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

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

Chiropractic Services1

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.

 SHIP Referrals

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