2021-22 YOUR RETIREE BENEFITS - www.uky.eduhr/benefits - University of Kentucky
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2021-22 YOUR RETIREE BENEFITS www.uky.edu/hr/benefits
Dear UK Retiree: TABLE OF CONTENTS
We are pleased to provide you with this 2021-22
University of Kentucky Retiree Benefits booklet.
This is your once a year opportunity to add, drop or Overview
change levels of coverage for any reason.
1 What You Need to Know
The Open Enrollment period is when we
communicate benefit plan changes on the dental Health Insurance Plans
and vision plans, as well as health plans offered to
retirees and/or spouses who are under age 65. We 2 UK Medicare Advantage
are pleased to continue the same coverage available For Retirees Age 65 and Over
through UK health plans for retirees who are under
age 65, and we will still incur only a small increase. 4 UK-HMO Plan
There are no rate increases for any of the UK Dental,
Delta Dental or EyeMed vision plans. 6 UK-RHP Plan
Please be reminded to check your beneficiaries you 8 UK-PPO Plan
have listed with your retirement carriers and to set
up a power of attorney with them, if needed. This is 10 UK-EPO Plan
a free service provided by TIAA and Fidelity — their
12 UK Indemnity Plan
phone numbers are on the back cover of this booklet.
14 Prescription Benefits
On behalf of UK Human Resources, we wish you the
best in your retirement.
Dental Plans
Sincerely,
16 UK and Delta Dental Plans
Vision Plans
18 EyeMed Vision
Essential and Enhanced Plans
Gail Carbol
Benefits Manager Additional Benefits and Resources
20 Retiree Resources
Elder Care, Well-being
and moreEverything you need to know
What You Need to Know about plan eligibility and making
changes throughout the year
UK retirees and health plans Making changes throughout the year:
Qualifying events
As a retiree from the University of Kentucky, you have several
options for health insurance coverage. These options depend The choices you make during Open Enrollment, or
on your age and date of retirement. Health plan rates for as a new retiree, remain in place from July 1, 2021,
retirees under 65 (early retirees) and those age 65 and over are through June 30, 2022. You cannot change coverage
calculated separately to more accurately account for differences until the next Open Enrollment in April/May 2022
in premium costs for each group. (for the plan year beginning July 1, 2021) unless
you have a change in family status or experience
another “qualifying event.”
Retirees and spouses under age 65
UK’s health and prescription benefit plans remain the main, or The following events would allow you to make
primary, source of health insurance coverage for retirees under changes to your current benefits during the plan
the age of 65, who may select from the health plans listed on year, within 30 days of the qualifying event: birth or
pages 4-13. Consider the major factors on each of these pages — adoption, marriage, divorce, turning 65 or obtaining
including how they may relate to your health plan needs — as alternate health coverage.
you review your benefits.
Retirees who return to work at the University on a temporary Dependent eligibility
or part-time basis may also qualify for the University’s active Children may be covered up to age 26. Sponsored
employee premium and health credit toward the cost of dependents and children of sponsored dependents
coverage. View rates at www.uky.edu/hr/retiree-rates. may be eligible for coverage. Visit UK Benefits
online at www.uky.edu/hr/benefits for details.
Many retirees under age 65 have options for health insurance
DISCLAIMER: The comparison of benefits is
coverage through another employer or through a spouse’s
not a contract. It is intended only to highlight
employer plan. If this is your situation, you can “defer” your UK principal benefits of the plans available. The
benefit. Once your health plan coverage has been deferred, it detailed provisions of each plan are covered by the
can be reactivated only one time. respective contracts. Every effort has been made
to be as accurate as possible; however, should
there be a difference between the comparison and
Retirees and spouses age 65 and over the individual plan contract, the plan contract
governs. It is the responsibility of each employee
For retirees age 65 and over, the UK Medicare Advantage plan is
to read the plan material provided by each plan
your main source of health insurance coverage provided by UK. administrator in order to fully understand the
Please see pages 2 and 3 for details on coverage of many of your provisions of the plan chosen. Retirees should
health care expenses. contact the plan administrators to understand and
clarify questions concerning coverage.
www.uky.edu/hr/benefits 3UK retirees age 65 and over
Medicare Advantage are eligible for the Medicare
Advantage plan.
Health and prescription plan Health plan for Medicare- Enrolling in the Medicare
eligible retirees age 65 Advantage plan
for retirees age 65 and over
and over Retirees enrolled in other UK
The Medicare Advantage UK offers the Medicare health plans should enroll
Advantage plan for retirees for Medicare Part B and the
plan for retirees age 65 and
age 65 and over. The Medicare Medicare Advantage plan at
over automatically includes Advantage plan, administered least 30 days prior to their 65th
prescription benefit coverage. by UnitedHealthcare, features a birthday. This coverage will
different “plan year” from other automatically renew each year.
As a result, you should not
UK benefit plans. The Medicare To get a copy of the Medicare
apply for a separate Medicare Advantage plan year begins on Advantage enrollment form, call
Part D plan. January 1 and ends on December 859-257-9519, option 3.
31. You will be mailed any changes
and information for the Medicare
Advantage plan in November
before enrollment begins.
2021 rates for retirees age 65 and over
Health and Prescription ID Rates are 10 percent of the total Medicare Advantage monthly
cards for retirees age 65 premium ($19 in 2021) for all eligible retirees age 65 and over hired
and over prior to Jan. 1, 2006.
