University of Cincinnati Medical Plan Summary and Comparison Non AAUP - Effective January 1- December 31, 2021
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
$1,800 individual $3,600 family
$3,600 per person $7,400 family
$600 individual $1,200 family Not applicable
$1,200 individual $2,400 family Not applicable
Annual Health Savings Account Funding (UC)
Varies by Annual Base Pay as of 1/1/21
Varies by Annual Base Pay as of 1/1/21
Copayment/co- insurance
As specified
As specified
As specified
As specified
Annual Out-of-Pocket Maximum*
$3,600 individual $7,400 family (includes in network medical and pharmacy expenses) $3,600 individual $7,400 family (non-embedded deductible) (includes in network medical and pharmacy expenses)
$7,400 individual $14,800 family (includes out of network medical and pharmacy expenses)
$1,800 individual $3,600 family (Medical services only, excludes office visit and Rx copays) $8,550 individual $17,100 family (includes copays medical and pharmacy)
$3,600 individual $7,200 family (Medical services, excludes copays)
Plan Maximum Out-of Pocket (per calendar year)**
$7,400 individual $14,800 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. 65% after deductible
Based on setting where services received.
Based on setting where services received.
Allergy Testing and Treatment/Serum
80% after deductible
80% after deductible
65% after deductible
Ambulance
80% after deductible
65% after deductible
80% after deductible
65% after deductible
Anesthesia
80% after deductible
65% after deductible
80% after deductible
65% after deductible
Page 1 of 7 Rev. 10/2020
Medical Insurance 6
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