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UT Flex: Flexible Spending Accounts

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UT Flex flexible spending accounts allow you to pay for eligible medical and daycare expenses with pre-tax dollars. This means you don't pay federal income or Social Security taxes on the money you set aside into these accounts. Currently, you can place up to $5,000 in a flexible medical account and $5,000 in a flexible daycare account.

Plan Information:

Determining Out-of-Pocket Costs for the UT Flex Medical Account

Remember some of these common out-of-pocket costs associated with university insurance plans while figuring out your medical expenses. Other eligible and ineligible expenses are available on the PayFlex Web site.

UT Select PPO (BCBS) Network Medical Costs

  • Physician office visits - $30 co-payment (family-care physician) or $35 co-payment (specialist)
  • Emergency room - $100 co-payment
  • Outpatient surgery - $100 co-payment, plus $250 deductible, plus 20% coinsurance
  • Hospital - $100 per day co-payment ($500 maximum), plus $250 deductible, plus 20% coinsurance
  • Out-of-pocket maximum - $1,750 for deductible and coinsurance per person OR $5,250 for deductible and coinsurance per family

UT Select (Medco) Prescription Drug Costs

  • Annual Deductible - $100 per person
  • Retail co-payments - $10 (generic), $35 (preferred) and $50 (non-preferred)
  • Home delivery co-payments - $20 (generic), $87.50 (preferred) and $125 (non-preferred)

UT Delta Network Costs

  • Annual Deductible - $25 (excludes oral exams, x-rays, cleanings, sealants, space maintainers and specialist consultations)
  • Fillings, Extractions, Root Canals, Periodontics – 20%
  • Crowns, Jackets, Cast Restorations, Bridges & Dentures – 50%
  • Orthodontics – 50%, $1,250 lifetime benefit per person
  • Maximum annual benefit payable by Delta - $1,250

Assurant Dental DMO Costs

  • Oral Exams, X-rays, Cleanings - $0-5
  • Sealants - $10 per tooth
  • Space Maintainers - $60-105
  • Fillings - $10-110
  • Extractions - $15-135
  • Root Canals - $90-175
  • Periodontics - $27-140
  • Crown, Jackets & Restorations - $275 (lab fees may apply)
  • Bridges & Dentures - $275-400 (lap fees may apply)
  • Orthodontics – 25% discount off Network Dentist retail fees

Superior Vision Network Costs

  • Eye exam - $35 co-payment
  • Contact lens fitting - $35 co-payment
  • Eyeglass frames - $140 benefit (standard lenses covered in full)
  • Contact lenses - $125 benefit in lieu of eyeglasses

Claims History

Your claims history may also assist you with determining your future out-of-pocket costs. Register at the Web sites below to review your claims history.

Contact Information:

Insurance Company Telephone Hours
PayFlex Systems 1-866-887-3539 Mon.-Fri. 8 a.m.-5 p.m. CST