You should Benefits Monthly UK Monthly
Coverage Level Cost to
only present Structure Rate Credit Retiree
your UK
Retiree (eligible for credit) $186 $167 $19
Medicare
Advantage Retiree + spouse (eligible for
$372 $167 $205
credit)
card for health coverage. For
UK Medicare Retiree or spouse (not
Medicare Parts A and B, you receive Advantage $186 $0 $186
eligible for credit)
a card when you become eligible Surviving spouse (eligible for
$186 $84 $102
for Medicare. You will not be issued credit)
Retiree + spouse (not eligible
a new card each year. for credit)
$372 $0 $372
4 Your UK Retiree Benefits 2021-22Benefits for Covered Services
Retiree 2021-22 Medicare Advantage Plan Benefits Provided at Participating Providers
Annual deductible $185/member
Out-of-Pocket Amount Medical out-of-pocket maximum $3,000/member; $6,000/family
Prescription out-of-pocket maximum N/A
Preventive Care
Routine mammogram and Pap smears, PSA, screening colonoscopy
*Coverage under and sigmoidoscopy*
100%
preventive care category Routine child care and immunizations (through age 18)
depends on age, Routine adult physical exam (19 years and above, one per plan year)
symptoms and diagnosis
Routine outpatient laboratory tests and X-rays
Office visits (excludes certain diagnostic lab tests and X-ray)
Lab tests and X-rays
Physician Services 96% after deductible
Allergy injections
Inpatient services
Outpatient surgery and diagnostic tests
Inpatient care (semi-private room and board, nursing care, ICU)
Physician visits to emergency room
Outpatient surgery, outpatient nonsurgical care
Hospital Services 96% after deductible
Outpatient tests, lab and X-ray
Ancillary services
Organ transplants
Emergency room $100 co-pay (waived if admitted within
24 hours for same condition)
Urgent care $65 co-pay (waived if admitted within
24 hours for same condition)
Home health care 100%
Other Medical Services Hospice services
Skilled nursing facility (up to 100 days per plan year)
Ambulance services
Durable medical equipment 96% after deductible
Physical, speech, hydrotherapy, occupational and acupuncture
therapy (limited to 45 visits per plan year, combined)
Mental Health and Inpatient mental health or substance abuse
96% after deductible
Substance Abuse Outpatient mental health or substance abuse
www.uky.edu/hr/benefits 5UK-HMO (Health Maintenance Organization) offers networks of quality
UK-HMO providers you must use to receive benefits (exceptions made for life- or
limb-threatening emergencies).
UK-HMO Factors to Consider
Rate information for retirees under age 65
• Consists of UK HealthCare
Monthly premium for employees retired or eligible to retire as of July 1, 2007
facilities and UK HealthCare
physicians Coverage Level Monthly Rate* UK Credit** Monthly Cost to
Retiree
• No referrals are required for
Retiree only; spouse only $917 $829 $88
specialty care services provided
Retiree + children $1,376 $829 $547
within the network
Retiree + spouse $1,835 $829 $1,006
• No deductibles to meet Retiree + family $2,294 $829 $1,465
• No lifetime maximum benefit Monthly premium for employees under age 65 hired before Jan. 1, 2006
Eligible to retire AFTER July 1, 2007
• No coverage for out-of-network
services unless it is a true Years of Service
emergency Age at Retirement
15 or more but 20 or more but 25 or more
less than 20 less than 25
County Availability Less than 60 $734 $550 $367
UK-HMO Lexington Service 60 or older but less than 61 $688 $504 $321
Area (LSA) is available in the 61 or older but less than 62 $642 $459 $275
following counties: Anderson, 62 or older but less than 63 $596 $413 $229
Bourbon, Clark, Fayette, Franklin,
63 or older but less than 64 $550 $367 $183
Jessamine, Madison, Mercer,
64 or older but less than 65 $504 $321 $138
Scott and Woodford.
To view a list of urgent care Retirees under age 65 and hired on or after Jan. 1, 2006, pay $917 per month.
options for UK-HMO members, If you wish to add a spouse who is under 65 years old or children, these
please visit www.uky.edu/hr/ additional rates apply:
Children Add $459/month
benefits/urgent.
Spouse Add $918/month
Spouse + children Add $1,377/month
At age 65 or older, retirees pay the lower Medicare Advantage rate.
* Spouse Only coverage offered at the full monthly rate (no UK credit).
** The UK credit toward the cost of plan coverage is available to employees
hired prior to Jan. 1, 2006.
6 Your UK Retiree Benefits 2021-22Benefits for Covered Services
Retiree 2021-22 UK-HMO Major Plan Benefits Provided at Participating
Providers
Lifetime Maximum Unlimited Unlimited
Benefit
Out-of-Pocket Medical out-of-pocket maximum $3,000/member; $6,000/family
Amount Prescription out-of-pocket maximum $4,800/member; $9,600/family
Preventive Care
Routine Pap smears, mammograms, PSA, screening colonoscopy and
*Coverage under sigmoidoscopy*
preventive care 100%
category depends Routine child care and immunizations (through age 18)
on age, symptoms Routine adult physical exam (19 years and above, one per plan year)
and diagnosis
100% after $10 co-pay for primary
care physician,
Office visits (excludes certain diagnostic lab and X-ray)
100% after $30 co-pay for
specialist
Physician Services Lab tests, X-rays and diagnostic tests 100%
Allergy injections 100% after $10 co-pay
Inpatient services
Outpatient surgery and diagnostics 100%
Physician visits to emergency room
100% after $200 co-pay per
Inpatient care (semi-private room and board, nursing care, ICU)
admission
Hospital observation stay 100% after $100 co-pay
Organ transplants 100%
Hospital Services Outpatient nonsurgical care
Outpatient tests, lab, X-ray and other diagnostic tests 100%
Ancillary services
Outpatient surgery 100% after $75 co-pay
Outpatient diagnostic testing (high costs - MRI, MRA, CT and PET scans) 100% after $75 co-pay
100% after $100 co-pay (waived if
Emergency room
admitted)
Emergent/Urgent UK Urgent treatment center 100% after $25 co-pay
Services
UK Children’s Twilight Clinic 100% after $15 co-pay
Ambulance 100% after $75 co-pay
Skilled nursing facility (up to 30 days per plan year) and hospice services 100%
Home health care (up to 60 visits per plan year) 80%
80% maximum member
Durable medical equipment, orthotics and prosthetics
Other Medical responsibility of $500/plan year
Services Hearing aids 80% for children under 18
Speech, music, physical, occupational, manipulative, hydrotherapy,
100% after $15 co-pay per visit for
acupuncture, pulmonary rehab, and cardiac rehab therapy (limited to 45
all therapies
visits per plan year, combined)
100% after $200 co-pay per
Inpatient mental health or substance abuse
Mental Health and admission
Substance Abuse 100% after $30 co-pay for
Outpatient mental health/substance abuse
specialist
www.uky.edu/hr/benefits 7UK-RHP (Regional Health Plan) offers networks of quality providers
UK-RHP who must be used to receive benefits for retirees who live in one of the
participating Kentucky counties.
