Primary Care Physicans are required, and should direct your care
In network:
$30
($40 for specialists)
Out of network:
Not covered
Scans (CT and PET) and MRIs:
In network:
No coinsurance after you've met your deductible
Out of network:
Not covered
Blood work and
X-rays:
In network:
No coinsurance after deductible is met
Out of network:
Not covered
Generic Drugs (Tier 1)
In network:
UCHealth Retail:
$13 for a 30-day supply
$26 for a 90-day supply
Anthem Retail:
$15 for a 30-day supply
$26 for a 90-day supply
Out of network:
Not covered
Preferred-brand drugs
(Tier 2)
In network:
UCHealth Retail:
$30 for a 30-day supply
$60 for a 90-day supply
Anthem Retail:
$35 for a 30-day supply
UCH Mail Order:
$60 for a 90-day supply
Out of network:
Not covered
Non-preferred-brand drugs
(Tier 3)
In network:
UCHealth Retail:
$50 for a 30-day supply
$100 for a 90-day supply
Anthem Retail:
$50 for a 30-day supply
UCH Mail Order:
$100 for a 90-day supply
Out of network:
Not covered
Specialty oral and injectable drugs
(Tier 4)
In network:
Anthem Retail, UCHealth Retail and UCH Mail Order:
$75 for a 30-day supply
Out of network:
Not covered
In network:
No coinsurance after deductible is met (100% covered)
Out of network:
Not covered
In network:
Emergency services:
$250 (waived if admitted)
Transportation:
No coinsurance after you've met your deductible
Urgent care:
$30 per visit
Out of network:
Emergency services:
$250 (waived if admitted)
Transportation:
No coinsurance after deductible is met
Urgent care:
$30 per visit
In network:
Facility fee:
No coinsurance after deductible is met
Physician and surgeon fee:
Fully covered
Out of network:
Facility,
physician and surgeon fees:
Not covered
In network:
Outpatient:
$30 per office visit and no coinsurance after deductible is met for the outpatient facility
Inpatient:
No coinsurance after deductible is met
Out of network:
Not covered
In network:
Prenatal and postnatal care:
$15 coinsurance for first prenatal care office visit
Delivery and
all inpatient services:
No coinsurance after deductible is met
Out of network:
Not covered
In network:
Home Health Care, Skilled Nursing Care & Hospice Care:
No coinsurance after deductible is met
Rehabilitation & Habilitation:
Inpatient:
No coinsurance after after deductible is met
Outpatient:
$30
Durable Medical Equipment:
20 percent coinsurance (not subject to deductible for prosthetic appliances, and no copayment after deductible is met for all other durable medical equipment
Out of network:
Not covered
In network:
Eye Exam:
$30 per visit (exam only)
Glasses:
Not covered
Dental checkup:
Not covered
Out of network:
Eye exam:
Up to a $35 maximum reimbursement
Glasses:
Not covered
Dental checkup:
Not covered
Abortion (except in cases of rape, incest, or when the life of the mother is endangered)
Adult dental care
Cosmetic surgery
Infertility treatment
Long-term care
Non-emergency care outside the United States
Private-duty nursing
Routine foot care
Weight-loss programs
CU Health Plan - Extended
Faculty
University Staff
Classified Staff
Preferred Provider
Organization (PPO)
administered by Anthem Blue Cross Blue Shield
Employee: $73.00
Employee + Spouse: $225.00
Employee + Child(ren): $145.00
Family: $294.50
Colorado and nationwide
Individual: $750
Family: $1,500
Individual:
$7,900
Family:
$15,800
Visit Anthem's microsite, or call 1-800-735-6072. Must use Anthem providers.
No referral required
In network:
$40
($50 for specialists)
Out of network:
Not covered
Scans (CT and PET) and MRIs:
In network:
10% coinsurance after you've met your deductible
Out of network:
10% coinsurance after you've met your deductible
Blood work and
X-rays:
In network:
10% coinsurance after deductible is met
Out of network:
10% coinsurance after deductible is met
Generic Drugs (Tier 1)
In network:
Anthem & UCHealth Retail:
$15 for a 30-day supply
UCH Mail Order:
$30 for a 90-day supply
Out of network:
Not covered
Preferred-brand drugs
(Tier 2)
In network:
Anthem & UCHealth Retail:
$35 for a 30-day supply
UCH Mail Order:
$70 for a 90-day supply
Out of network:
Not covered
Non-preferred-brand drugs
(Tier 3)
In network:
Anthem & UCHealth Retail:
$50 for a 30-day supply
UCH Mail Order:
$100 for a 90-day supply
Out of network:
Not covered
Specialty oral and injectable drugs
(Tier 4)
In network:
Anthem & UCHealth Retail & Mail Order:
$75 for a 30-day supply
Out of network:
Not covered
In network:
10% coinsurance after deductible is met
Out of network:
Not covered
In network:
Emergency services:
$250 (waived if admitted)
Transportation:
10% coinsurance after you've met your deductible
Urgent care:
$40 per visit
Out of network:
Emergency services:
$250 (waived if admitted)
Transportation:
10% coinsurance after deductible is met
Urgent care:
$40 per visit
In network:
Facility and physician surgeon fee:
10% coinsurance after deductible is met
Out of network:
Facility,
physician and surgeon fees:
Not covered
In network:
Outpatient:
$40 per office visit
Inpatient:
10% coinsurance after deductible is met
Out of network:
Not covered
In network:
Prenatal and postnatal care:
$25 copayment for first prenatal care office visit
Delivery and
all inpatient services:
10% coinsurance after deductible is met
Out of network:
Not covered
In network:
Home Health Care, Skilled Nursing Care & Hospice Care:
10% coinsurance after deductible is met
Rehabilitation & Habilitation:
Inpatient:
10% coinsurance after deductible is met
Outpatient: $40
Durable Medical Equipment:
10 percent coinsurance after deductible is met
Out of network:
Not covered
In network:
Eye Exam, glasses and dental checkup:
Not covered
Out of network:
Eye exam, glasses and dental checkup:
Not covered
Abortion (except in cases of rape, incest, or when the life of the mother is endangered)
Adult dental care
Cosmetic surgery
Infertility treatment
Long-term care
Non-emergency care outside the United States
Private-duty nursing
Routine foot care
Weight-loss programs
CU Health Plan - High Deductible
Faculty University Staff Classified Staff Non-Medicare-eligible retirees Non-Medicare-eligible surviving spouses
Preferred Provider
Organization (PPO)
administered by Anthem Blue Cross Blue Shield