Medical - Outpatient

Medical office visits

At UHS: $15 co-pay for primary care, physical therapy and gynecology. $25 co-pay for specialists. 

Outside of UHS:
Pays 100% after $15 co-pay for primary care and $25 for specialty care from in-network providers. Plan pays 50%2 of the allowable non-network rates.
Note: If the visit is at a hospital setting, a facility (hospital) fee may apply. After the deductible, plan pays 90% for network rates or 50% non-network rates.

Adult preventative services

Select adult preventative services at UHS (including routine mammograms, pap smears and prostate cancer screenings as determined necessary by your provider) covered at 100% (only one per plan year).

Lab tests, x-rays, imaging, mammograms

At UHS: Pays 90% of UHS fees.

Outside of UHS2Pays 90% of network rates or 50% of non-network rates.

Maternity, prenatal care, abortion

Prenatal: $25 co-pay for first visit; 100% covered for subsequent in-network visits or 50%2 non-network. 

Maternity: Pays 90% in-network or 50% non-network (Newborns are covered for the first 31 days from the date of birth. Plan pays 100% for newborn well visits. Plan pays 90% in-network or 50% non-network for sickness or injury after a separate $300 deductible is met)3. See our maternity flier. If you wish to see a midwife, see our list of in-network midwives. (Note: This provider list is only periodically updated. Please confirm that your midwife is still in-network prior to receiving services.)

Breast Feeding Durable Medical Equipment:  Pays 100% in-network or 50%2 non-network. 

Abortion: Pays 100% in-network or 50%2 non-network.

Acupuncture4

Pays 100% after $25 co-pay or 50%2 of non-network rates; requires precertification after 12th visit

Chiropractic Services4

Pays 100% after $25 co-pay or 50%2 of non-network rates; requires precertification after 12th visit

Podiatric Services 2

Pays 90% of network rates or 50% of non-network rates.

Physical Therapy

At UHS: $15 co-pay

Outside of UHS: Pays 100% after $15 co-pay for network rates or 50%2 of non-network rates. Requires precertification after 12th visit.

Occupational and Speech Therapy

Pays 100% after $15 copay or 50%2 of non-network rates. Requires precertification after 12th visit.

Allergy Testing & Injections

At UHS: Pays 90% of network rates or 50%2 of non-network rates. 

Outside of UHS2: Pays 90% of network rates or 50% of non-network rates.

UHS does not provide allergy testing services.

Immunizations 

Pays 100% UHS charges or network rates, or 50%2 of non-network rates, for the following immunizations:
Diphtheria/Tetanus/ Pertussis, Measles, Mumps and Rubella; Meningococcal; Varicella; Influenza; Hepatitis A and Hepatitis B; Pneumococcal; Polio; Human Papillomavirus; Cholera; Typhoid; Yellow Fever; Japanese B. Encephalitis; and Lyme Vaccine. TB testing/screening covered 100%. Routine immunizations are recommended to be administered at UHS. Flu shots are NOT covered when obtained at a pharmacy

All other immunizations covered at 90% of charge at UHS or 90% of network rates or 50%2 of non-network rates.       

NOTE: Routine immunizations are recommended to be administered at UHS. All immunizations must meet all FDA regulations prior to approval.

Home Health Visits2

Pays 90% of network rates or 50% of non-network rates.

Skilled Nursing Facility2

Pays 90% of network rates or 50% of non-network rates.

Durable Medical Equipment2

Pays 90% of network rates or 50% of non-network rates for the rental or purchase of medical equipment and supplies that are ordered by a physician and are of no further use when medical need ends. For breast pump coverage, please see maternity benefits. 
Equipment must be obtained from a durable medical equipment supplier, including rental or purchase of diabetic equipment and supplies (excluding insulin). 

 

2Subject to the $300 deductible. 

3If the student's plan terminates before the 31 days from date of birth, the newborn's coverage ends on the same termination date as that of the student.

4 Please note after the 12th visit per plan year, these services are subject to pre-certification and medical necessity review.

This page provides a summary of some benefits. Please see the SHIP Benefits Brochure for plan details.