UK-RHP Factors to Consider
Rate information for retirees under age 65
• Local network providers may
be utilized in your region. Monthly premium for employees retired or eligible to retire as of
In areas where primary or July 1, 2007
specialty care may not be Monthly Cost
Coverage Level Monthly Rate* UK Credit**
available in your area, these to Retiree
services must be provided by Retiree only; spouse only $939 $829 $110
UK HealthCare providers in Retiree + children $1,406 $829 $577
Retiree + spouse $1,875 $829 $1,046
Lexington.
Retiree + family $2,345 $829 $1,516
• No referrals are required
for specialty care services Monthly premium for employees under age 65 hired before Jan. 1, 2006
provided within the network Eligible to retire AFTER July 1, 2007
• No deductibles to meet Years of Service
Age at Retirement 15 or more but 20 or more but
• No lifetime maximum benefit less than 20 less than 25 25 or more
• No coverage for out-of- Less than 60 $751 $563 $376
network services unless it is a 60 or older but less than 61 $704 $516 $329
true emergency 61 or older but less than 62 $657 $470 $282
62 or older but less than 63 $610 $423 $235
County Availability
63 or older but less than 64 $563 $376 $188
UK-RHP is available across all of 64 or older but less than 65 $516 $329 $141
Kentucky but is NOT available in
the following counties: Anderson, Retirees under age 65 and hired on or after Jan. 1, 2006, pay $939 per month.
Bourbon, Clark, Fayette, Franklin, If you wish to add a spouse who is under 65 years old or children, these
Jessamine, Madison, Mercer, additional rates apply:
Scott and Woodford. Children Add $467/month
Spouse Add $936/month
Spouse + children Add $1,406/month
At age 65 or older, retirees pay the lower Medicare Advantage rate.
* Spouse Only coverage offered at the full monthly rate (no UK credit).
** The UK credit toward the cost of plan coverage is available to employees
hired prior to Jan. 1, 2006.
8 Your UK Retiree Benefits 2021-22Benefits for Covered Services
Retiree 2021-22 UK-RHP Major Plan Benefits Provided at Participating Providers
Lifetime Maximum Benefit Unlimited Unlimited
Medical out-of-pocket maximum $3,000/member; $6,000/family
Out-of-Pocket Amount
Prescription out-of-pocket maximum $4,800/member; $9,600/family
Preventive Care Routine Pap smears, mammograms, PSA, screening
colonoscopy and sigmoidoscopy*
*Coverage under preventive Routine child care and immunizations (through age 18) 100%
care category depends
on age, symptoms and Routine adult physical exam (19 years and above, one
diagnosis per plan year)
100% after $10 co-pay for primary care
Office visits (excludes certain diagnostic lab and X-ray) physician,
100% after $30 co-pay for specialist
Lab tests, X-rays and diagnostic tests 100%
Physician Services
Allergy injections 100% after $10 co-pay
Inpatient services
Outpatient surgery and diagnostics 100%
Physician visits to emergency room
Inpatient care (semi-private room and board, nursing
100% after $200 co-pay per admission
care, ICU)
Hospital observation stay 100% after $100 co-pay
Organ transplants 100%
Outpatient nonsurgical care
Hospital Services
Outpatient tests, lab, X-ray and other diagnostic tests 100%
Ancillary services
Outpatient surgery 100% after $75 co-pay
Outpatient diagnostic testing (high costs - MRI, MRA,
100% after $75 co-pay
CT and PET scans)
Emergency room 100% after $100 co-pay (waived if admitted)
UK Urgent treatment center 100% after $25 co-pay
Emergent/Urgent Services
UK Children’s Twilight Clinic 100% after $15 co-pay
Ambulance 100% after $75 co-pay
Skilled nursing facility (up to 30 days per plan year)
100%
and hospice services
Home health care (up to 60 visits per plan year) 80%
80% maximum member responsibility of
Durable medical equipment, orthotics and prosthetics
$500/plan year
Other Medical Services
Hearing aids 80% for children under 18
Speech, music, physical, occupational, manipulative,
hydrotherapy, acupuncture, pulmonary rehab, and
100% after $15 co-pay per visit for all therapies
cardiac rehab therapy (limited to 45 visits per plan
year, combined)
Mental Health and Inpatient mental health or substance abuse 100% after $200 co-pay per admission
Substance Abuse Outpatient mental health/substance abuse 100% after $30 co-pay for specialist
Please note: It is your responsibility to make sure the providers you see are participating providers in your provider network.
This includes RHP providers and facilities located in your region and the University of Kentucky. To find out if a provider is a
participating provider, visit UK’s website at www.uky.edu/hr/benefits.
www.uky.edu/hr/benefits 9UK-PPO (Preferred Provider Organization) offers a large selection of
UK-PPO network providers, including UK HealthCare physicians and the national
Anthem Blue Cross and Blue Shield network.
UK-PPO Factors to Consider: Rate information for retirees under age 65
• Low premium, same as Monthly premium for employees retired or eligible to retire as of July 1, 2007
UK-HMO and UK-RHP
Monthly Cost to
Coverage Level Monthly Rate* UK Credit**
• Lower co-pays when using UK Retiree
HealthCare providers (versus Retiree only; spouse only $917 $829 $88
other providers) for certain
Retiree + children $1,376 $829 $547
procedures
Retiree + spouse $1,835 $829 $1,006
• Providers available in all Retiree + family $2,294 $829 $1,465
50 states
Monthly premium for employees under age 65 hired before Jan. 1, 2006
• 80 percent benefit after
Eligible to retire AFTER July 1, 2007
meeting your deductible (when
applicable) when using an Years of Service
in-network provider Age at Retirement
15 or more but 20 or more but 25 or more
less than 20 less than 25
• 50 percent benefit after
Less than 60 $734 $550 $367
meeting your deductible
when using an out-of-network 60 or older but less than 61 $668 $504 $321
provider 61 or older but less than 62 $642 $459 $275
• Deductible does not apply to 62 or older but less than 63 $596 $413 $229
in-network preventive services
63 or older but less than 64 $550 $367 $183
• No lifetime maximum benefit
64 or older but less than 65 $504 $321 $138
Health Plan Availability Retirees under age 65 and hired on or after Jan. 1, 2006, pay $917 per month.
