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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 that have agreed to provide services at
negotiated rates.
You can search for an in-network provider at myuhc.com, by using UHC’s
mobile app (Health4Me), or by calling UnitedHealthcare’s customer service.

Medical benefits summary

Benefit Description In-Network Out-of-Network
Preventive care office visits $0 copay
Virtual office visits through UnitedHealthcare $0 copay

Mental health virtual office visit $20 copay

Primary physician office visits $20 copay 40% after deductible
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 In-network deductible does Out-of-network deductible
deductible. not apply toward out-of- does apply toward in-
network deductible. network deductible
Benefit for non-copayment services 20% after deductible 40% after deductible
Individual / Family out-of-pocket maximum per $3,000 / $7,000 $7,500 / $22,500
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

Employee Benefits Guide 5