Page 5 - 2016 Enrollment
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Medical Plan Options Glossary
Premium: The amount you contribute
UHC Account-based Plans each month from your paycheck for
insurance coverage.
Let’s take a look at the key features of each plan. Deductible: A set dollar amount
you have to pay for your healthcare
Health Reimbursement High Deductible Health Plan
Arrangement with HSA expenses before the company starts
Out-of-
Out-of-
In-Network Network In-Network Network to share costs with you. Deductibles
vary by plan and by coverage levels.
Calendar Year Deductible Coinsurance: Once you’ve satisied
Individual $1,750 $3,500 $3,000 $6,000
Family $3,500 $7,000 $6,000 $12,000 the deductible, this is a set percentage
Coinsurance 80% 60% 80% 60% of the remaining costs which are your
Out-of-Pocket Includes Deductible Includes Deductible responsibility, until you reach your out-
Maximum of-pocket max.
Individual (Union) $2,800 $5,600 $6,000 $12,000
Family (Union) $5,600 $11,200 $12,000 $24,000 Copay: A set dollar amount you pay
Preventive care 100% Not available 100% Not available for services every time you use them.
Ofice Visit Copay Out of pocket max: Generally, the
Primary care $30 copay Ded/60% Ded/80% Ded/60% most you can spend on healthcare for
physician
Specialist $60 copay Ded/60% Ded/80% Ded/60% the year, not including your monthly
Emergency room $200 copay; $200 copay; Ded/80% Ded/80% premiums.
Ded/80% Ded/80% HRA: A Health Reimbursement
Urgent care $60 copay Ded/60% Ded/80% Ded/60% Arrangement includes an account
Virtual visits $20 copay Not available Ded/80% Not available
Prescription Drugs that the company establishes for
Pharmacy Out-of-Pocket Maximum you. HRAs do not accept employee
Individual $3,100 N/A Pharmacy expenses are contributions.
included in your medical out of HSA: A Health Savings Account is
Family $6,200 N/A pocket maximum a personal bank account you own
Retail (30-day supply) and is used to pay for qualiied
Tier 1 $10 copay $10 copay Ded/80% Ded/60% medical expenses. Whatever money
Tier 2 $30 copay $30 copay Ded/80% Ded/60%
Tier 3 $60 copay $60 copay Ded/80% Ded/60% you contribute or accumulate is
Tier 4 $90 copay $90 copay Ded/80% Ded/60% yours for life. Employees can make
Mail Order or Retail (90-day supply) contributions to the account up to
Tier 1 $20 copay Ded/80% the allowed maximum contribution
Tier 2 $60 copay Not available Ded/80% Not available limits. The IRS contribution limits for
Tier 3 $120 copay Ded/80% 2016 are $3,350 for individuals and
Tier 4 Not available Not available $6,750 for families. These funds can
be withdrawn at any time to cover
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits, qualiied medical expenses as deined
limitations, and exclusions. In the event of a conlict between the SPD and this description, the by the IRS.
terms of the SPD will prevail.
2016 New Hire Enrollment
Medical Plan Options Glossary
Premium: The amount you contribute
UHC Account-based Plans each month from your paycheck for
insurance coverage.
Let’s take a look at the key features of each plan. Deductible: A set dollar amount
you have to pay for your healthcare
Health Reimbursement High Deductible Health Plan
Arrangement with HSA expenses before the company starts
Out-of-
Out-of-
In-Network Network In-Network Network to share costs with you. Deductibles
vary by plan and by coverage levels.
Calendar Year Deductible Coinsurance: Once you’ve satisied
Individual $1,750 $3,500 $3,000 $6,000
Family $3,500 $7,000 $6,000 $12,000 the deductible, this is a set percentage
Coinsurance 80% 60% 80% 60% of the remaining costs which are your
Out-of-Pocket Includes Deductible Includes Deductible responsibility, until you reach your out-
Maximum of-pocket max.
Individual (Union) $2,800 $5,600 $6,000 $12,000
Family (Union) $5,600 $11,200 $12,000 $24,000 Copay: A set dollar amount you pay
Preventive care 100% Not available 100% Not available for services every time you use them.
Ofice Visit Copay Out of pocket max: Generally, the
Primary care $30 copay Ded/60% Ded/80% Ded/60% most you can spend on healthcare for
physician
Specialist $60 copay Ded/60% Ded/80% Ded/60% the year, not including your monthly
Emergency room $200 copay; $200 copay; Ded/80% Ded/80% premiums.
Ded/80% Ded/80% HRA: A Health Reimbursement
Urgent care $60 copay Ded/60% Ded/80% Ded/60% Arrangement includes an account
Virtual visits $20 copay Not available Ded/80% Not available
Prescription Drugs that the company establishes for
Pharmacy Out-of-Pocket Maximum you. HRAs do not accept employee
Individual $3,100 N/A Pharmacy expenses are contributions.
included in your medical out of HSA: A Health Savings Account is
Family $6,200 N/A pocket maximum a personal bank account you own
Retail (30-day supply) and is used to pay for qualiied
Tier 1 $10 copay $10 copay Ded/80% Ded/60% medical expenses. Whatever money
Tier 2 $30 copay $30 copay Ded/80% Ded/60%
Tier 3 $60 copay $60 copay Ded/80% Ded/60% you contribute or accumulate is
Tier 4 $90 copay $90 copay Ded/80% Ded/60% yours for life. Employees can make
Mail Order or Retail (90-day supply) contributions to the account up to
Tier 1 $20 copay Ded/80% the allowed maximum contribution
Tier 2 $60 copay Not available Ded/80% Not available limits. The IRS contribution limits for
Tier 3 $120 copay Ded/80% 2016 are $3,350 for individuals and
Tier 4 Not available Not available $6,750 for families. These funds can
be withdrawn at any time to cover
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits, qualiied medical expenses as deined
limitations, and exclusions. In the event of a conlict between the SPD and this description, the by the IRS.
terms of the SPD will prevail.
2016 New Hire Enrollment
