Medical Benefits at a Glance
Below is a summary of all medical options. For more detailed descriptions of each plan, visit the Plan Documents page.
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| UNITED HEALTHCARE (UHC) | Network Plan | Tiered Plan | One Step Plan (Closed to New Entrants) |
||
|---|---|---|---|---|---|
| Benefits | In-Network Only | In-Network | Out-of-Network* | In-Network | Out-of-Network* |
| Calendar Year Deductible (ded.) Individual / Family | $750 / $1,500 | $2,500 / $5,000 | $4,000 / $8,000 | $4,400 / $8,750 | $4,400 / $8,750 |
| Out-of-Pocket Maximum Individual / Family |
$2,000 / $4,000 | $4,400 / $8,750 | $6,000 / $12,000 | $4,400 / $8,750 | $6,000 / $12,000 |
| Coinsurance (You pay) | 20% | 10% or 20% | 30% | 0% | 30% |
| Preventive Care | No charge | No charge | 30% after ded. | No charge | 30% after ded. |
| Primary Care Physician (PCP) / Specialist | Tier 1 PCP: $25 copay Tier 2 PCP: $50 copay Tier 1 Specialist: $50 copay Tier 2 Specialist: $75 copay |
Tier 1: 10% after ded. Tier 2: 20% after ded. |
30% after ded. | 0% after ded. | 30% after ded. |
| OT, PT, Speech Therapy |
$75 copay | 20% after ded. | 30% after ded. | 0% after ded. | 30% after ded. |
| Acupuncture | $75 copay | 20% after ded. | 30% after ded. | 0% after ded. | 30% after ded. |
| Fertility/Infertility | Not covered | $35,000 lifetime maximum, including Rx. Requires use of Optum Fertility Solutions. See plan details for more information. |
Not covered | $35,000 lifetime maximum, including Rx. Requires use of Optum Fertility Solutions. See plan details for more information. |
Not covered |
| Virtual Visits | $25 copay | 10% after ded. | Not Covered | 0% after ded. | Not covered |
| Diagnostic and Labs | 20% after ded. | 30% after ded. | 20% after ded. | 0% after ded. | 30% after ded. |
| Urgent Care | $75 copay | 20% after ded. | 30% after ded. | 0% after ded. | 30% after ded. |
| Emergency Room | $500 copay | 20% after ded. | 20% after ded. | 0% after ded. | 0% after ded. |
| Hospital Inpatient / Outpatient |
$500 copay, then 20% after ded. | 20% after ded. | 30% after ded. | 0% after ded. | 30% after ded. |
* Out-of-network providers may be reimbursed differently than In-network providers. This may result in higher out-of-pocket costs for you including "balance billed" amounts that do not apply to your plan deductible or plan out-of-pocket maximum.