UK-EPO and UK-PPO plans are
If you wish to add a spouse who is under 65 years old or child(ren), these
available in every Kentucky county additional rates apply:
and within all 50 states (with some Children Add $459/month
exceptions in rural areas). Spouse Add $918/month
Spouse + children Add $1,377/month
At age 65 or older, retirees pay the lower Medicare Advantage rate.
* Spouse Only coverage offered at the full monthly rate (no UK credit).
** The UK credit toward the cost of plan coverage is available to employees
hired prior to Jan. 1, 2006.
10 Your UK Retiree Benefits 2021-22Retiree Out-of-Network
UK-PPO Major Plan Benefits UK HealthCare Providers Anthem Providers
2021-22 Providers
Lifetime
Maximum Unlimited Unlimited Unlimited Unlimited
Benefit
$1,500/member;
Annual deductible $100/member; $200/family $500 /member; $1,000/family
$3,000/family
Out-of- $3,000/member; $3,000/member;
Medical out-of-pocket maximum N/A
Pocket Amount $6,000/family $6,000/family
$4,900/member; $$4,900/member; $4,900/member;
Prescription out-of-pocket maximum
$9,800/family $9,800/family $9,800/family
Preventive Routine immunizations
Care
(through age 18)
(Coverage
under Routine mammogram and Pap smears
preventive Routine child care (through age 18) 100% 100% 50% after deductible
care category Routine adult physical exam (19 years
depends on and above)
age, symptoms
and diagnosis) Routine outpatient lab tests and X-rays
100% after $15 co-pay per 100% after $25 co-pay per
Office visits (excludes diagnostic lab and
primary care visit or $40 co-pay primary care visit or $50 50% after deductible
X-ray)
per specialist visit -pay per specialist visit
Lab tests and X-rays 100% after office visit co-pay 100% after office visit co-pay 50% after deductible
Physician 100% after $10 co-pay per
Services Allergy injections 100% after $10 co-pay per visit 50% after deductible
visit
Inpatient services $300 co-pay per visit 80% after deductible 50% after deductible
Diagnostic tests $75 co-pay 80% after deductible 50% after deductible
Physician visits to emergency room 80% 80% 50% after deductible
Inpatient care (semi-private room and $300 co-pay 80% after deductible 50% after deductible
board, nursing care, ICU)
Outpatient surgery $100 co-pay 80% after deductible 50% after deductible
Outpatient nonsurgical care 90% after deductible 80% after deductible 50% after deductible
Outpatient tests, lab and X-ray
Hospital Ancillary services
Services
Organ transplants
80% after $100 co-pay per visit 80% after $100 co-pay
80% after $100 co-pay per
Emergency room (waived if admitted) per visit (waived if
visit (waived if admitted)
admitted)
100% after $50 co-pay per
Urgent treatment center N/A 50% after deductible
visit
Skilled nursing facility
80% after deductible 80% after deductible 50% after deductible
(up to 100 days/plan year)
Home health care (up to 100 visits/plan
80% after deductible 80% after deductible 50% after deductible
year) and hospice services
Durable medical equipment 80% after deductible 80% after deductible 50% after deductible
Other Medical
Services Ambulance 80% after deductible 80% after deductible 80% after deductible
Chiropractic care*, physical, speech,
music, hydrotherapy, occupational and
acupuncture therapy (limited to 45 visits 100% after $20 co-pay/visit 100% after $30 co-pay/visit 50% after deductible
per plan year, combined)
*Maximum 20 visits for chiropractic care
Mental Health Inpatient $300 co-pay per visit 80% after deductible 50% after deductible
and Substance
Abuse Outpatient 100% after $40 co-pay/visit 100% after $50 co-pay/visit 50% after deductible
www.uky.edu/hr/benefits 11UK-EPO (Exclusive Provider Organization) offers a network of quality
UK-EPO
providers who must be used to receive benefits. The plan features UK
HealthCare providers, as part of the broader national Anthem Blue Cross and
Blue Shield provider network.
UK-EPO Factors to Consider: Rate information for retirees under age 65
• Large selection of network Monthly premium for employees retired or eligible to retire as of July 1, 2007
providers, including UK Monthly Cost
Coverage Level Monthly Rate* UK Credit**
HealthCare facilities, UK to Retiree
HealthCare physicians and the Retiree only/spouse only $1,221 $829 $392
Anthem Blue Cross and Blue Retiree + children $1,829 $829 $1,000
Shield network Retiree + spouse $2,441 $829 $1,612
• No referrals required for Retiree + family $3,050 $829 $2,221
specialty care services Monthly premium for employees under age 65 hired before Jan. 1, 2006
• Providers available in all 50 states Eligible to retire AFTER July 1, 2007
• No coverage for out-of-network Years of Service
services, unless it is a life- or Age at Retirement
15 or more but 20 or more but
limb-threatening emergency less than 20 less than 25 25 or more
• No deductibles to meet Less than 60 $977 $733 $488
60 or older but less than 61 $916 $672 $427
• No lifetime maximum benefit
61 or older but less than 62 $855 $611 $366
Health Plan Availability 62 or older but less than 63 $794 $549 $305
UK-EPO and UK-PPO plans are 63 or older but less than 64 $733 $488 $244
available in every Kentucky county
64 or older but less than 65 $672 $427 $183
and within all 50 states (with some
exceptions in rural areas).
Retirees under age 65 and hired on or after Jan. 1, 2006, pay
$1,221 per month.
If you wish to add a spouse who is under 65 years old or child(ren), these
additional rates apply:
Children Add $608/month
Spouse Add $1,210/month
Spouse + children Add $1,829/month
At age 65 or older, retirees pay the lower Medicare Advantage rate.
* Spouse Only coverage offered at the full monthly rate (no UK credit).
** The UK credit toward the cost of plan coverage is available to employees
hired prior to Jan. 1, 2006.
