Page 5 - 2017 Benefits Enrollment
P. 5
2017 BENEFITS ENROLLMENT
2017 Medical Plan Design
Comparison Chart
Plan POS plan HDP
Feature In-Network Out-of-Network In-Network Out-of-Network
Network UnitedHealthcare Choice Plus POS Network
Deductible $750 per person $1,500 per person $2,750 per person $5,500 per person
(per calendar year) $1,500 per family* $3,000 per family* $5,500 per family* $11,000 per family*
Coinsurance 20% of eligible expenses 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
after the ded .
after the ded .
after the ded .
after the ded .
Out-of-pocket
maximum (per $3,500 per person $7,000 per person $5,500 per person $11,000 per person
calendar year: $7,000 per family $14,000 per family $11,000 per family $22,000 per family
includes ded .)
Physician Visits
Primary care $25 copay 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
after the ded .
after the ded .
after the ded .
Specialist $35 copay 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
after the ded .
after the ded .
after the ded .
Preventive care Plan pays 100% Not covered Plan pays 100% Not covered
Virtual ofice visits $25 copay Not covered 20% of eligible expenses Not covered
after the ded .
Hospital Services
Hospital—inpatient $300 copay per stay; 20% 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
stay of eligible expenses after after the ded . after the ded . after the ded .
ded .
$200 copay per date of 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
Outpatient surgery service; 20% of eligible after the ded . after the ded . after the ded .
expenses after ded .
Prescription medications—In-Network Coverage Only
You pay the discounted price of the prescription You pay the discounted price of the prescription
medications until you reach the combined medical/ medications until you reach the combined medical/
pharmacy ded .; after the ded . is met you pay 20% pharmacy ded .; after the ded . is met you pay 20%
of the discounted price until the out-of-pocket of the discounted price until the out-of-pocket
maximum is met maximum is met
Emergencies
Emergency room $250 per visit $250 per visit 20% of eligible expenses 20% of eligible expenses
service after the ded . after the ded .
Urgent care service $75 per visit 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
after the ded .
after the ded .
after the ded .
Qualities and Features
Cost Higher medical premium cost but lower ded . Lower medical premium cost but higher ded .
Same level of lexibility with the Choice Plus POS network (same network of preferred providers, with the
option to choose providers outside of the network—generally out-of-pocket costs are lower when you use
Flexibility to choose an in-network provider); a complete list of providers in the UHC network can be found on the UHC website,
doctors www .myuhc .com; remember, if you can choose an in-network provider, you will receive the highest level
of beneits under the plan; you can still see a doctor who is outside the network, but your services will be
covered at a lower level of beneits
Control over how More control—you are eligible to have an HSA
healthcare dollars are Some control allowing you to choose how to spend your
spent healthcare dollars
Some awareness required since you are responsible More awareness required (for example, research
Consumer awareness for expenses that apply to the ded . and out-of- your healthcare options to determine the most cost-
effective care since the ded . and out-of-pocket
pocket maximum maximums are higher under the HDP)
Preventive care No cost when in-network providers are utilized
* Both the POS plan and the HDP plan are embedded. This means if you are covering dependent(s) on either plan, only one
person is required to reach the single deductible (or out-of-pocket maximum) before coinsurance is applied for that person.
Note: all ofice visit, urgent care, emergency room, inpatient hospital stay, outpatient surgery copays,
and deductibles apply towards the out-of-pocket maximum .
Thompson Coburn LLP 5
2017 Medical Plan Design
Comparison Chart
Plan POS plan HDP
Feature In-Network Out-of-Network In-Network Out-of-Network
Network UnitedHealthcare Choice Plus POS Network
Deductible $750 per person $1,500 per person $2,750 per person $5,500 per person
(per calendar year) $1,500 per family* $3,000 per family* $5,500 per family* $11,000 per family*
Coinsurance 20% of eligible expenses 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
after the ded .
after the ded .
after the ded .
after the ded .
Out-of-pocket
maximum (per $3,500 per person $7,000 per person $5,500 per person $11,000 per person
calendar year: $7,000 per family $14,000 per family $11,000 per family $22,000 per family
includes ded .)
Physician Visits
Primary care $25 copay 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
after the ded .
after the ded .
after the ded .
Specialist $35 copay 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
after the ded .
after the ded .
after the ded .
Preventive care Plan pays 100% Not covered Plan pays 100% Not covered
Virtual ofice visits $25 copay Not covered 20% of eligible expenses Not covered
after the ded .
Hospital Services
Hospital—inpatient $300 copay per stay; 20% 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
stay of eligible expenses after after the ded . after the ded . after the ded .
ded .
$200 copay per date of 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
Outpatient surgery service; 20% of eligible after the ded . after the ded . after the ded .
expenses after ded .
Prescription medications—In-Network Coverage Only
You pay the discounted price of the prescription You pay the discounted price of the prescription
medications until you reach the combined medical/ medications until you reach the combined medical/
pharmacy ded .; after the ded . is met you pay 20% pharmacy ded .; after the ded . is met you pay 20%
of the discounted price until the out-of-pocket of the discounted price until the out-of-pocket
maximum is met maximum is met
Emergencies
Emergency room $250 per visit $250 per visit 20% of eligible expenses 20% of eligible expenses
service after the ded . after the ded .
Urgent care service $75 per visit 40% of eligible expenses 20% of eligible expenses 40% of eligible expenses
after the ded .
after the ded .
after the ded .
Qualities and Features
Cost Higher medical premium cost but lower ded . Lower medical premium cost but higher ded .
Same level of lexibility with the Choice Plus POS network (same network of preferred providers, with the
option to choose providers outside of the network—generally out-of-pocket costs are lower when you use
Flexibility to choose an in-network provider); a complete list of providers in the UHC network can be found on the UHC website,
doctors www .myuhc .com; remember, if you can choose an in-network provider, you will receive the highest level
of beneits under the plan; you can still see a doctor who is outside the network, but your services will be
covered at a lower level of beneits
Control over how More control—you are eligible to have an HSA
healthcare dollars are Some control allowing you to choose how to spend your
spent healthcare dollars
Some awareness required since you are responsible More awareness required (for example, research
Consumer awareness for expenses that apply to the ded . and out-of- your healthcare options to determine the most cost-
effective care since the ded . and out-of-pocket
pocket maximum maximums are higher under the HDP)
Preventive care No cost when in-network providers are utilized
* Both the POS plan and the HDP plan are embedded. This means if you are covering dependent(s) on either plan, only one
person is required to reach the single deductible (or out-of-pocket maximum) before coinsurance is applied for that person.
Note: all ofice visit, urgent care, emergency room, inpatient hospital stay, outpatient surgery copays,
and deductibles apply towards the out-of-pocket maximum .
Thompson Coburn LLP 5
