Page 6 - NH Non NC Guide
P. 6
Medical and Pharmacy Insurance
For many of us, nothing is more important than our health and the health of our family members. The
importance of having health insurance should not be dismissed or underestimated. Medical and pharmacy
insurance can help you avoid or limit some of these costs and it can also help you develop and maintain a
healthier lifestyle.
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.
The medical plan deductible and out-of-pocket maximum will run through December 31, 2016 and will restart
again on January 1, 2017. 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 apply to the out-of-pocket maximum.
6
New Hire Guide
For many of us, nothing is more important than our health and the health of our family members. The
importance of having health insurance should not be dismissed or underestimated. Medical and pharmacy
insurance can help you avoid or limit some of these costs and it can also help you develop and maintain a
healthier lifestyle.
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.
The medical plan deductible and out-of-pocket maximum will run through December 31, 2016 and will restart
again on January 1, 2017. 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 apply to the out-of-pocket maximum.
6
New Hire Guide
