Page 5 - 2018 Thompson Coburn Enrollment
P. 5
Thompson Coburn
2018 Medical Plan Design
Comparison Chart
Plan POS plan HDP
Feature In-Network Out-of-Network In-Network Out-of-Network
Network UnitedHealthcare Choice Plus POS Network
Deductible (ded.) $750 per person $1,500 per person $2,750 per person $5,500 per person
(per calendar year) $1,500 per family* $3,000 per family* $5,500 per family* $11,000 per family*
Coinsurance 20% of eligible expenses 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
after the ded. the ded. the ded. after the ded.
Out-of-pocket maximum $3,500 per person $7,000 per person $5,500 per person $11,000 per person
(per calendar year: $7,000 per family $14,000 per family $11,000 per family $22,000 per family
includes ded.)
Physician Visits
Primary care $25 copay 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
the ded. the ded. after the ded.
Specialist $35 copay 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
the ded. the ded. after the ded.
Preventive care Plan pays 100% Not covered Plan pays 100% Not covered
Virtual ofice visits $25 copay Not covered 20% of eligible expenses after Not covered
the ded.
Hospital Services
Hospital—inpatient stay $300 copay per stay; 20% 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
of eligible expenses after the ded. the ded. after the ded.
the ded.
Outpatient surgery $200 copay per date of 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
service; 20% of eligible the ded. the ded. after the ded.
expenses after the ded.
Prescription medications—In-Network Coverage Only
You pay the discounted price of the prescription medications You pay the discounted price of the prescription medications
until you reach the combined medical/pharmacy ded.; after until you reach the combined medical/pharmacy ded.; after
the ded. is met you pay 20% of the discounted price until the the ded. is met you pay 20% of the discounted price until
out-of-pocket maximum is met the out-of-pocket maximum is met
Emergencies
Emergency room service $250 per visit $250 per visit 20% of eligible expenses after 20% of eligible expenses
the ded. after the ded.
Urgent care service $75 per visit 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
the ded. the ded. after the ded.
Qualities and Features
Cost Higher medical premium cost but lower ded. Lower medical premium cost but higher ded.
Flexibility to choose Same level of lexibility within the UHC Choice Plus POS network (same network of preferred providers, with the option to
doctors choose providers outside of the network—generally out-of-pocket costs are lower when you use an in-network provider); a
complete list of providers in the UHC network can be found on the UHC website, www.myuhc.com; remember, if you can
choose an in-network provider, you will receive the highest level of beneits under the plan; you can still see a doctor who is
outside the network, but your services will be covered at a lower level of beneits
Control over how Some control More control—you are eligible to have an HSA allowing you
healthcare dollars are to choose how to spend your healthcare dollars
spent
Consumer awareness Some awareness required since you are responsible for More awareness required (for example, research your
expenses that apply to the ded. and out-of-pocket maximum healthcare options to determine the most cost-effective
care since the ded. and out-of-pocket maximums are higher
under the HDP)
Preventive care No cost when in-network providers are utilized
* Both the POS plan and the HDP plan are embedded. This means if you are covering dependent(s) on either plan, only one
person is required to reach the single deductible (or out-of-pocket maximum) before coinsurance is applied for that person.
Note: all ofice visits, urgent care, emergency room, inpatient hospital stay, outpatient surgery copays, and deductibles apply towards the out-of-
pocket maximum. Preventive care does not apply towards the out-of-pocket maximum.
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2018 Medical Plan Design
Comparison Chart
Plan POS plan HDP
Feature In-Network Out-of-Network In-Network Out-of-Network
Network UnitedHealthcare Choice Plus POS Network
Deductible (ded.) $750 per person $1,500 per person $2,750 per person $5,500 per person
(per calendar year) $1,500 per family* $3,000 per family* $5,500 per family* $11,000 per family*
Coinsurance 20% of eligible expenses 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
after the ded. the ded. the ded. after the ded.
Out-of-pocket maximum $3,500 per person $7,000 per person $5,500 per person $11,000 per person
(per calendar year: $7,000 per family $14,000 per family $11,000 per family $22,000 per family
includes ded.)
Physician Visits
Primary care $25 copay 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
the ded. the ded. after the ded.
Specialist $35 copay 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
the ded. the ded. after the ded.
Preventive care Plan pays 100% Not covered Plan pays 100% Not covered
Virtual ofice visits $25 copay Not covered 20% of eligible expenses after Not covered
the ded.
Hospital Services
Hospital—inpatient stay $300 copay per stay; 20% 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
of eligible expenses after the ded. the ded. after the ded.
the ded.
Outpatient surgery $200 copay per date of 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
service; 20% of eligible the ded. the ded. after the ded.
expenses after the ded.
Prescription medications—In-Network Coverage Only
You pay the discounted price of the prescription medications You pay the discounted price of the prescription medications
until you reach the combined medical/pharmacy ded.; after until you reach the combined medical/pharmacy ded.; after
the ded. is met you pay 20% of the discounted price until the the ded. is met you pay 20% of the discounted price until
out-of-pocket maximum is met the out-of-pocket maximum is met
Emergencies
Emergency room service $250 per visit $250 per visit 20% of eligible expenses after 20% of eligible expenses
the ded. after the ded.
Urgent care service $75 per visit 40% of eligible expenses after 20% of eligible expenses after 40% of eligible expenses
the ded. the ded. after the ded.
Qualities and Features
Cost Higher medical premium cost but lower ded. Lower medical premium cost but higher ded.
Flexibility to choose Same level of lexibility within the UHC Choice Plus POS network (same network of preferred providers, with the option to
doctors choose providers outside of the network—generally out-of-pocket costs are lower when you use an in-network provider); a
complete list of providers in the UHC network can be found on the UHC website, www.myuhc.com; remember, if you can
choose an in-network provider, you will receive the highest level of beneits under the plan; you can still see a doctor who is
outside the network, but your services will be covered at a lower level of beneits
Control over how Some control More control—you are eligible to have an HSA allowing you
healthcare dollars are to choose how to spend your healthcare dollars
spent
Consumer awareness Some awareness required since you are responsible for More awareness required (for example, research your
expenses that apply to the ded. and out-of-pocket maximum healthcare options to determine the most cost-effective
care since the ded. and out-of-pocket maximums are higher
under the HDP)
Preventive care No cost when in-network providers are utilized
* Both the POS plan and the HDP plan are embedded. This means if you are covering dependent(s) on either plan, only one
person is required to reach the single deductible (or out-of-pocket maximum) before coinsurance is applied for that person.
Note: all ofice visits, urgent care, emergency room, inpatient hospital stay, outpatient surgery copays, and deductibles apply towards the out-of-
pocket maximum. Preventive care does not apply towards the out-of-pocket maximum.
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