Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
UHC PPO Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,000
Rx Deductible (Individual/Family)
$100/$300
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
$0
Primary Care Visit
$25
Specialist Visit
$40
Urgent Care
$50
Emergency Room
$200
Retail Rx (Up to 31-Day Supply)
Generic
$15**
Preferred Brand
$35**
Non-Preferred Brand
$75**
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$37.50**
Preferred Brand
$87.50**
Non-Preferred Brand
$187.50**
Specialty
Not covered
* After deductible
** After Rx deductible
Out-of-Network
Deductible (Individual/Family)
$2,000/$4,000
Rx Deductible (Individual/Family)
Combined with In-Network
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
$0
Primary Care Visit
40%*
Specialist Visit
40%*
Urgent Care
40%*
Emergency Room
$200
Retail Rx (Up to 31-Day Supply)
Generic
$15**
Preferred Brand
$35**
Non-Preferred Brand
$75**
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Per-Pay-Period Plan Cost
Earnings Under $49,999
Employee Only: $105.64
Employee and Spouse: $337.20
Employee and Child(ren): $281.00
Employee and Family: $489.74
Earnings Between $50,000 – $99,999
Employee Only: $116.20
Employee and Spouse: $354.94
Employee and Child(ren): $295.79
Employee and Family: $528.40
Earnings Greater Than $100,000
Employee Only: $126.77
Employee and Spouse: $354.94
Employee and Child(ren): $310.57
Employee and Family: $567.06
UHC EPO Plan
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$2,000/$4,000
Rx Deductible (Individual/Family)
$100/$300
Out-of-Pocket Max (Individual/Family)
$5,500/$11,000
Preventive Care
$0
Primary Care Visit
$30
Specialist Visit
$50
Urgent Care
$50
Emergency Room
$200
Retail Rx (Up to 31-Day Supply)
Generic
$15**
Preferred Brand
$30**
Non-Preferred Brand
$50**
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$37.50**
Preferred Brand
$75**
Non-Preferred Brand
$125**
Specialty
Not covered
* After deductible
** After Rx deductible
Per-Pay-Period Plan Cost
Earnings Under $49,999
Employee Only: $66.01
Employee and Spouse: $256.43
Employee and Child(ren): $213.69
Employee and Family: $372.43
Earnings Between $50,000 – $99,999
Employee Only: $74.26
Employee and Spouse: $277.22
Employee and Child(ren): $231.02
Employee and Family: $412.70
Earnings Greater Than $100,000
Employee Only: $66.01
Employee and Spouse: $277.22
Employee and Child(ren): $242.57
Employee and Family: $442.89
UHC HSA Plan
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$5,000/$6,850
Preventive Care
$0
Primary Care Visit
20%*
Specialist Visit
20%*
Urgent Care
20%*
Emergency Room
20%*
Retail Rx (Up to 31-Day Supply)
Generic
$15*
Preferred Brand
$35*
Non-Preferred Brand
$75*
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$37.50*
Preferred Brand
$87.50*
Non-Preferred Brand
$187.50*
Specialty
Not covered
* After deductible
** After Rx deductible
Per-Pay-Period Plan Cost
Earnings Under $49,999
Employee Only: $40.05
Employee and Spouse: $180.24
Employee and Child(ren): $150.20
Employee and Family: $261.78
Earnings Between $50,000 – $99,999
Employee Only: $45.78
Employee and Spouse: $216.29
Employee and Child(ren): $180.24
Employee and Family: $366.49
Earnings Greater Than $100,000
Employee Only: $48.64
Employee and Spouse: $276.37
Employee and Child(ren): $200.27
Employee and Family: $383.94