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://uhc.com.

	Network Only Coverage
Member Coinsurance	20%
Deductible (Individual/Family)	$4,000/$8,000
Out-of-Pocket Max (Individual/Family)	$6,500/$13,000
Physician Visits
Primary Care	$0 Copay
Preventive Care	Fully Covered
Virtual Care	$0 Copay
Specialist	$100 Copay
Hospital Services
Inpatient Hospitalization	Deductible + 20%
Physician Services	Deductible + 20%
Outpatient Surgery	Deductible + 20%
Outpatient Diagnostics	Deductible + 20%
Urgent Care	$50 Copay
Emergency Room	Deductible + 20% Coinsurance


* In-network coverage only. Only emergency services available out-of-network ** Using UHC’s Designated Specialist Network

Prescription Drugs
Retail	$15/$45/$85/$200
Mail Order	3x Retail Copay

	Total Rate	Employer Share	Employee Share	Per Pay Period
Employee Only	$434.80	$340.31	$94.49	$43.61
Employee + Spouse	$869.60	$680.62	$188.98	$87.22
Employee + Child(ren)	$826.12	$646.59	$179.53	$82.86
Employee + Family	$1,391.36	$1,088.99	$302.37	$139.56

Downloads

Summary of Benefits

Summary of Benefits - Spanish

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://uhc.com.

	In-Network	Non-Network
Member Coinsurance	20%	50%
Deductible (Individual/Family)	$5,000/$10,000	$10,000/$20,000
Out-of-Pocket Max (Individual/Family)	$6,500/$13,000	$20,000/$40,000
Physician Visits
Primary Care	$0 Copay	Deductible + 50%
Preventive Care	Fully Covered	Deductible + 50%
Virtual Care	$0 Copay	N/A
Specialist	$100 Copay	Deductible + 50%
Hospital Services
Inpatient Hospitalization	Deductible	Deductible + 50%
Physician Services	Deductible	Deductible + 50%
Outpatient Surgery	Deductible	Deductible + 50%
Outpatient Diagnostics	Deductible	Deductible + 50%
Urgent Care	$50 Copay	Deductible + 50%
Emergency Room	Deductible + 20% Coinsurance	Deductible + 20% Coinsurance


* In-network coverage only. Only emergency services available out-of-network ** Using UHC’s Designated Specialist Network

Prescription Drugs
Retail	$15/$45/$85/$200
Mail Order	3x Retail Copay

	Total Premium	Employer Share	Employee Share	Per Pay Period
Employee Only	$531.27	$422.66	$108.61	$50.13
Employee + Spouse	$1,062.54	$845.32	$217.22	$100.26
Employee + Child(ren)	$1,009.42	$803.06	$206.36	$95.24
Employee + Family	$1,700.07	$1,352.52	$347.55	$160.41

Downloads

Summary of Benefits

Summary of Benefits - Spanish

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://uhc.com.

	In-Network	Non-Network
Member Coinsurance	20%	50%
Deductible (Individual/Family)	$2,000/$4,00	$5,000/$10,000
Out-of-Pocket Max (Individual/Family)	$6,000/$12,000	$10,000/$20,000
Physician Visits
Primary Care	$30 Copay	Deductible + 50% $0 Copay for children under 19
Preventive Care	Fully Covered	Deductible + 50%
Virtual Care	$0 Copay	N/A
Specialist	$30 Copay** $60 Copay	Deductible + 50%
Hospital Services
Inpatient Hospitalization	Deductible + 20%	Deductible + 50%
Physician Services	Deductible + 20%	Deductible + 50%
Outpatient Surgery	Deductible + 20%	Deductible + 50%
Outpatient Diagnostics	Deductible + 20%	Deductible + 50%
Urgent Care	$50 Copay	Deductible + 50%
Emergency Room	$250 Copay, then Deductible + 20%	$250 Copay, then Deductible + 20%


* In-network coverage only. Only emergency services available out-of-network ** Using UHC’s Designated Specialist Network

Prescription Drugs
Retail	$15/$45/$85/$200
Mail Order	3x Retail Copay

	Total Rate	Employer Share	Employee Share	Per Pay Period
Employee Only	$618.79	$411.24	$207.55	$95.79
Employee + Spouse	$1,237.58	$822.48	$415.10	$191.58
Employee + Child(ren)	$1,175.70	$781.35	$394.35	$182.01
Employee + Family	$1,980.13	$1,315.97	$664.16	$306.53

Downloads

Summary of Benefits

Summary of Benefits - Spanish

Group Number

542873

Provided By

United Healthcare

Provider Website

https://uhc.com

Customer Service

800.357.0978

Resources

Frequently Asked Questions