Page 9 - P&A Group Benefits Enrollments Guide

Employee Cost for Medical

Employee Bi-Weekly Deductions

Employee Employee & Employee & Employee &
Only Spouse Child(ren) Family

Core H.S.A
$106.15 $233.53 $161.35 $329.07
Plan

Buy Up Plan $136.87 $301.11 $208.04 $424.29

Note: This is a different
UHC Virtual Visits program from My Ideal
Doctor. You can connect
with a doctor from your
mobile device or computer
24/7. Doctors can diagnose and treat a wide range of non-emergency medical conditions and
even write a prescription. And, the cost of a Virtual Visit is typically lower than being treated at
a doctor’s office, urgent care center or emergency room.* A $15 co-pay per visit applies. The
per visit co-pay does not apply to you deductible. For the AJ-PM HSA plan , the member will
pay a contracted rate of $40 per virtual visit until the deductible is met. Once the deductible is
met for the Core HSA plan the member will pay $15
per virtual visit. This added benefit provided by UHC
will not interfere with your utilization of My Ideal United Healthcare Health4me
SM
Doctor. Mobile App
 Download out Health4Me mobile app
to your Apple or Android smartphone
or tablet and see how easy it is to:
 Find nearby physicians
 Check the status of a claim
 See your account balance
 Speak directly with a nurse
 Pull up an image of your health plan
ID card if it’s not in your wallet.

*Access to virtual visits and prescription services may not be available in all states or for all groups. Prescription services may not be available in all states. Go to
myuhc.com for more information about availability of virtual visits and prescription services. Always refer to your plan documents for your specific coverage and
costs. Virtual visits are not an insurance product, health care provider or a health plan. Virtual visits are an internet based service provided by contracted
UnitedHealthcare providers that allow members to select and interact with independent physicians and other health care providers. It is the member’s
responsibility to select health care professionals. Care decisions are between the consumer and physician. Virtual visits are not intended to address emergency or
life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times or in all locations. Members have cost
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share responsibility and all claims are adjudicated according to the terms of the member’s benefit plan. Payment for virtual visit services does not cover pharmacy

charges; members must pay for prescriptions (if any) separately. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates.
Administrative services provided by United HealthCare Services, Inc. or their affiliates.