose Blue Access (PPO) for both the PPO and HDHP). Follow the rest of the prompts for specialties, provider names. • Looking for information about medical services, prices or information about your claims? Visit quality reviews? Visit www.Anthem.com. Establish a username and password. With yoru password you can also access Sydney health, an Anthem mobile app, for assistance. • Be Well UC : Visit this site to learn more about your one-stop resource for wellness at UC: https://bit.ly/bewelluc. • Coverage and payment for services subject to Mental Health Parity Act. • For details about the plans and to find more information about Behavioral Health Services contact Anthem at 844-249-5372. • Discounts available through University of Cincinnati Physicians. Exclusions and Limitations: • All plans are subject to exclusions, limitations and periodic updates. • To receive maximum benefits under the plans, eligible services must be provided by participating providers. Any services provided outside the plan’s specifications may not be eligible for benefits. All non-network services under the plans are subject to Usual, Customary, and Reasonable (UCR) limits. UCR limits are determined by the insurance company and subject to change. Acceptance of UCR limits is at the discretion of the non-network provider. If the non-network provider does not accept the UCR limit, you are responsible for any amount not covered by UCR in addition to the deductible, copay and out-of-pocket limit. • All services must be medically necessary. Pre-approval must be obtained for all non-routine services. • Advance approval for elective admissions is required. The plan must be notified immediately upon emergency admission. A medically appropriate length of stay is assigned for each admission, and the need for continued hospital stay is evaluated during the admission to avoid unnecessary hospital stay. Case management may authorize coverage for lower-cost treatment alternatives which are also medically appropriate. The Plan Document governs payment of benefits. * The out-of-pocket maximum limits the amount of money you will pay during a calendar year for medical expenses. It includes your deductible and any co-insurance you pay for qualified medical expenses during the calendar year. ** The Plan out-of-pocket maximum includes all expenses paid toward the annual out-of-pocket maximum, as well as copays for office visits and prescription drugs. After you have paid the amount indicated in the chart the Anthem plan will pay 100% of all eligible medical and prescription expenses for the calendar year for you and your family, if applicable. For AAUP members the annual maximum out-of-pocket cost for prescription co-pays is $3,000 per covered person; the family maximum out-of-pocket is $17,400 regardless of the number of family members on the plan. For further information see https://bit.ly/ uc-benefits.
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