Page 4 - Future Steps

Medical

Medical coverage is provided by UnitedHealthcare. Eligible employees will continue
to have the choice between two medical plans—the Traditional Plan and the High
Deductible Health Plan. Each plan utilizes the UnitedHealthcare Choice Plus
network.

Please review the beneit details of your plan options before deciding which plan is
best for you.

UnitedHealthcare UnitedHealthcare
Qualified High Deductible Health Plan—
Traditional PPO HSA
In-Network Out-of-Network In-Network Out-of-Network
Lifetime Unlimited Unlimited
Maximum
Calendar Year Deductible
Embedded Non-Embedded
Individual $1,000 $2,000 $2,500 $5,000
Family $2,000 $4,000 $5,000 $10,000
Out-of-pocket Includes embedded deductibles, Includes non-embedded deductibles,
maximum coinsurance, and copays coinsurance, and prescription copays
Individual $3,500 $5,000 $4,000 $8,000
Family $7,000 $10,000 $8,000 $16,000
Physician Office Visits
Primary care $25 copay 50% after 20% after 50% after
deductible deductible deductible
Specialist $50 copay 50% after 20% after 50% after
deductible deductible deductible
Urgent care $75 copay 50% after 20% after 50% after
deductible deductible deductible
Preventive Care Services
Covered at 100% 50% after Covered at 100% 50% after
deductible deductible
Hospital Services
Inpatient 20% after 50% after 20% after 50% after
deductible deductible deductible deductible
Outpatient 20% after 50% after 20% after 50% after
To find an In-Network provider deductible deductible deductible deductible
or hospital, please visit Emergency $200 copay $200 copay 20% after 20% after
www.myuhc.com. When Room deductible deductible
asked to select a network,
choose UnitedHealthcare
Choice Plus.

4 Electric Power Systems