Page 5 - 2015 NISC Open Enrollment
P. 5
2015 Open Enrollment
Medical
Medical
NISC offers a Consumer Driven Health Plan, which combines a High
Deductible Health Plan (HDHP) and a tax-advantaged Health Savings NISC values the health
Account (HSA). The HDHP, providing medical and prescription drug and wellness of its
coverage, is administered by UnitedHealthcare (UHC). The HSA is provided employees, and is
through U.S. Bank (see pages 7-8). committed to providing
benefits to meet their
The medical plan allows you to see the healthcare provider of your choice, needs.
although your out-of-pocket cost is reduced when you see providers who are
part of the UHC Preferred Provider Organization (PPO) network.
z Preventive care is covered at 100% UHC Health Plan
To check physician participation:
z Preventive prescriptions are available at a three-tier copay rate z www.myuhc.com
z All other expenses go towards the deductible z Under Links and Tools
z Once deductible is met, the plan pays 80% of the cost of eligible in- section, select Find Physician,
network medical services and prescription drug are available for a copay Laboratory, or Facility
z Coverage for dependent children extends through the end of the month z Select UnitedHealthcare
Choice Plus plan
in which they turn 26 z Fill in search criteria
Employee Employee +1 Family UHC Prescription Drug
Premium $0.00 $0.00 $0.00 Plan
Deductible $2,000 $4,000 (1) $4,000 (1) To check pharmacy participation
Maximum Out-of- $4,000 $8,000 (2) $8,000 (2)
Pocket or view prescription drug list:
(1) Includes an individual deductible limit of $2,600 z www.myuhc.com
(2) Includes an individual out-of-pocket maximum limit of $6,400
z Under Links and Tools section,
select Pharmacy Information
z Scroll down for Prescription
Drug List options
5
Medical
Medical
NISC offers a Consumer Driven Health Plan, which combines a High
Deductible Health Plan (HDHP) and a tax-advantaged Health Savings NISC values the health
Account (HSA). The HDHP, providing medical and prescription drug and wellness of its
coverage, is administered by UnitedHealthcare (UHC). The HSA is provided employees, and is
through U.S. Bank (see pages 7-8). committed to providing
benefits to meet their
The medical plan allows you to see the healthcare provider of your choice, needs.
although your out-of-pocket cost is reduced when you see providers who are
part of the UHC Preferred Provider Organization (PPO) network.
z Preventive care is covered at 100% UHC Health Plan
To check physician participation:
z Preventive prescriptions are available at a three-tier copay rate z www.myuhc.com
z All other expenses go towards the deductible z Under Links and Tools
z Once deductible is met, the plan pays 80% of the cost of eligible in- section, select Find Physician,
network medical services and prescription drug are available for a copay Laboratory, or Facility
z Coverage for dependent children extends through the end of the month z Select UnitedHealthcare
Choice Plus plan
in which they turn 26 z Fill in search criteria
Employee Employee +1 Family UHC Prescription Drug
Premium $0.00 $0.00 $0.00 Plan
Deductible $2,000 $4,000 (1) $4,000 (1) To check pharmacy participation
Maximum Out-of- $4,000 $8,000 (2) $8,000 (2)
Pocket or view prescription drug list:
(1) Includes an individual deductible limit of $2,600 z www.myuhc.com
(2) Includes an individual out-of-pocket maximum limit of $6,400
z Under Links and Tools section,
select Pharmacy Information
z Scroll down for Prescription
Drug List options
5
