Page 496 - outbind://23/

MEDICAL PLAN CHANGE HIGHLIGHTS

Effective August 01, 2019

CURRENT PLAN RENEWAL PLAN
HMO 1
UnitedHealthcare UnitedHealthcare
Advantage Platinum 20-40/30% (AV- Advantage Platinum 20-40/20% (BH-GY)
MB)
Deductible In Net $0 $0
PC/Specialist In Net $20/$40 $20/$40
Co-Insurance In Net 30% 20%
OOP Limit In Net $2,500 $3,000
Inpatient Hospital In 30% 20%
Net
Rx Generic In Net $15 $15
Rx Preferred In Net $35 $35
Rx Non-Preferred In $50 $70
Net

CURRENT PLAN RENEWAL PLAN
HMO2
UnitedHealthcare UnitedHealthcare
Advantage Gold 30-50/30% (AV-MC) Advantage Gold 30-60/20%/250ded (BH-
G2)
Deductible In Net $0 $250
PC/Specialist In Net $30/$50 $30/$60
Co-Insurance In Net 30% 20%
OOP Limit In Net $5,500 $6,000 (incl ded)
Inpatient Hospital In 30% 20% after ded
Net
Rx Generic In Net $15 $15 ded waived
Rx Preferred In Net $35 $40 after $250
Rx Non-Preferred In $70 $80 after $250
Net

6
© 2006-2009, 2011-2018 Zywave, Inc. All rights reserved.