Page 4 - 2022 OCFJSD Benefits Guide

Health Insurance

YOUR MEDICAL PLAN
Is with United Healthcare

IN/OUT-OF-NETWORK COVERAGE
Your medical plan features in- and out-of-network coverage;
individual and family deductibles; copays; coinsurance; and
out-of-pocket maximums. If you don’t understand some of
these terms, please refer to the Glossary on page 16.

You may use in- or out-of-network providers. You will always
pay less if you see a doctor or receive services within the
provider network because the plan pays more for “in-network
services.”

DEDUCTIBLE
You must meet a calendar year annual deductible before the
medical plan begins to cover a portion of your costs. Once the
deductible is met, the medical plan begins to pay for a
percentage of covered expenses (this is called coinsurance).

OUT-OF-POCKET MAXIMUMS
Out-of-pocket maximums apply to all of the plans. This is the
maximum amount you will pay for health care costs in a
calendar year. Once you have reached the out-of-pocket
maximum, the plan will fully cover eligible medical expenses
for the rest of the benefits plan year (except for any
copayments). If you see an out-of-network provider, you may
be responsible for out-of-pocket costs that are considered
above the “reasonable and customary” fees.

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