Page 4 - 2025 Texas Flood LLP - Benefit Guide

Medical Options:

Assured Benefit Administrators (ABA)

ABA 6000 (UHC PPO Network)
Effective: 1/1/2025
Bi-Weekly Rates We offer our full-time employees and
their eligible dependents coverage.
Employee Only $ 90.16 Children can join or remain on a
parent’s medical plan until age 26.
Employee + Spouse $427.38 When a child turns 26, they will lose
medical coverage on the last day of
Employee + Child $265.51 their birth month.
Employee + Family $584.76

Assured Benefit Administrators (ABA)
Brief Member
(UHC PPO Choice Network)
In-Network Summary In Network Benefits

Network UHC PPO Network
(CYD) Calendar Year Deductible Individual: $6,000
(Jan .1st to Dec. 31st) Family: $12,000
Coinsurance Carrier 80%
(After CYD Calendar Year Deductible) Member: 20%
Individual: $7,500
Annual (OOP) Out of Pocket Maximum
Family: $15,000
(PCP) Primary Care Physician (Dr. Services Only) $40 Copay

Specialist Physicians and Providers $75 Copay
(Dr. Services Only)

Dr. Consultation - Virtual Visits, $0 Copay
powered by Lyric Virtual Visit Service (See Pg. 6) *When using the Lyric Virtual Visit Service (See Pg. 6)

Basic: Lab, X-Rays & Diagnostic Basic: 20%; No CYD
Major: Diagnostic & Imaging Major: 20% after CYD
Annual Preventive Care Covered 100%
(See Pg. 5 for a list of covered services) (No CYD, Co-Ins. Copays)

$75 (Dr. Services Only)
Urgent Care
(CYD apply to other services)
Emergency Room $250 Copay plus 20% after CYD

Hospitalization: In Patient: 20% after CYD
In Patient/ Outpatient Outpatient: 20% after CYD

Tier 1: $10 Copay
Tier 2: $45 Copay
Prescription Drugs
Tier 3: $150 Copay
31 Day Supply Retail
Specialty: *Specialty medications as specified by the VersusRX Specialty Medication List are
90 Day Supply Mail Order(2.5 Times Retail cost)
not a standard covered benefit. See page 8 for more information)

NOTE: This is only a brief overview. Please see Benefit Summary and policy for more details.
Website: www.ABA.com or Customer Service: 888-400-9304
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