Page 12 - Brady Corporation 2021 Annual Benefits Florida

2021

Medical Plan Details

UnitedHealthcare UnitedHealthcare
Medical Plan Details Preferred Provider Organization (PPO) High Deductible Health Plan (HDHP)
In-Network Out-of-Network In-Network Out-of-Network
Calendar Year Deductible
Individual $750 $1,500 $1,500 $3,000
Family $1,500 $3,000 $3,000 $6,000
Out-of-Pocket Maximum (includes deductible)
Individual $3,500 $7,000 $4,500 $9,000
Family $7,000 $14,000 $9,000 $18,000
Physician Oice Visits
Preventive Care Covered at 100% 50% after deductible Covered at 100% 50% after deductible
Primary Care Visit 20% after deductible 50% after deductible 15% after deductible 50% after deductible

Urgent Care $50 copay per visit and $50 copay per visit and 15% after deductible 15% after deductible
20% after deductible
20% after deductible
Hospital Services
$250 copay per admission 50% coinsurance per 15% coinsurance per 50% coinsurance per
Inpatient and 20% coinsurance admission after deductible admission after deductible admission after deductible
after deductible

Emergency Room $150 copay and 20% after $150 copay and 20% after 15% after deductible 15% after deductible
deductible
deductible
Prescription Drugs
Generic 20% after deductible* 20% coinsurance* 15% coinsurance 15% coinsurance
Preferred Brand 30% after deductible* 30% coinsurance* 15% coinsurance 15% coinsurance
Formulary
Non-Preferred 40% after deductible* 40% coinsurance* 15% coinsurance 15% coinsurance
Brand Formulary
Mail Order
Generic 20% after deductible* 20% coinsurance* 15% coinsurance 15% coinsurance
Preferred Brand 30% after deductible* 30% coinsurance* 15% coinsurance 15% coinsurance
Formulary
Non-Preferred 40% after deductible* 40% coinsurance* 15% coinsurance 15% coinsurance
Brand Formulary
Specialty Specialty medications are covered under the above Specialty medications are covered under the above
categories, depending on the speciic drug
categories, depending on the speciic drug
*$100 individual deductible, $200 family deductible applies
This is a high level summary of your beneit coverage. Full coverage details are available in your summary plan description (SPD). In the event there is
a discrepancy between what is relected in this guide and what is communicated in your SPD, the terms of your SPD will prevail.

Employee Monthly Medical Contributions

UnitedHealthcare PPO UnitedHealthcare HDHP
Monthly Cost
You Pay Brady Pays You Pay Brady Pays
Employee Only $211.78 $493.00 $113.17 $580.43
Employee and Spouse $480.66 $1,001.68 $265.98 $1,188.54
Employee and Child(ren) $334.36 $929.63 $173.95 $1,078.59
Family $649.08 $1,590.18 $343.14 $1,811.54

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