MEDICAL PLAN
MEDICAL PLAN
Following is a high-level overview of the coverage available. For complete coverage details, please refer to the Summary Plan Description (SPD).
HSA-Eligible Health Plan The High-Deductible Health Plan (HDHP) gives you the freedom to seek care from the provider of your choice. You will maximize your benefits & reduce your out-of-pocket costs if you choose a provider who participates in the network. In addition, the HDHP comes with a health savings account (HSA) that allows you to save pre-tax dollars* to pay for any qualified health care expenses as defined by the IRS, including most out-of-pocket medical, prescription drug, dental & vision expenses. For a complete list of qualified health care expenses, visit www.irs.gov/pub/irs-pdf/p502.pdf. We are proud to offer you a medical plan that provides comprehensive medical & prescription drug coverage. The plan also offers many resources & tools to help you maintain a healthy lifestyle. Following is a brief description of this plan.
Plan Feature
In-Network *Out-of-Network HSA Choice Plus Advanced Plan - January 1, 2024 Metal Level: Silver
Deductible Single
$3,200 $6,000
$5,000 $10,000
Deductible Family (Embedded)
Coinsurance
80%
60%
Out-of-Pocket Maximum Single Out-of-Pocket Maximum Family
$5,000 $7,500
$7,500 $15,000
Preventive Care
100% No Deductible
Deductible & Coinsurance
Office Visit
Premium Tier 1 – 100% after deductible All Other Providers – Deductible & Coinsurance
Deductible & Coinsurance
Here’s how the plan works:
I mportant: Your contributions, in addition to the company’s contributions, may not exceed the annual IRS limits listed below.
▶ Annual Deductible: You must meet the entire annual deductible before the plan starts to pay for non-preventive medical & prescription drug expenses. NOTE: If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible. ▶ Coinsurance: Once you’ve met the plan’s annual deductible,you are responsible for a percentage of your medical expenses, which is called coinsurance. For example, the plan may pay 80 percent & you may pay 20 percent. ▶ Out-of-Pocket Maximum: Once your deductible & coinsurance add up to the plan’s annual out-of-pock- et maximum, the plan will pay 100 percent of all eligible covered services for the rest of the calendar year. NOTE: If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met. ▶ Health Savings Account (HSA): You may contribute to your HSA through pre-tax payroll deductions to help offset your annual deductible and pay for qualified health care expenses. In addition, you will have the opportunity to earn up to $1,000 annually for your HSA by completing various wellness activities submitted through UHC Rewards. To be eligible for the HSA, you cannot be covered through Medicare Part A or Part B programs. See the plan documents for full details.
Telehealth (UHC Network Physician) Virtual Visit- Amwell, Doctors on Demand, Optum Virtual Care, & Teladoc / $49 per Call
Deductible & Coinsurance Deductible & Coinsurance
Deductible & Coinsurance Deductible & Coinsurance
HSA Contribution Limit
2023 2024 $3,850 $4,150 $7,750 $8,300 $1,000 $1,000
Advocate4Me
No Cost – call the customer care number on the back of your UHC ID Card (1-800-846-4678) or visit myuhc.com Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance
Employee Only
Family (employee + 1 or more)
Convenience Care Inpatient Hospital Outpatient Hospital Emergency Room
Catch-up (age 55+)
Your HSA is yours for life. The money is yours to spend or save, regardless of whether you change health plans**, retire or leave the company. There is no “use it or lose it” rule. Your account grows tax-free over time as you continue to roll over unused dollars from year to year. You decide how or if you want to spend your HSA funds. You can use them to pay for you & your dependents’ doctor’s visits, prescriptions, braces, glasses— even laser vision correction surgery. * Tax free under federal tax law; state taxation rules may apply ** You must be enrolled in a qualified health plan to contribute to an HSA.
$250 copay after deductible
Urgent Care
Deductible & Coinsurance Deductible & Coinsurance Deductible** & Coinsurance **Deductible waived for prescriptions identified on UHC’s list of preventive medications Some prescriptions may require prior authorization
Prescription Drug Coverage
Tier
Medical Monthly Premiums
$135.73 $267.83 $256.35 $411.48
Employee Only
Employee + Spouse Employee + Child(ren)
The Affordable Care Act does not require employers to provide health insurance for the spouse of an employee. Therefore, we provide medical coverage for your legally married spouse who does not have access to group health insurance coverage through another employer.
EMPLOYEE PREMIUMS Your monthly medical payroll deductions before taxes.
Family
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