2018 AAPL Benefits Guide

MEDICAL INSURANCE

AAPL offers two medical plans through United Healthcare. To find participating providers go to www.myuhc.com and click on “Find a Doctor”. On the following screen select “All United Healthcare Plans.” Select either “Choice HMO” or “Choice”, depending on which plan you are interested in. See chart below for network per plan. Complete the remaining information and click Search.

The chart below provides a brief overview of the medical plans. This chart is intended only to highlight the benefits available and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is suggested that you review your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage.

HMO Plan Choice AUXC

PPO Plan Choice AUW4

IN-NETWORK

Choice HMO

Choice PPO

Deductible (Individual / Family)

$3,500 / $7,000

$2,000 / $4,000

Maximum Out-of-Pocket (Individual / Family)

$7,350 / $14,700

$4,000 / $8,000

Deductible, Coinsurance, & Copays

Deductible, Coinsurance, & Copays

Out-of-Pocket Max Includes

Coinsurance

80% / 20%

90% / 10%

Routine Preventive Services

Wellness

Immunizations

Covered 100%

Covered 100%

Mammography/Colonoscopy

Office Visits & Facility Services

Referral required

No

No

PCP Office Visits

$40 Copay

$25 Copay

Specialist Visits

$80 Copay

$50 Copay

Inpatient Hospital

20% after deductible

10% after deductible

Outpatient Surgery

20% after deductible

10% after deductible

Emergency Room

20% after deductible

$250 copay

Urgent Care

20% after deductible

$50 copay

OUTPATIENT DIAGNOSTIC SERVICES

Lab Services (Freestanding Lab)

20% after deductible

10% after deductible

X-Ray Services (Freestanding Lab)

20% after deductible

10% after deductible

Complex Diagnostic

20% after deductible

10% after deductible

PRESCRIPTIONS

Retail (30 day supply)

$10 / $35 / $60

$10 / $35 / $60

Mail Order (90 day supply)

2.5x retail

2.5x retail

OUT-OF-NETWORK

Deductible

Maximum Out-of-Pocket

Not Available

Not Available

Coinsurance

3

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