Your Health Care Benefits

Outpatient Medical Expenses that are Covered

After you meet the annual deductible, the Plan pays 80% of the allowance for outpatient medical expenses required for the diagnosis and/or treatment of an injury or illness.

Outpatient medical expenses that are covered

The following are considered covered outpatient medical expenses:

  • x-ray examinations and diagnostic laboratory and pathology tests
  • radiation therapy, including charges for X-ray, radon, radium and radioactive isotope treatments
  • surgical dressing, splints, trusses, braces and crutches
  • oxygen and its administration, including the rental of necessary equipment
  • blood transfusions, including the cost of blood, blood plasma and plasma expanders
  • surgical appliances required to replace or aid natural organs or body parts, including, among others, artificial limbs, eyes, and larynxes, and electronic heart pacemakers
  • rental (or purchase if more cost-effective) of durable medical equipment
  • physician services
  • services of a licensed speech therapist or physiotherapist (prior authorization by UHC is required before any services or treatment begins)
  • contraceptive devices not available over-the-counter
  • anesthesia and its administration
  • treatment of a fracture or dislocation of the jaw, oral surgery, or treatment of natural teeth, if medically appropriate as the result of, and within 12 months after, an accidental injury

Services received as an inpatient are covered under the hospitalization portion of the Plan.

What’s Not Covered

  • dental x-rays unless required as a result of an accidental injury to natural teeth (see here)
  • any medical care not prescribed by or under the direction of a physician
  • medical services or supplies determined by the Board of Trustees as not medically appropriate for the care or treatment of any illness or injury