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MEDICAL PLAN CHANGE HIGHLIGHTS

Effective August 01, 2020

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

CURRENT PLAN RENEWAL PLAN
HMO2
UnitedHealthcare UnitedHealthcare
Advantage Gold 30-60/20%/250ded (BH- Advantage Gold 30-60/1000d (BH-GZ)
G2)
Deductible In Net $250 $0
PC/Specialist In Net $30/$60 $30/$60
Co-Insurance In Net 20% 20%
OOP Limit In Net $6,000 (incl ded) $6,000 (incl ded)
Inpatient Hospital In Net 20% after ded $1,000/day; 4 days/admt
Rx Generic In Net $15 ded waived $15 ded waived
Rx Preferred In Net $40 after $250 $40 after $250
Rx Non-Preferred In Net $80 after $250 $80 after $250

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