12 Your UK Retiree Benefits 2021-22Retiree Benefits for Covered Services
UK-EPO Major Plan Benefits UK HealthCare Providers
2021-22 Provided at Anthem Providers
Lifetime
Maximum Unlimited Unlimited Unlimited
Benefit
Out-of-Pocket Medical out-of-pocket maximum $3,000/member; $6,000/family $3,000/member; $6,000/family
Amount Prescription out-of-pocket maximum $4,800/member; $9,600/family $4,800/member; $9,600/family
Preventive
Care
(Coverage Routine immunizations (through age 18)
under Routine mammogram and Pap smears
preventive care Routine child care (through age 18) 100% 100%
category
depends Routine adult physical exam (19 years
on age, and above, one per plan year)
symptoms and
diagnosis)
100% after $15 co-pay per primary 100% after $25 co-pay per primary
Office visits (excludes certain diagnostic
care visit or $40 co-pay per care visit or $50 co-pay per
lab tests and X-ray)
specialist visit specialist visit
Lab tests and X-rays
Physician 100% after office visit co-pay 100% after office visit co-pay
Diagnostic tests
Services
Allergy injections 100% after $10 co-pay per visit 100% after $10 co-pay per visit
Inpatient services
Outpatient surgery and diagnostics 100% 100%
Physician visits to emergency room
Inpatient care (semi-private room and 100% after $300 co-pay per admission 100% after $500 co-pay per admission
board, nursing care, ICU) (limited to two co-pays per plan year) (limited to two co-pays per plan year)
Outpatient surgery 100% after $100 co-pay per procedure 100% after $150 co-pay per procedure
Outpatient diagnostic testing (high
Hospital 100% after $75 co-pay per test 100% after $100 co-pay per test
Services costs - MRI, MRA, CT, PET scans)
Outpatient nonsurgical care
Outpatient tests, lab and X-ray
100% 100%
Ancillary services
Organ transplant
100% after $100 co-pay 100% after $100 co-pay (waived if
Emergency room
Emergent/ (waived if admitted) admitted)
Urgent 100% after $50 co-pay per primary
Services Urgent Treatment Center N/A
care visit
Ambulance services 100% after $100 co-pay 100% after $100 co-pay
Skilled nursing facility (up to 100 days
per plan year)
Home health care (up to 100 visits 100% 100%
per plan year)
Hospice services
Other Medical Durable medical equipment 80% up to $500 member cost per year 80% up to $500 member cost per year
Services
Chiropractic care*, physical, speech,
music, hydrotherapy, occupational and
acupuncture therapy (limited to 45 visits 100% after $20 co-pay per visit 100% after $30 co-pay per visit
per plan year, combined)
*Maximum 20 visits for chiropractic care
Mental Health Inpatient 100% after $300 co-pay per admission 100% after $500 co-pay per admission
and Substance
Abuse Outpatient 100% after $40 co-pay per visit 100% after $50 co-pay per visit
www.uky.edu/hr/benefits 13UK Indemnity provides coverage for participants traveling
UK Indemnity
out of the country for extended periods and for those in rural
areas where UK HealthCare has no providers. This plan offers
coverage for care from any physician for covered benefits.
UK Indemnity Factors to Rate information for retirees under age 65
Consider: Monthly premium for employees retired or eligible to retire as of July 1, 2007
• Complete freedom to receive Monthly Cost
Coverage Level Monthly Rate* UK Credit**
services from any provider to Retiree
• If you will be out of the Retiree only; spouse only $917 $829 $88
UK-HMO, UK-RHP, UK-PPO Retiree + children $1,376 $829 $547
or UK-EPO plan service Retiree + spouse $1,835 $829 $1,006
areas for more than 120 Retiree + family $2,294 $829 $1,465
consecutive days in the plan
Monthly premium for employees under age 65 hired before Jan. 1, 2006
year, you must enroll in the
Eligible to retire AFTER July 1, 2007
UK Indemnity plan.
• Covered transplants include Years of Service
Age at Retirement
kidney, liver, pancreas, kidney/ 15 or more but 20 or more but 25 or more
less than 20 less than 25
pancreas, heart, lung, heart/
Less than 60 $734 $550 $367
lung, bone marrow and cornea
60 or older but less than 61 $688 $504 $321
transplants
61 or older but less than 62 $642 $459 $275
Health Plan Availability
62 or older but less than 63 $596 $413 $229
UK Indemnity is only available
63 or older but less than 64 $550 $367 $183
to those participants who
live in or travel for extended 64 or older but less than 65 $504 $321 $138
periods of time to areas where
Retirees under age 65 and hired on or after Jan. 1, 2006, pay $917 per month.
UK HealthCare plans have no
providers (rural areas and out of If you wish to add a spouse who is under 65 years old or child(ren), these
additional rates apply:
country).
Children Add $459/month
Spouse Add $918/month
Spouse + children Add $1,377/month
At age 65 or older, retirees pay the lower Medicare Advantage rate.
* Spouse Only coverage offered at the full monthly rate (no UK credit).
** The UK credit toward the cost of plan coverage is available to employees
hired prior to Jan. 1, 2006.
14 Your UK Retiree Benefits 2021-22Benefits for Covered Services Provided
Retiree 2021-22 UK Indemnity Major Plan Benefits at Anthem Providers
Annual deductible $500/member; $1,000/family
Out-of-Pocket Medical out-of-pocket maximum $3,000/member; $6,000/family
Amount
Prescription out-of-pocket maximum $4,800/member; $9,600/family
Preventive Care
Routine mammogram and Pap smears
(Coverage under Routine child care and immunizations
preventive care (through age 18) 100%
category depends on Routine adult physical exam (19 years and above,
age, symptoms and one per plan year)
diagnosis)
Routine outpatient laboratory tests and X-rays
Office visits (excludes certain diagnostic lab tests
and X-ray)
Physician Services Lab tests and X-rays 80% after deductible
Allergy injections
Inpatient services
Outpatient surgery and diagnostic tests
Inpatient care (semi-private room and board,
nursing care, ICU)
Physician visits to emergency room
Hospital Services Outpatient surgery, outpatient nonsurgical care 80% after deductible
Outpatient tests, lab and X-ray
Ancillary services
Organ transplants
Emergency room 80% after $100 co-pay (waived if admitted)
Urgent treatment center
Skilled nursing facility (up to 100 days per plan year)
Home health care (up to 100 visits per plan year)
Other Medical Ambulance services
Services
Hospice services 80% after deductible
Durable medical equipment
Physical, speech, hydrotherapy, occupational, music,
and acupuncture therapy (limited to 45 visits per plan
year, combined)
Mental Health and Inpatient mental health or substance abuse
80% after deductible
Substance Abuse Outpatient mental health or substance abuse
www.uky.edu/hr/benefits 15There is one universal prescription
UK Prescription Benefit benefit administered directly by the University
for all UK health plans. Enroll in any UK health
plan and recieve this benefit automatically.
