Health Insurance Options
| PLAN PROVISIONS | SHIP | UIGRADCare |
|---|---|---|
Co-insurance |
10% for Select inpatient hospital |
10% |
Out-of-Pocket |
$1,000 per hospital stay | $1,200/$1,800 |
| Pre-existing Condition Waiting Period |
None | None |
| Pre-approval of Inpatient Admissions |
Required | Required |
| Second Surgical Opinion |
Voluntary | Voluntary |
| Prior Approval for Outpatient Surgery |
None | Physician discretion |
| Benefits Available from Non-member Providers |
Co-payment deductibles and co-insurances are higher plus individual is responsible for charges above the maximum allowable fee |
Not available without approved referrals |
| Dependent Child Age Limit | End of calendar year after turning 26 or unlimited if full-time student |
End of calendar year after turning 26 or unlimited if full-time student |
| Lifetime Maximum | None |
None |
| OFFICE CARE | SHIP | UIGRADCare |
|---|---|---|
| Office Calls |
$10 co-payment for Select providers
|
$10 co-payment |
| Routine Physicals |
$0 co-pay (1 per calendar year); |
$0 co-pay (1 per calendar year); $10% co-insurance for lab and imaging |
| Gynecological pelvic examinations and Pap Smears |
Covered (1 per calendar year unless medically-necessary) |
Covered (1 per calendar year unless medically-necessary) |
| Imaging and Lab |
Diagnostic only; $10 co-payment at Physician’s Office; $30 co-payment at Outpatient Facility |
10% co-insurance |
| Well-Child Care |
Covered; $0 co-pay |
Covered; $0 co-pay |
| Routine Eye & Hearing Exam |
Not covered |
$10 co-payment ($0 co-pay at UIHC) |
| HOSPITAL SERVICES |
SHIP | UIGRADCare |
|---|---|---|
| Room and Board |
10% co-insurance after $300 deductible for Select hospital; 20% co-insurance after $600 deductible for non-Select hospital; semi-private room |
10% co-insurance after $125 daily deductible; semi-private room |
| Physicians Services |
Included in hospital deductible and co-insurance |
10% co-insurance |
| Inpatient Surgery |
10% co-insurance after $300 deductible for Select hospital; 20% co-insurance after $600 deductible for non-Select hospital; semi-private room |
10% co-insurance |
| Inpatient Supplies, Drugs |
10% co-insurance after $300 deductible for Select hospital; 20% co-insurance after $600 deductible for non-Select hospital; semi-private room |
10% co-insurance |
| OUTPATIENT SERVICES | SHIP | UIGRADCare |
|---|---|---|
Ambulance |
$10 co-payment for Select providers $30 co-payment for non-Select |
10% co-insurance |
Allergy Treatments |
$10 co-payment for Select physician $30 co-payment for non-Select |
$10 co-payment |
Chiropractor |
$10 co-payment for Select providers $30 co-payment for non-Select |
$10 co-payment |
Dental Accident Care |
$10 co-payment for Select treatment must be completed within 12 months of injury |
10% co-insurance; treatment must be completed within 12 months of injury |
Durable Medical Equipment |
$10 co-payment for Select providers $30 co-payment for non-Select |
10% co-insurance |
Speech, Occupational Respiratory, and Physical Therapy |
$10 co-payment for Select providers $30 co-payment for non-Select |
10% co-insurance |
Prescription Drugs and
|
3 tier plan: |
$7 or 25%, whichever is greater |
Immunizations |
Covered; $0 co-pay |
Covered; $0 co-pay |
| Home Health Care |
Maximum of 30 days/calendar year |
10% co-insurance |
| Emergency Services |
$50 co-payment |
$50 co-payment followed by 10% co-insurance |
| Outpatient Surgery |
$50 co-payment for Select hospital |
10% co-insurance |
| Organ Transplants |
Prior approval; cornea, kidney coverage only |
Prior approval |
| Skilled Nursing Services |
Maximum of 30 visits per calendar year |
10% co-insurance after $125 daily deductible |
| Hospice Care |
Cover |
10% co-insurance |
| Not Covered |
Eyeglasses, Hearing Aid, Infertility Treatment |
Eyeglasses, Hearing Aid, Infertility Treatment |