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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. 

Aetna

Aetna administers the University of Chicago Health Plan (UCHP).  As the UCHP administrator, Aetna provides customer service and medical management services. In addition, Aetna provides members with better access to health tools, resources, and programs, such as a 24-hour Informed Nurse Healthline and

online access to plan information. Aetna administers the plan benefits as outlined by UCHP with current UCHP plan requirements and provider network access remaining in place.

Expanded Network Access

NorthShore addition to the UCHP Plan

UCHP members have access to the NorthShore providers in the UCHP portal.  The Aetna DocFind site for UCHP on the UCHP site includes the NorthShore providers. You can also view the list of NorthShore doctors and hospitals here. 

 

UChicago Medicine Advent Health

Beginning January 1, 2024, the University of Chicago Medicine expanded your network options to include AdventHealth in the Western Suburbs.  For more information about the doctors and hospitals included in this partnership, visit the UChicago Medicine AdventHealth website. To find a full list of providers, visit UChicagoMedicine.org or log into your account at www.aetna.com and search using the UCHP custom DocFind.

CVS Minute Clinics

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.

Cost of Coverage

Your cost for the plan depends on the coverage you select and your income. Please visit Medical, Dental and Vision Plan Rates. 

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

  • 50% copayment for maintenance medications after second refill (not applicable if filled by DCAM Pharmacy)

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 -Specialty prescription drugs are not available through mail service

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 - Specialty prescription drugs are not available through mail service

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