Page 10 - National General 2021 Annual Benefits Enrollment

UHC Medical Plan Comparison

UnitedHealthcare Choice Plus PPO Plan

Benefit In-Network Out-of-Network
Benefit Period Calendar Year
Deductible (individual/family) $1,000/$2,000 $2,000/$4,000

Coinsurance 20% after deductible 40% after deductible
Out-of-Pocket Maximums (individual/family) $4,500/$13,500 $9,000/$27,000
Lifetime Maximum Unlimited
Preventive Care No cost 40% after deductible
Physician Office Visits $25 copay 40% after deductible

Specialist Office Visit $50 copay 40% after deductible
Emergency Room $250 copay
Urgent Care $50 copay 40% after deductible

Therapy (physical, speech, occupational) $50 copay 40% after deductible
Diagnostic Services 20% after deductible 40% after deductible
Inpatient Hospital Services 20% after deductible 40% after deductible
Outpatient Services 20% after deductible 40% after deductible
Prescription Drugs
Optum Rx
Tier 1: $5 copay
Retail Tier 2: 25% coinsurance to a $250 maximum
(up to a 31-day supply) Tier 3 and Tier 4: 50% coinsurance
to a $250 maximum
Tier 1: $10 copay
Mail Order Tier 2: 25% coinsurance to a $500 maximum
(90-day supply) Tier 3 and Tier 4: 50% coinsurance
to a $500 maximum
Out-of-Pocket Maximum Accumulates to medical out-of-pocket maximums

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