U of U Gold Copay Plan
This is a University of Utah Marketplace plan. Marketplace plans include an annual physical and many preventative services for free, include prescription benefits, cover maternity, and mental health visits. They also cover preexisting conditions without a waiting period. Based on your household size, zip code, and income; you may receive subsidies to pay for a portion of your premium. University of Utah health plans are an EPO plan which means that you must use in-network doctors and hospitals, except for emergencies. Their hospital network includes University of Utah hospitals. The provider network has a very large network of doctors in Utah, plus you do not need a referral to see a specialist. Clients love these plans for the great customer service and large network.
U of U
The company that provides and manages your insurance coverage. You pay your insurance premiums, which are regular payments to maintain your coverage, directly to the carrier.
A health plan's plan year typically spans from January 1st to December 31st. At the start of each new year, plans reset, and any deductibles, out-of-pocket maximums, and benefits calculations begin anew.
A deductible is the amount you pay out of your own pocket before your insurance coverage starts. It's a way to share costs between you and the insurance company.
Maximum Out Of Pocket
Maximum out-of-pocket refers to the highest amount you'll have to pay for covered medical expenses in a given period, including deductibles and co-payments. Once you reach this limit, your insurance covers 100% of eligible expenses.
Doctor visit copays are predetermined fixed amounts that you pay directly to your healthcare provider each time you visit the doctor's office. Typically, these copays are applied before your deductible is met, meaning you're responsible for these payments regardless of whether you've reached your deductible limit. However, some health insurance plans might have exceptions where certain preventive services or specific types of visits are covered without requiring copayments before meeting the deductible. It's essential to review your plan details to understand how doctor visit copays are applied in your specific insurance coverage.
Primary Care Visit
A primary care visit is a routine appointment with a general healthcare provider for basic medical needs, which might have a fixed copayment before your deductible is met, unless otherwise stated.
Specialty Care Visit
A specialist care visit involves consulting a healthcare provider who has expertise in a specific area of medicine or a particular medical condition, such as a cardiologist, dermatologist, or orthopedic surgeon. These visits address more complex health issues.
Mental Health Visit
A mental health visit is a session with a mental health professional, such as a psychiatrist, psychologist, or therapist, to address and manage emotional or psychological well-being.
Virtual Visits / Telehealth
Telehealth refers to the remote delivery of healthcare services and medical consultations through digital communication technologies, allowing patients to connect with healthcare providers virtually, often via video calls or phone calls.
Emergency and Urgently Needed Services
Emergency and urgently needed services in the context of health insurance refer to medical care that is required immediately due to a life-threatening situation or when delaying care could result in serious harm. Emergency services encompass situations like severe injuries, heart attacks, or sudden illnesses that demand immediate attention. Urgently needed services involve medical conditions that require prompt care to avoid complications, even though they might not be immediately life-threatening. Health insurance plans typically cover these services, even if the provider is out of network, ensuring that individuals receive essential care regardless of the circumstances.
Urgent Care Visit
Urgent care is for non-emergency medical needs that require prompt care but is not severe enough to warrant a trip to the emergency room. It's a convenient option when your regular doctor is unavailable.
Emergency Room Visit
$200 copay after deductible
An emergency room visit is for immediate, life-threatening medical situations requiring urgent medical attention, such as severe injuries, heart attacks, or critical illnesses. It's the place to go when there's a medical crisis.
$250 copay/trip after deductible
A ground ambulance is a specially equipped vehicle used to transport individuals to medical facilities, often in cases of emergencies or when there's a need for medical supervision during transportation.
Prescription medications are prescribed by healthcare providers to treat various medical conditions. They play a crucial role in managing health, and their cost can vary significantly based on factors such as the drug's brand or generic status, dosage, and insurance coverage. If you're looking for information about the cost of your prescription drugs and how they are covered by your insurance plan, a local agent at Utah Avenue Insurance can provide assistance and help you understand the specifics of your medication coverage.
Preferred Generic Rx
Typically refers to a category of prescription drugs that health insurance plans favor due to their cost-effectiveness. These medications are often available at lower co-payment or co-insurance rates to encourage their use as a cost-saving measure.
Extra Benefits for Children
Many health insurance plans offer extra benefits for kids under 18 to ensure their well-being. These benefits often include coverage for pediatric services such as well-child visits, immunizations, vision and dental care, and preventive screenings. Additionally, some plans might provide access to specialized pediatric care and therapies, ensuring that children receive comprehensive healthcare tailored to their developmental needs. It's important to review your insurance policy to understand the specific extra benefits available for kids and their coverage details.
Children's Eye Exam
Vision assessment performed by an eye doctor to evaluate a child's visual health and identify any eye conditions. These exams are essential for early detection and treatment of issues that could affect a child's vision and overall development.
This benefit is designed to ensure that children have access to glasses or contacts, helping them maintain clear and healthy eyesight as they grow. This benefit is for children under 18 typically.
Children's Dental Check Up
Children's dental checkups involve routine visits to the dentist for teeth and gum examinations, along with professional cleanings to prevent dental issues and maintain oral health.
Full Summary of Benefits and Helpful Links
Official documents, such as your insurance policy or Summary of Benefits and Coverage (SBC), outline the details of your coverage, including deductibles, copayments, and covered services. Provider links, often available through your insurance company's website, offer directories of in-network healthcare professionals and facilities, helping you find the right doctors and hospitals that are covered by your plan. Utilizing these resources can empower you to make informed healthcare decisions and effectively navigate your insurance coverage.
Schedule a consultation with a local Utah health insurance agent
We're delighted to offer both in-person and phone consultations to assist you with your health insurance requirements. Our expertise extends to health insurance solutions both within and outside the marketplace, Medicare Advantage and supplements, dental and vision insurance, as well as life insurance and accident plans. We appreciate the opportunity to serve as your advocate in navigating these options. The best part is that our guidance and support come at no cost to you. Your well-being is our priority, and we're committed to ensuring you make informed decisions about your insurance coverage.
Here's a brief overview of the prominent copays, deductibles, and coinsurance associated with this plan. If you'd like to understand the definitions of these terms, we encourage you to visit our dedicated terms and definitions page. The mentioned copays and coinsurance reflect amounts paid prior to reaching the deductible unless otherwise indicated. It's important to note that this overview doesn't encompass the entirety of services covered by the plan. Please be aware that this snapshot is not guaranteed to be fully accurate. To confirm plan benefits or access comprehensive details, we recommend referring to the complete summary of benefits. You can also obtain thorough coverage terms by visiting the health plan carrier's website.