Working retirees or retirees under age 65 prescription benefit
Co-pays for each type of retail 30-day prescription at your local participating
Health and prescription ID cards
pharmacy, including the UK Retail Pharmacies or Express Scripts Mail Service for retirees age 65 and over
Max of $50 per
Generic 20% or minimum of $8
prescription You should only
Formulary Brand 40% or minimum of $20
Max of $60 per present your UK
prescription Medicare Advantage
Non-Formulary
Brand
50% or minimum of $40 No maximum card for health
Max of $50 per coverage. For
Specialty Generic 20% or minimum of $8
prescription Medicare Parts A and B, you receive a
Specialty Brand $200 per 30-day prescription card when you become eligible for
Co-pays for each type of 90-day prescription only at UK Retail Pharmacies or Medicare. You will not be issued a new
Express Scripts Mail Service are:
card each year.
Max of $100 per
Generic 10% or minimum of $24
prescription
Max of $120 per
Formulary Brand 30% or minimum of $60
prescription The Prescription Benefit section of your
Non-Formulary
Brand
40% or minimum of $120 No maximum health summary plan description or
Specialty Generic N/A (limited to 30 days) certificate of coverage has details on covered
Specialty Brand N/A (limited to 30 days) services, exclusions and benefit limitations.
Medicare Part D prescription drug plan How to save money on your prescriptions
Retail Pharmacy (per Express Scripts Mail Order
To use your UK prescription benefit, present
Medicare Part D
Prescription Drug Plan 30-day supply) Pharmacy (90-day supply) your Express Scripts prescription benefit ID
Generic
20% co-insurance, 10% co-insurance, card at your local pharmacy.
$50 maximum $100 maximum
40% co-insurance, 30% co-insurance, Many pharmacies offer a 30-day supply of
Preferred Brand $20 minimum, $60 minimum,
selected generic prescriptions for $4 or a
$60 maximum $120 maximum
Non-Preferred Brand 90-day supply for $10-$15. Prescriptions
50% co-insurance, 40% co-insurance,
(excludes some ordered by UK HealthCare providers and
generics) $40 minimum $120 minimum
Non-Formulary Drug Not covered Not covered filled at a UK Retail Pharmacy (list at
As above, limit to As above, limit to ukhealthcare.uky.edu/pharmacy-services)
Specialty Drug
30-day supply 30-day supply are eligible for a 50 percent discount up to
a maximum of $60 per prescription (does
Prescription Coverage: The 2021-22 UK Formulary is available on
not apply to Medicare part D). Ask your
the UK Benefits web site, www.uky.edu/hr/benefits.
pharmacist if discounts are available.
16 Your UK Retiree Benefits 2021-22Call Know Your Rx Coalition for personalized How to fill your prescription
advice from our pharmacist team At your local participating pharmacy: Present your
As a UK health plan member, you can take advantage of a Express Scripts ID card to your pharmacist to get your
free prescription counseling service known as PharmAssist immediate need (30-day supply) prescriptions filled at any
provided by the Know Your Rx Coalition. You may phone or one of over 40,000 chain and independent retail pharmacies
email a UK pharmacist for: participating in the Express Scripts national network.
• Help with questions or concerns regarding Through Express Scripts mail service: You are able to
prescription and over-the-counter medications. receive by mail up to a 90-day supply of your medications.
Your medications will be delivered free of shipping costs
• Advice on how you may save money on your prescriptions. within two weeks (extra charge for faster shipping). Order
If needed, you will receive a complete medication evaluation forms for the mail service prescription drug program are
for effectiveness, appropriateness, duplications and possible available from Express Scripts (877-242-1864) or online at
drug interactions. www.express-scripts.com or UK Pharmacy Benefits office
at 859-218-5979.
Know Your Rx Coalition: Know Your Rx Coalition
pharmacists are here to help you find potential Through UK HealthCare retail pharmacies: Patients may
money-saving alternatives to your current medications have both 30- and 90-day prescriptions filled at any of the
and answer any prescription-related questions. UK retail pharmacies (including Kentucky Clinic Pharmacy,
Chandler Retail Pharmacy, Good Samaritan Retail
To contact Know Your Rx Coalition, call between Pharmacy, Turfland Retail Pharmacy and University Health
8 a.m. - 6 p.m. Eastern at 859-218-5979, 1-855-218-5979 Services Retail Pharmacy).
(toll free) or email KYRx@uky.edu.
Express Scripts (Prescription Benefits)
Customer Service Call Center and Website
Toll-free Number: 877-242-1864
TDD Number: 800-899-2114
Express Scripts Member Website: www.express-scripts.com
www.uky.edu/hr/benefits 17Dental Plans There are four dental plans offered through two
carriers: UK Dental Care and Delta Dental Program.
UK Dental Care UK Dental Retiree UK Dental Retiree
Summary of Benefits
Classic - plan pays Ultra - plan pays
UK Dental Care members must receive
services at a UK Dentistry clinic. Members Choosing a dentist
Faculty, residents or students at a UK
Dentistry clinic
may elect to be seen by faculty, residents
or dental students. Dental services Annual plan maximum $600 $1,200
provided at non-UK Dentistry clinics are Diagnostic and preventive: 2 exams and
100% 100%
not covered under UK Dental Care. Both cleanings per year
plans come with no annual deductible.
