Medical Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit https://myuhc.com.

Choice Plus Network	In-Network
Deductible (Individual/Family)	$6,000 / $12,000
Out-of-Pocket Max (Individual/Family)	$6,000 / $12,000
Shared Coinsurance	0%
Physician Visits
Primary Care	Deductible
Specialist	Deductible
Routine Preventive	Covered at 100%
Hospital Services
Physician Services	Deductible
Inpatient Hospitalization	Deductible
Outpatient Surgery	Deductible
Outpatient Diagnostics	Deductible
Urgent Care	Deductible
Emergency Room	Deductible
Prescription Card
Retail
Tier 1 - Generic	Deductible
Tier 2 - Preferred Brand	Deductible
Tier 3 - Non-preferred Brand	Deductible
Tier 4 - Specialty	Deductible
Specialty Retail
Tier 1 - Generic	Deductible
Tier 2 - Preferred Brand	Deductible
Tier 3 - Non-preferred Brand	Deductible
Tier 4 - Specialty	Deductible
Mail Order Prescriptions
Tier 1 - Generic	Deductible
Tier 2 - Preferred Brand	Deductible
Tier 3 - Non-preferred Brand	Deductible
Tier 4 - Specialty	Deductible

	Per Pay Period Cost
Employee Only	$26.92
Employee + Spouse	$290.29
Employee + Child(ren)	$254.38
Employee + Family	$517.74

Downloads

Benefit Summary

Summary of Benefits Coverage

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit https://myuhc.com.

Choice Plus Network	In-Network
Deductible (Individual/Family)	$5,000 / $10,000
Out-of-Pocket Max (Individual/Family)	$8,150 / $16,300
Shared Coinsurance	0%
Physician Visits
Primary Care	$25 Copay $0 Copay <19yrs. of age
Specialist	$75 Copay
Routine Preventive	Covered at 100%
Hospital Services
Physician Services	Deductible
Inpatient Hospitalization	Deductible
Outpatient Surgery	Deductible
Outpatient Diagnostics	Deductible
Urgent Care	$50 Copay
Emergency Room	$300 Copay per occurance + Deductible
Prescription Card
Retail
Tier 1 - Generic	$10 Copay
Tier 2 - Preferred Brand	$35 Copay
Tier 3 - Non-preferred Brand	$75 Copay
Tier 4 - Specialty	$250 Copay
Specialty Retail
Tier 1 - Generic	$10 Copay
Tier 2 - Preferred Brand	$150 Copay
Tier 3 - Non-preferred Brand	$350 Copay
Tier 4 - Specialty	$500 Copay
Mail Order
Tier 1 - Generic	$25 Copay
Tier 2 - Preferred Brand	$87.50 Copay
Tier 3 - Non-preferred Brand	$187.50 Copay
Tier 4 - Specialty	$625 Copay

	Per Pay Period Cost
Employee Only	$62.10
Employee + Spouse	$364.16
Employee + Child(ren)	$322.97
Employee + Family	$625.03

Downloads

Summary of Benefits Coverage

Benefit Summary

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit https://myuhc.com.

Choice Plus Network	In-Network
Deductible (Individual/Family)	$3,000 / $6,000
Out-of-Pocket Max (Individual/Family)	$5,500 / $11,000
Shared Coinsurance	0%
Physician Visits
Primary Care	$25 Copay $0 Copay <19yrs. of age
Specialist	$75 Copay
Routine Preventive	Covered at 100%
Hospital Services
Physician Services	Deductible
Inpatient Hospitalization	Deductible
Outpatient Surgery	Deductible
Outpatient Diagnostics	Deductible
Urgent Care	$50 Copay
Emergency Room	$300 Copay per occurance + Deductible
Prescription Card
Retail
Tier 1 - Generic	$10 Copay
Tier 2 - Preferred Brand	$35 Copay
Tier 3 - Non-preferred Brand	$75 Copay
Tier 4 - Specialty	$250 Copay
Specialty Retail
Tier 1 - Generic	$10 Copay
Tier 2 - Preferred Brand	$150 Copay
Tier 3 - Non-preferred Brand	$350 Copay
Tier 4 - Specialty	$500 Copay
Mail Order
Tier 1 - Generic	$25 Copay
Tier 2 - Preferred Brand	$87.50 Copay
Tier 3 - Non-preferred Brand	$187.50 Copay
Tier 4 - Specialty	$625 Copay