Medical - Outpatient

Medical office visits

At UHS: $15 co-pay for primary care and specialists. 

Outside of UHS1:
Pays 100% after $15 co-pay for primary care and specialty care from network providers. Plan pays 60%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 60% 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 UHS1, 2Pays 90% of network rates or 60% of non-network rates.

Maternity, prenatal care, abortion1

Prenatal: $15 co-pay for first visit; 100% covered for subsequent in-network visits or 60%2 non-network. 

Maternity: 90% in-network or 60% 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 60% 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, please click here for a list of in-network providers. (Note: This provider list is only perdiocally updated. Please confirm that your midwife is still in-network prior to receiving services.)

Breast Feeding Durable Medical Equipment: 100% in-network or 60%2 non-network. 

Abortion: 100% in-network or 60%2 non-network.

Acupuncture1, 4

Pays 100% after $15 co-pay or 60%2 of non-network rates.

Chiropractic Services1, 4

Pays 100% after $15 co-pay or 60%2 of non-network rates.

Podiatric Services1, 2

Pays 90% of network rates or 60% of non-network rates.

Physical Therapy

At UHS: $15 co-pay

Outside of UHS1: Pays 100% after $15 co-pay for network rates or 60%2 of non-network rates.

Occupational and Speech Therapy1

Pays 100% after $15 copay or 60%2 of non-network rates.

Allergy Testing & Injections

At UHS:Pays 90% of network rates or 60%2 of non-network rates. 

Outside of UHS1, 2: Pays 90% of network rates or 60% of non-network rates.

UHS does not provide allergy testing services.

Immunizations 

Pays 100% UHS charges or network rates, or 60%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; Rabies; 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 60%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 Visits1, 2

Pays 90% of network rates or 60% of non-network rates.

Skilled Nursing Facility1, 2

Pays 90% of network rates or 60% of non-network rates.

Durable Medical Equipment1, 2

Pays 90% of network rates or 60% 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). 

1A referral by a UHS Clinician is required BEFORE seeking services outside of UHS or your claims will be denied.

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 As of 1/1/19 our referral guidelines for acupunture and chiropractic services have changed.  Please reach out to your UHS primary care provider to determine if a referral is appropriate for you.

 SHIP Referrals

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