Simple restorative (filling) 50% 100%
UK Retiree Classic Plan Features Major restorative (crown/bridge) Not covered 20%/30%
Dentures (complete & partial, fixed &
• Fully covers two oral exams, X-rays and removable)
50% 50%
cleanings per year
Repairs (certain types) 50% 50%
• Offers benefits for restorative, simple
extractions, dentures and more Endodontics (root canal) Not covered 30%
• Includes discounted fees on many Periodontics (scaling and root planning
50% 50%
and perio evaluation)
services
Periodontics (surgical) Not covered 30%
• No annual deductible
Periodontics: 2 maintenance visits per year 100% 100%
UK Retiree Ultra Plan Features
Simple extractions 50% 100%
• Includes all Classic Plan benefits
Oral surgery Not covered 30%
• Offers benefits for oral surgery, root
canals and more Anesthesia (certain types) 50% 30%
• Orthodontic coverage for children and Orthodontics (no age limits) Not covered
20% up to $1,000
lifetime maximum
adults
Emergency treatment (with UK Dentistry
50% 100%
provider)
Dental Plan ID Cards (all retirees)
Depending on the dental plan you pick, an Benefits Structure Coverage Level Monthly Rate
ID card may or may not be required: Retiree only; spouse only $17.98
Retiree + children $37.82
• UK Dental plans do not require a plan UK Dental Retiree Classic
Retiree + spouse $37.82
ID card.
Retiree + family $59.87
• Delta Dental plans do provide a new ID Retiree only; spouse only $40.03
card for members who enroll for the first Retiree + children $82.36
time. UK Dental Retiree Ultra
Retiree + spouse $82.36
Retiree + family $127.24
18 Your UK Retiree Benefits 2021-22Delta Dental Summary of Benefits Delta Dental Basic Delta Dental
Enhanced
Delta Dental Basic and Delta Dental
Based on Delta Based on Delta
Enhanced both offer choice and Choosing a dentist Dental PPO & Dental PPO &
flexibility. Both the Delta Dental PPO Premier in-network Premier in-network
and Delta Dental Premier networks are $25/person; $25/person;
Annual deductible
available when covered by the Delta $75/family $75/family
Dental Basic and Enhanced plans. Here’s Annual plan maximum $1,500 $1,500
how the two networks differ: Routine oral exams 100% 100%
Delta Dental PPO in-network Preventive: two cleanings/
100% 100%
routine office visits per year*
providers offer services at a lower
negotiated fee schedule, resulting in Restorative fillings 80% 80%
lower member co-pays. There is also Simple extractions 80% 80%
no balance billing when utilizing a PPO Periodontic services 80% 80%
dentist.
Crown, bridge & dental implants Not covered 50%
Delta Dental Premier in-network or Endodontics (root canal) 80% 80%
out-of-network dentists are paid at Oral surgery 80% 80%
a higher negotiated fee schedule, but
Complete/partial dentures Not covered 50%
with a Premier network dentist, there
will never be billing for the balance of Orthodontics (up to age 19 on 50% up to a $1,000
Not covered
Enhanced plan) lifetime maximum
the bill above the Usual, Customary and
Not covered Not covered
Reasonable (UCR) rates. Space maintainers
* Four cleanings for patients with certain medical conditions
Dental Plan ID Cards (all retirees)
Depending on the dental plan you pick, Dental Plan Coverage Level Monthly Rate
an ID card may or may not be required:
Retiree only; spouse only $24.40
• UK Dental plans do not require a plan Retiree + child(ren) $46.30
Delta Dental Basic Plan
ID card. Retiree + spouse $51.90
• Delta Dental plans do provide a new Retiree + family $76.30
ID card for members who enroll for the Retiree only; spouse only $33.00
first time. Retiree + child(ren) $69.80
Delta Dental Enhanced Plan
Retiree + spouse $72.80
Retiree + family $113.50
www.uky.edu/hr/benefits 19Vision Plans There are two vision plans offered through EyeMed:
the Essential Vision Plan and the Enhanced Vision Plan.
The UK vision plan through UK’s EyeMed vision plan
EyeMed offers savings on eye UK offers two tiers of vision coverage through EyeMed: an Essential
examinations, contact lenses, Vision Plan and an Enhanced Vision Plan. This allows your family to
lens options and accessories, choose between plans that best fit your needs.
as well as LASIK and PRK laser The EyeMed network includes the University of Kentucky, private
vision correction procedures. practice opticians, optometrists, ophthalmologists and all LensCrafters
store locations nationwide. In addition, the network includes Pearle
For a complete list of providers Vision, JC Penney, Sears and Target Vision Centers. For a complete
near you, use EyeMed’s list of providers near you, use EyeMed’s provider locator at
provider locator at www.eyemedvisioncare.com.
www.eyemedvisioncare.com.
Benefits Structure Coverage Level Monthly Rate
Retiree only; spouse only $8.50
EyeMed Essential Retiree + children $15.20
Retiree + spouse $16.00
Retiree + family $21.40
Retiree only; spouse only $21.40
EyeMed Enhanced Retiree + children $38.00
Retiree + spouse $40.00
Retiree + family $53.60
20 Your UK Retiree Benefits 2021-22UK Vision Plans EyeMed Essential EyeMed Enhanced
Vision Care Services Member Cost Out-of-Network Cost Member Cost Out-of-Network Cost
Exam with dilation as necessary $10 co-pay Up to $40 $0 co-pay Up to $42
$0 co-pay, paid-in-full, fit
Standard contact lens exam $55 N/A Up to $40
and two follow-up visits
$0 co-pay, 10% off retail
Premium contact lens exam 10% off retail price N/A Up to $40
prices, then $55 allowance
Frames: any available frame at provider $130 allowance, 20% off $160 allowance, 20% off
Up to $55 Up to $80
location balance over $130 balance over $160
Single vision standard plastic lens $10 co-pay Up to $40 $10 co-pay Up to $40
Bifocal standard plastic lens $10 co-pay Up to $60 $10 co-pay Up to $60
Trifocal standard plastic lens $10 co-pay Up to $80 $10 co-pay Up to $80
Standard progressive lens $75 co-pay Up to $60 $10 co-pay Up to $83
Premium progressive lens (Tier 1-3) $95-$120 co-pay Up to $60 $30-$55 co-pay Up to $83
$75 co-pay, 80% of charge $10 co-pay, 80% of charge
Premium progressive lens (Tier 4) Up to $60
less $120 allowance less $120 allowance
UV treatment $15 N/A $0 co-pay Up to $12
Tint (solid and gradient) $15 N/A $0 co-pay Up to $12
Standard scratch resistance $15 N/A $0 co-pay Up to $12
Standard polycarbonate (adults) $40 N/A $0 co-pay Up to $30
Standard polycarbonate (kids under 19) $0 co-pay, paid-in-full Up to $30 $0 co-pay Up to $30
Standard anti-reflective coating $45 N/A $0 co-pay Up to $34
Premium anti-reflective coating (Tier 1&2) $57-$68 N/A $12-$23 co-pay N/A
$45 allowance, then
Premium anti-reflective coating (Tier 3) 20% off retail price N/A N/A
20% off
Polarization, other add-ons and services 20% off retail price N/A 20% off retail price N/A
$0 co-pay, $130 annual $0 co-pay, $160 annual
Conventional contact lenses Up to $100 Up to $128
allowance, 15% off balance allowance, 15% off balance
$0 co-pay, $130 annual $0 co-pay, $160 annual
Disposable contact lenses Up to $100 Up to $128
allowance allowance
Medically necessary contact lenses $0 co-pay, paid-in-full Up to $200 $0 co-pay, paid-in-full Up to $200
15% off retail price or 15% off retail price or
Laser vision correction N/A N/A
5% off promo price 5% off promo price
Examination frequency Once every 12 months Once every 12 months
Purchase frame Once every 24 months Once every 12 months
Purchase lenses or contacts Once every 12 months Once every 12 months
www.uky.edu/hr/benefits 21Retiree Resources
The university offers retirees a wide variety of easily
accessible resources ranging from elder care to health
and well-being services.
