UI Grad Care - Plan Provisions

  1. Co-insurance Percentage - 10%
  2. Out-Of-Pocket Limit - Single/Family $1,000/$1,700; Drug Card - $1,000/$1,700
  3. Pre-existing Condition Waiting Period - None
  4. Pre-approval of Inpatient Admissions - Required
  5. Second Surgical Opinion - Voluntary
  6. Prior Approval for Outpatient Surgery - Physician Discretion
  7. Benefits Available from Nonmember Providers - Not available without approved referrals.
  8. Office Calls - $10 co-pay
  9. Routine Physicals - $0, lab tests and materials - 10% co-insurance
  10. Well-Child Care - $0, including required immunizations
  11. X-Ray and Lab - 10% co-insurance
  12. Routine Eye Exam - $10 co-payment ($0 at UIHC)
  13. Hearing Exam - $10 co-payment
  14. Room & Board - 10% coinsurance after $125 daily deductible. Pre-approval of admission required. Semi-private room.
  15. In-Hospital Physician Services - 10% co-insurance
  16. Inpatient Surgery - 10% coinsurance
  17. Out-patient Surgery - 10% coinsurance
  18. Inpatient Supplies/Drugs - 10% coinsurance
  19. Inpatient Tests, ICU, Operating Room, specialized care, etc. - 10% coinsurance
  20. Immunizations - $0
  21. Allergy Treatments - $10 co-payments
  22. Chiropractor - $10 co-payment, referral for over 12 visits
  23. Ambulance - 10% co-insurance
  24. Organ Transplants - prior approval
  25. Emergency Room Care - 10% coinsurance after $50 co-payment
  26. Physical Therapy - 10% coinsurance
  27. Blood, etc. - 10% coinsurance
  28. Durable Medical Equipment - 10% coinsurance
  29. Outpatient Chemotherapy - 10% coinsurance
  30. Speech, Occupational & Respiratory Therapy - 10% coinsurance
  31. Dental Accident Care - 10% coinsurance within 6 months of injury
  32. Dependent Child Age Limit - end of the calendar year the child turns 26
  33. Lifetime Maximum - none
  34. Prescription Drugs - Rx Card $7 or 25% whichever is greater
  35. Contraceptives – Generic and brand-name drugs without a generic and devices: $0; Brand-name drugs with a generic: 25%
  36. STI, HIV & HPV testing & counseling - $0
  37. Mental Health - 0%; 50%
  38. Outpatient Substance Abuse - 10% coinsurance
  39. Employees and their families must use a University of Iowa provider and facility for their health services. These providers include the Student Health Clinic (restricted to only University students), Family Practice, Internal Medicine, Obstetrics and Gynecology, Pediatrics, or any of the University Community Health Clinics, such as the North Liberty and the Southeast Iowa City Clinic. Benefits under this plan are also provided for services received from out-of-area providers in cases of emergencies or accidental injuries, referrals under special circumstances, and for individuals temporarily living out of the area who have notified the University Benefits Office before leaving the area. A separate panel of providers is available for mental health and substance abuse care provided under 37 and 38 above.