Medical & Rx
We offer you a comprehensive benefits program to help you and your family protect your health and financial security. Your benefits are a valuable part of your compensation; we encourage you to learn how your plans work so you can get the most from them.
You have two (2) plan options through United Healthcare (UHC).
Learn more about your Medical Plans
Medical Plan Design
This is not a complete list of covered services. For more details, please refer to the plan documents.
The United Healthcare Choice Plus network is available nationwide for all employees. You are encouraged to visit www.myuhc.com to search the provider directory for physicians and hospitals within your service area.
Your healthcare ID card reflects your coverage under the medical and prescription drug (if enrolled). Your dependents’ names will be listed on the card; additional cards can also be ordered with UHC at myuhc.com.
HSA Plan
In-Network
Type of Deductible
Embedded
Calendar Year Deductible1,2 (Individual / Family)
$3,000 / $6,000
Your Coinsurance3
20%
Out-of-Pocket Maximum (Individual / Family)
$6,000 / $12,000
Physician Visit (Primary Care / Specialist)
Deductible, then coinsurance
Preventive Care Services4
Covered 100%
Lab, X-Ray or Other Preventative Tests
Deductible, then coinsurance
Hospital Services
(Inpatient / Outpatient)
Deductible, then coinsurance
Urgent Care Visit
Deductible, then coinsurance
Emergency Room Visit
Deductible, then coinsurance
Out-of-Network
Calendar Year Deductible1,2 (Individual / Family)
$5,000 / $10,000
Your Coinsurance3
50%
Out-of-Pocket Maximum (Individual / Family)
$10,000 / $20,000
PPO Plan
In-Network
Type of Deductible
Embedded
Calendar Year Deductible2 (Individual / Family)
$1,250 / $2,500
Your Coinsurance3
10%
Out-of-Pocket Maximum (Individual / Family)
$5,000 / $10,000
Physician Visit (Primary Care / Specialist)
$20 copay / $50 copay
Preventive Care Services4
Covered 100%
Lab, X-Ray or Other Preventative Tests
Deductible, then coinsurance
Hospital Services
(Inpatient / Outpatient)
Deductible, then coinsurance
Urgent Care Visit
$50 copay
Emergency Room Visit
$300 copay; waived if admitted
Out-of-Network
Calendar Year Deductible2 (Individual / Family)
$5,000 / $10,000
Your Coinsurance3
50%
Out-of-Pocket Maximum (Individual / Family)
$10,000 / $20,000
- When enrolling in a High Deductible Health Plan, all covered services are subject to the deductible except Preventive Care services.
- The deductible year runs on the calendar year, January 1 through December 31.
- The amount you pay after the deductible is reached. Your coinsurance kicks in once the calendar year deductible is met.
- Preventive care services include but are not limited to routine wellness exams, pelvic exams, pap testing, PSA tests, and immunizations. Covers preventive care services rendered in a physician's office and outpatient service centers.
Prescription (Rx) Plan Design
Express Scripts | For more details, please refer to the plan document.
HSA Plan
RETAIL (31-DAY SUPPLY)
Tier 1 - Generic
Deductible, then coinsurance
Tier 2 - Preferred Brand
Deductible, then coinsurance
Tier 3 - Non-Preferred Brand
Deductible, then coinsurance
Tier 4 - Specialty Brand
Deductible, then coinsurance
MAIL ORDER (90-DAY SUPPLY)
Tier 1 - Generic
Deductible, then coinsurance
Tier 2 - Preferred Brand
Deductible, then coinsurance
Tier 3 - Non-Preferred Brand
Deductible, then coinsurance
Tier 4 - Specialty Brand
Deductible, then coinsurance
PPO Plan
RETAIL (31-DAY SUPPLY)
Tier 1 - Generic
$10 copay
Tier 2 - Preferred Brand
$35 copay
Tier 3 - Non-Preferred Brand
$60 copay
Tier 4 - Specialty Brand
$160 copay
MAIL ORDER (90-DAY SUPPLY)
Tier 1 - Generic
$20 copay
Tier 2 - Preferred Brand
$70 copay
Tier 3 - Non-Preferred Brand
$120 copay
Tier 4 - Specialty Brand
N/A
- HDHP Plan: Full medical deductible applies
- PPO Plan: No Deductible
Contribution Rates
Biweekly Pre-Tax Contributions (26 Pay Periods)
Employee Only
HSA Plan
$20.00
PPO Plan
$50.00
Employee & Spouse
HSA Plan
$50.00
PPO Plan
$95.00
Employee & Child(ren)
HSA Plan
$80.00
PPO Plan
$120.00
Employee & Family
HSA Plan
$95.00
PPO Plan
$160.00
Contact the provider of these benefits by calling this phone number or visiting this website: (888) 475-6206, myuhc.com
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This Digital Benefits Guide is intended to highlight available benefits and should not be relied upon to fully determine coverage. The benefits plan may not cover all health care expenses. More complete descriptions of benefits and the terms under which they are provided are contained in the Certificate of Coverage that you will receive upon request. If this Digital Benefits Guide conflicts in any way with the policy issued by the employer, the policy shall prevail.