Elder Care Fitness Facilities and Classes on Alzheimer’s disease and dementia
859-323-4600 or toll free 800-873-8532 MoveWell membership is $7 per month are offered.
www.uky.edu/hr/work-life/elder-care and includes access to two facilities and
Donovan Scholars
This free service assists employees unlimited group fitness classes.
The Donovan Scholarship pays tuition
and retirees caring for aging relatives
Wellness Consults and mandatory course fees for adults
or friends.
Registered dietitians, health coaches 65 years and older taking academic
Specialists provide confidential and exercise specialists are available to courses at UK. The scholarship is
consultation and counseling services; provide personalized guidance. All one- available for courses held on campus
referrals to local, state and national on-one consults are free and available and limited availability for online
resources; guidance on Medicare and by phone, email or in person. classes. Learn more at www.uky.edu/
Medicaid issues; and more. olli/donovan-fellowship
Ongoing support
Work+Life Connections Whether the goal is to quit tobacco, Voluntary Benefits through MPM
859-257-9433 improve nutrition, reduce stress or 859-223-4973
www.uky.edu/hr/wlc thrive more in your daily life — these www.thempmgroupllc.com
UK employees, retirees, spouses and classes and coaching sessions make
Long-Term Care
sponsored dependents are eligible progress possible. Many programs
Long-term care insurance provides
for up to five free, confidential are free!
financial support for services that
consultations per year.
LiveWell Rewards normally are not covered by health
Osher Lifelong Learning Institute Earn incentives for participating in insurance or Medicare.
at UK programs such as the Check In health
Voluntary Benefits through
859-257-2656, toll free 866-602-5862 screening.
MetLife
www.uky.edu/OLLI
Silver Sneakers 800-GET-MET8 (800-438-6388)
OLLI at UK offers educational and
www.silversneakers.com www.metlife.com/mybenefits
enrichment courses, programs and
This free fitness program, available
events created for dynamic lifelong Auto, Home and Pet Insurance
to members of the UK Medicare
learners age 50+ who are continually MetLife offers home and auto
Advantage plan, includes unlimited
searching for exciting topics and insurance, as well as veterinary pet
access to participating gyms and
exploring new opportunities in insurance. You may enroll in these
fitness centers.
learning. The OLLI at UK has sites in voluntary plans at any time.
Sanders-Brown Center on Aging
Lexington and Morehead.
859-323-6040
UK Health and Wellness www.uky.edu/coa
859-257-9355 As a core component of ongoing
www.uky.edu/hr/wellness/ research, information and resources
22 Your UK Retiree Benefits 2021-22Questions? Contact the appropriate provider listed below.
Benefit Phone Web Email
Health
Medicare Advantage (retirees over 1-844-488-3956 www.UHCretiree.com/uky ukhmo@uky.edu
age 65)
1-855-634-3383 www.anthem.com
UK-PPO, UK-EPO, UK-RHP, UK Indemnity benefits@email.uky.edu
1-800-955-8547 www.mc.uky.edu/ukhmo
UK-HMO
859-257-2124
Employee Benefits Advocate
Pharmacy 1-877-242-1864 www.express-scripts.com KYRx@uky.edu
Express Scripts (Hearing impaired:
1-800-899-2114)
Know Your Rx PharmAssist featuring
UK pharmacists (formerly Help with Your 859-218-5979 www.uky.edu/hr/benefits/
Medicine and Co-Pay Counseling) Toll free 1-855-218-5979 pharmacy
Dental and Vision
UK Dental 859-323-8566 dentistry.uky.edu/
patient-care/plan
Delta Dental 1-800-955-2030 www.deltadentalky.com
www.enrollwitheyemed.com/
EyeMed Vision Care 1-866-723-0596 access
Retirement Plans 859-224-6900 www.tiaa.org
TIAA (to schedule a meeting) 1-800-842-2776
TIAA (for telephone counseling)
1-800-343-0860 www.fidelity.com
Fidelity Investments (general) 1-800-642-7131
Fidelity Investments (to schedule
a meeting)
Voluntary Benefits
Long-term care insurance, universal 859-223-4973 www.thempmgroupllc.com mpmgroup@msn.com
life insurance (Administered by The Toll free 1-888-388-1676
MPM Group, LLC)
Group home and auto insurance 1-800-GET-MET8 www.metlife.com/mybenefits
Pet insurane (Administered (1-800-438-6388)
by MetLife)
Have a general question? Contact UK Employee Benefits: Email us at benefits@email.uky.edu.
Reach us by phone at 859-257-9519, select option 3 or toll-free 1-800-999-2183, select option 3.
Send faxes to 859-323-1095.You can also read
