Page 5 - Yaskawa Motoman Robotics 2022 Benefits Guide
P. 5
2022
Benefits Guide
Medical and Prescription Drug Plans
Yaskawa Motoman Robotics will continue to ofer our medical health insurance through UnitedHealthcare.
The program provides eligible Employees access to a national network of healthcare providers who meet
stringent credentialing standards. You will not need a referral from your primary doctor to see a specialist in
the network.
A Side-by-Side Comparison of Your Health Coverage Options
2022 Plan Design High Deductible Plan (CDHP) Standard Plan
Network Non-Network Network Non-Network
Annual Deductible
Individual $2,800 $4,500 $1,500 $4,500
Family $5,000 $9,000 $3,000 $9,000
Out-of-Pocket Maximum (includes deductible and medical copays)
Individual $4,000 $5,500 $3,500 $11,500
Family $8,000 $11,000 $7,000 $23,000
Medical Beneits
Preventive Oice Visit Covered in full 30% coverage* Covered in full 50% coverage*
Primary Physician Oice Visit 15% coverage* 30% coverage* $30 50% coverage*
$50 ($25 if premium
Specialist Physician Oice Visit 15% coverage* 30% coverage* 50% coverage*
designated provider)
Urgent Care 15% coverage* 30% coverage* $75 50% coverage*
Emergency Room Care 15% coverage $300
Outpatient Lab and X-Ray in 15% coverage* 30% coverage* Dependent on billing 50% coverage*
Doctor’s Oice
Outpatient Imaging 15% coverage* 30% coverage* 20% coverage* 50% coverage*
(CT/PET scans, MRIs)
Outpatient Surgery 15% coverage* 30% coverage* 20% coverage* 50% coverage*
Inpatient Hospital Care 15% coverage* 30% coverage* 20% coverage* 50% coverage*
This is a listing of the most commonly used beneits. For a complete listing of covered procedures, view the actual plan documents. Contact your HR
Department for copies. The annual deductible and out-of-pocket maximums are calculated on a calendar year basis. The out-of-pocket maximum
includes the deductible. Copayments, coinsurance, and deductibles accumulate towards the out-of-pocket maximum.
* After deductible is met.
Prescription Drug Plan For Medical Plan Participants
2022 Plan High Deductible Standard Plan Yaskawa Motoman Robotics has a mail-order
Design Plan (CDHP)
Prescription Out-of-Pocket Maximums prescription drug program, OptumRx Mail Service,
Prescription Combined with Individual: $3,100 which will deliver a three-month supply (90-day
Out-of-Pocket medical out-of- supply) of routine maintenance drugs to your
Maximums pocket Family: $6,200
Prescription Drug Retail (31-day supply) home for less than the cost of illing at a retail
Tier 1 $10 pharmacy. To enroll in the mail order program
Tier 2 Medical deductible $25 for the irst time, you should request a new
Tier 3 and out-of-pocket $60
apply 30% coinsurance with a 12-month supply prescription from your physician
Tier 4
maximum of $250 and submit it with the mail order form available
Prescription Drug Mail Order (90-day supply) on www.optumrx.com or call 855.856.0541.
Tier 1 $25
Tier 2 Medical deductible $87.50
Tier 3 and out-of-pocket $150
apply 30% coinsurance with a
Tier 4
maximum of $250
5
Benefits Guide
Medical and Prescription Drug Plans
Yaskawa Motoman Robotics will continue to ofer our medical health insurance through UnitedHealthcare.
The program provides eligible Employees access to a national network of healthcare providers who meet
stringent credentialing standards. You will not need a referral from your primary doctor to see a specialist in
the network.
A Side-by-Side Comparison of Your Health Coverage Options
2022 Plan Design High Deductible Plan (CDHP) Standard Plan
Network Non-Network Network Non-Network
Annual Deductible
Individual $2,800 $4,500 $1,500 $4,500
Family $5,000 $9,000 $3,000 $9,000
Out-of-Pocket Maximum (includes deductible and medical copays)
Individual $4,000 $5,500 $3,500 $11,500
Family $8,000 $11,000 $7,000 $23,000
Medical Beneits
Preventive Oice Visit Covered in full 30% coverage* Covered in full 50% coverage*
Primary Physician Oice Visit 15% coverage* 30% coverage* $30 50% coverage*
$50 ($25 if premium
Specialist Physician Oice Visit 15% coverage* 30% coverage* 50% coverage*
designated provider)
Urgent Care 15% coverage* 30% coverage* $75 50% coverage*
Emergency Room Care 15% coverage $300
Outpatient Lab and X-Ray in 15% coverage* 30% coverage* Dependent on billing 50% coverage*
Doctor’s Oice
Outpatient Imaging 15% coverage* 30% coverage* 20% coverage* 50% coverage*
(CT/PET scans, MRIs)
Outpatient Surgery 15% coverage* 30% coverage* 20% coverage* 50% coverage*
Inpatient Hospital Care 15% coverage* 30% coverage* 20% coverage* 50% coverage*
This is a listing of the most commonly used beneits. For a complete listing of covered procedures, view the actual plan documents. Contact your HR
Department for copies. The annual deductible and out-of-pocket maximums are calculated on a calendar year basis. The out-of-pocket maximum
includes the deductible. Copayments, coinsurance, and deductibles accumulate towards the out-of-pocket maximum.
* After deductible is met.
Prescription Drug Plan For Medical Plan Participants
2022 Plan High Deductible Standard Plan Yaskawa Motoman Robotics has a mail-order
Design Plan (CDHP)
Prescription Out-of-Pocket Maximums prescription drug program, OptumRx Mail Service,
Prescription Combined with Individual: $3,100 which will deliver a three-month supply (90-day
Out-of-Pocket medical out-of- supply) of routine maintenance drugs to your
Maximums pocket Family: $6,200
Prescription Drug Retail (31-day supply) home for less than the cost of illing at a retail
Tier 1 $10 pharmacy. To enroll in the mail order program
Tier 2 Medical deductible $25 for the irst time, you should request a new
Tier 3 and out-of-pocket $60
apply 30% coinsurance with a 12-month supply prescription from your physician
Tier 4
maximum of $250 and submit it with the mail order form available
Prescription Drug Mail Order (90-day supply) on www.optumrx.com or call 855.856.0541.
Tier 1 $25
Tier 2 Medical deductible $87.50
Tier 3 and out-of-pocket $150
apply 30% coinsurance with a
Tier 4
maximum of $250
5
