Page 8 - Non-NC OE Guide
P. 8
Medical and Pharmacy Insurance
For many of us, nothing is more important than our health and the
Your medical plan contributions are
based on completion of the Health Risk health of our family members. The importance of having health
Assessment (HRA). Employees need to insurance should not be dismissed or underestimated. Medical and
complete the HRA in order to receive pharmacy insurance can help you avoid or limit some of these costs
the discounted HRA medical plan and it can also help you develop and maintain a healthier lifestyle.
premiums. Please complete the HRA
through Healthcheck360.
UnitedHealthcare (UHC)
UnitedHealthcare (UHC) insures our comprehensive medical plan.
UHC’s network offers exceptional access to in-network providers and deep discounts on services. This results in
lower costs to you and our plan. It is highly recommended you verify all associated providers are participating in
the UHC network. This helps you avoid incurring any unexpected out-of-network charges and ensures the most
cost effective use of your health plan. Items bolded below have changed for the 2015–16 plan year.
PPO Plan PPO Plan
In-Network Out-of-Network
Plan Year Deductible
Individual deductible * $2,000 $4,000
Family deductible * $4,000 $8,000
Plan Year Out-of-Pocket Maximum
Individual out-of-pocket maximum ** $5,000 $9,000
Family out-of-pocket maximum $9,000 $17,000
Wellness Care
Preventive care 100% 50% after deductible
Ofice Visits
Primary care visits 80% after deductible 50% after deductible
Specialist visits 80% after deductible 50% after deductible
Hospital
Inpatient services 80% after deductible 50% after deductible
Outpatient services 80% after deductible 50% after deductible
Emergency room 80% after deductible 80% after deductible
Urgent care 80% after deductible 50% after deductible
Pharmacy
Retail supply limit 31 days
Tier 1 $10 copay $10 copay
Tier 2 $35 copay $35 copay
Tier 3 $60 copay $60 copay
Mail order supply limit 90 days
Tier 1 $25 copay Not covered
Tier 2 $87.50 copay Not covered
Tier 3 $150 copay Not covered
* Employees will be responsible for paying the irst $500 for individual coverage and $1,000 for family coverage
before the HRA pays. MG + BW will continue to fund the HRA at the same level and will pay $1,000 in claims
which apply toward the deductible for individual coverage and $2,500 for family coverage, regardless of
whether the claims are in-network or out-of-network.
** Prescription copays will apply to the out-of-pocket maximum.
8
2015 Open Enrollment
For many of us, nothing is more important than our health and the
Your medical plan contributions are
based on completion of the Health Risk health of our family members. The importance of having health
Assessment (HRA). Employees need to insurance should not be dismissed or underestimated. Medical and
complete the HRA in order to receive pharmacy insurance can help you avoid or limit some of these costs
the discounted HRA medical plan and it can also help you develop and maintain a healthier lifestyle.
premiums. Please complete the HRA
through Healthcheck360.
UnitedHealthcare (UHC)
UnitedHealthcare (UHC) insures our comprehensive medical plan.
UHC’s network offers exceptional access to in-network providers and deep discounts on services. This results in
lower costs to you and our plan. It is highly recommended you verify all associated providers are participating in
the UHC network. This helps you avoid incurring any unexpected out-of-network charges and ensures the most
cost effective use of your health plan. Items bolded below have changed for the 2015–16 plan year.
PPO Plan PPO Plan
In-Network Out-of-Network
Plan Year Deductible
Individual deductible * $2,000 $4,000
Family deductible * $4,000 $8,000
Plan Year Out-of-Pocket Maximum
Individual out-of-pocket maximum ** $5,000 $9,000
Family out-of-pocket maximum $9,000 $17,000
Wellness Care
Preventive care 100% 50% after deductible
Ofice Visits
Primary care visits 80% after deductible 50% after deductible
Specialist visits 80% after deductible 50% after deductible
Hospital
Inpatient services 80% after deductible 50% after deductible
Outpatient services 80% after deductible 50% after deductible
Emergency room 80% after deductible 80% after deductible
Urgent care 80% after deductible 50% after deductible
Pharmacy
Retail supply limit 31 days
Tier 1 $10 copay $10 copay
Tier 2 $35 copay $35 copay
Tier 3 $60 copay $60 copay
Mail order supply limit 90 days
Tier 1 $25 copay Not covered
Tier 2 $87.50 copay Not covered
Tier 3 $150 copay Not covered
* Employees will be responsible for paying the irst $500 for individual coverage and $1,000 for family coverage
before the HRA pays. MG + BW will continue to fund the HRA at the same level and will pay $1,000 in claims
which apply toward the deductible for individual coverage and $2,500 for family coverage, regardless of
whether the claims are in-network or out-of-network.
** Prescription copays will apply to the out-of-pocket maximum.
8
2015 Open Enrollment
