Page 8 - 2022 Benefits Resource Guide

Medical, vision & pharmacy benefits

The company’s medical plan is self-funded, which means when you incur
a medical expense, the company pays for your health care services. If
you are a wise consumer of medical care, it will save money for both you
and the company.
The medical plan is a Choice Plus PPO, which means you will have access
to a network of physicians and facilities which have agreed to provide
services at negotiated rates. You can search for an in-network provider
at myuhc.com, by using UnitedHealthcare’s mobile app, or by calling
UnitedHealthcare’s customer service at (866) 414-1959.

Medical benefits summary
Benefit Description In-Network Out-of-Network
Preventive care office visits $0 copay

Virtual office visits (General) $0 copay

Mental health virtual office visit $20 copay 40% after deductible
Primary physician office visits $20 copay

Specialist physician office visits $45 copay
Surgical procedures performed in physician’s office 20% after deductible

Primary physicians are family and general practitioners, internal medicine physicians, pediatricians, and
obstetricians/gynecologists. All other physicians are Specialists.
Individual / Family calendar year deductible $750 / $2,250 $1,500 / $4,500

Copays do not accumulate toward the deductible. In-network deductible Out-of-network deductible
does not apply toward does apply toward
out-of-network deductible. in-network deductible
Benefit for non-copayment services 20% after deductible 40% after deductible
Individual / Family out-of-pocket maximum $3,000 / $7,000 $7,500 / $22,500
per calendar year
Out of pocket maximum includes medical, pharmacy copays and deductible. After the maximum has been
reached, the Plan pays 100% of covered expenses incurred during the rest of the calendar year.
Maximum lifetime benefit Unlimited

Second medical opinion service
2nd MD is a free resource available to all medical plan participants.
If you are dealing with a medical issue or if you are considering surgery,
this resource allows you to receive a second medical opinion from
world-class leading doctors. 2nd MD takes care of collecting your medical
records and connecting you with the right doctor to review your health
issue. This resource may lead you to a better medical outcome and
help save you money. See the benefit contacts section for how to
contact 2nd MD.

Employee Benefits Guide 5