What’s covered?

The plan summary document outlines the specifics of what medical treatments are covered and what is not covered. Not all medical procedures are covered (for example surgeries that are considered elective or for cosmetic reasons are typically not covered), so it is important for you to review this plan information, particularly if you have known medical issues.

Components of a typical HMO Plan:

• Primary Care Physician - This physician is central to the HMO plan and is responsible for “managing” your medical care. When making your decision to enroll in the HMO Plan, you should review the list of network providers for the plan. It is a good idea to confirm that your current doctor is in the network if you intend to continue using him/her. Otherwise, you will need to choose a new primary care physician from the network.
• Copays/Deductibles - The HMO plan includes copayments for services at the time of your visit. These are different for a primary care physician visit and a visit to a specialist. There is a deductible for diagnostic services. The details of the copays and deductibles are provided in the plan summary document.
• Preventive Coverage – Preventative care services are provided at 100% coverage. For a full list of preventative care services, please visit HealthCare.gov. This is an important element of your plan – one that can save you money and help you prevent major illnesses. You should familiarize yourself with this portion of your plan and take full advantage of these preventive services. These tests may help your physician detect illnesses early and in some cases can help save your life.
• Employee Cost Share – This is the regular fee or premium you pay to participate in the health plan. This is only a portion of the cost of the plan. The University pays the remaining portion as a benefit to employees. The exact costs per month for each level of coverage (single, family, etc), are listed under the  Cost Share page.