Benefits

University of Chicago Health Plan (HMO)

University of Chicago Health Plan (UCHP) is not formally organized as an HMO, but it works like one. UCHP doctors and facilities are affiliated with the University of Chicago Medical Center (UCMC). UCHP facilities are mainly located at UCMC.  You can compare UCHP benefits to the other medical plans to determine if it will meet your medical needs.

As long as your care is coordinated by your Primary Care Physician, UCHP generally covers 100% of the cost for approved care after you pay your required copayment. Coverage includes preventive care such as physicals, mammograms, gynecological exams, well-child care and immunizations, and prescription drugs.

You must use UCMC providers in order receive benefits. If you go to a doctor or hospital outside of UCMC for care without prior approval, you will not receive any benefits from the plan, except for emergencies. 

In addition, CVS Minute Clinics nationally provide urgent care services to UCHP members in accordance with UCHP Certificate of Coverage. Urgent Care Centers should be utilized for "urgent care" and not "emergency care". If you have an urgent care issue that can not wait for you to see your primary care provider (PCP), you can seek services at a CVS Minute Clinic. Please note, you should call your PCP for prior authorization and you must call your PCP within 24 hours and UCHP within 48 hours after your CVS Minute Clinic visit. All routine Primary Care Services, including vaccinations and immunizations, must be provided and coordinated by a UCHP PCP.

Effective January 1, 2017, the University of Chicago Health Plan (UCHP) will contract with Aetna to administer existing UCHP benefits. UCHP will continue to provide comprehensive health care benefits through the University of Chicago Medicine facilities including The University of Chicago Medical Center (UCMC), and by UCHP primary care physicians (PCPs) and UCHP specialists. As the UCHP administrator, Aetna will help UCHP provide customer service and medical management services. In addition, Aetna will enable UCHP membership to better access health tools, resources, and programs, such as a 24-hour Informed Nurse Healthline and online access to plan information. All UCHP members will receive new ID cards that will include both the UCHP and Aetna logos along with CVS Caremark pharmacy information on back. Aetna will be administering the plan benefits as outlined by UCHP with current UCHP plan requirements and provider network access remaining in place.

Your cost for the plan depends on the coverage you select and your income. Enrolling in the plan is limited to certain times or events during your employment.

Prescription Drugs

Participating Retail Pharmacy - Per prescription for up to 30-day supply

  • Generic - 100% after $10 Copayment
  • Preferred brand-name - 100% after $30 Copayment
  • Non-preferred brand-name - 100% after $45 Copayment
  • Specialty - 100% after $75 Copayment

Mail Order -

Per prescription for up to a 90-day supply at DCAM only;

  • Generic - 100% after $10 Copayment
  • Preferred brand-name - 100% after $30 Copayment
  • Non-preferred brand-name - 100% after $60 Copayment

Per prescription for up to a 90-day supply at CVS/Caremark;

  • Generic -100% after $20 Copayment
  • Preferred brand-name - 100% after $60 Copayment
  • Non-preferred brand-name - 100% after $90 Copayment