Benefits

University of Chicago Health Plan (UCHP)

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.  

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.

The University of Chicago Health Plan (UCHP) has contracted with Aetna to administer UCHP benefits.  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. 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. 

Prescription Drugs

DCAM - Per prescription for up to a 30-day supply at DCAM only;

  • Generic - $5 Copayment

  • Preferred Brand - $15 Copayment

  • Non-Preferred Brand - $30 Copayment

  • Specialty Pharmacy - $75 Copayment

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

  • Generic - $10 Copayment

  • Preferred Brand - $30 Copayment

  • Non-Preferred Brand - $50 Copayment

  • Specialty Pharmacy - $75 Copayment

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

  • Generic - $10 Copayment

  • Preferred Brand - $30 Copayment

  • Non-Preferred Brand - $60 Copayment

  • Specialty Pharmacy - NA Copayment

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

  • Generic - $20 Copayment

  • Preferred Brand - $60 Copayment

  • Non-Preferred Brand - $100 Copayment

  • Specialty Pharmacy - NA Copayment