University of Cincinnati Medical Plan Summary and Comparison Non AAUP - Effective January 1- December 31, 2022
Covered Service
Health Saving Account/HDHP In network 80% after deductible Maximum 20 visits per calendar year
Health Saving Account/HDHP Out-of-network
PPO Traditional Plan In network
PPO Traditional Plan Out-of-network
Chiropractic Services
65% after deductible
$30 copay
65% after deductible Maximum 20 visits per calendar year
Maximum 20 visits per calendar year 65% after deductible
Maximum 20 visits per calendar year
Diagnostic Tests (e.g., MRI, CAT, MRA, PET, etc.) and X-Rays Durable Medical Equipment
80% after deductible
80% after deductible
65% after deductible
80% after deductible
65% after deductible
80% after deductible
65% after deductible
Emergency Room Visit (covered emergency)
80% after deductible
Same as in network benefit
$200 emergency room copay (waived if admitted) $250 copay non-emergency use of ER
$200 emergency room copay (waived if admitted)
Eye Exams/Refraction
100% Screening
65% after deductible Screening
100% Screening
65% after deductible Screening
Eyewear - Lenses and Frames
VSP Vision Plan
VSP Vision Plan
VSP Vision Plan
VSP Vision Plan
Hearing Screening
100% - screening only 80% after deductible
No coverage
100% - screening only 80% after deductible
No coverage
Hospitalization Room and Board Immunizations (covered by plan and age appropriate)
65% after deductible
65% after deductible
100%
65% after deductible
100%
65% after deductible
Page 2 of 7 Rev. 10/2021
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