HOW THE MEDICAL PLANS WORK
STARTING WITH THE BASICS (KEY TERMS)
Deductible : When enrolled in the medical coverage you are a UHC member. As a member you receive their discounted rate for all medical services and prescription drugs with their network providers. This discount is typically 50%-70% off the amount charged to someone without insurance. You are responsible for the discounted rate on all medical services and/or prescriptions subject to the deductible Coinsurance: is cost-sharing. You and UHC sharing in the cost for service subject to the deductible after you have met the deductible. The medical summary chart reflects each medical plans coinsurance amount, this is the percent of cost you're responsible for once you’ve met the deductible, UHC is responsible for the reminder.
Copayment: (aka Copay) – A flat fee that you pay for medical services or prescriptions.
Out of Pocket Maximum is the maximum amount you will pay in deductible costs, coinsurance and copays during the policy year.
EMBEDDED V.S. NON-EMBEDDED
On an Embedded plan no one individual would be responsible for more than the individual deductible and no family would exceed more than the family deductible collectively.
On a Non-Embedded plan the family deductible can be met by one individual or the family collectively.
HEALTH SAVINGS ACCOUNT (H.S.A.)
When you’re enrolled in a qualified High Deductible Health Plan (HDHP) you and you employer can contribute to your H.S.A account. What are the perks?
• Your contributions are pre-tax . • Money rolls over year to year, you never lose it. • It’s owned by you . The account and money in it are your’s to keep whether you retire, come off the group plan, or leave. • It’s easy to use ! Optum Health Bank sends you a H.S.A card when you open an account. The card is just like a debit card, simply swipe the card when you want to use the funds.
Maximum Contribution Limits* 2016 2017
Single Coverage
$3,350
$3,400
Family Coverage $6,650
$6,750
* Individuals who are age 55 or older may contribute an additional $1,000 per year .
ELIGIBLE EXPENSES
• Alcohol & drug dependency treatment • Artificial Teeth • Acupuncture & Chiropractic services
• Hearing aids & batteries for use • Hospital, Surgical, lab & X-Ray fees • Long-term care (expenses & premiums) & Nursing home • Physical & speech therapies • Smoking-cessation programs & products
• Dental expenses (exams, X-rays, root canals, bridges, etc.) • Diagnostic devices (blood sugar test kits for diabetics) • Prescription drugs • Eyeglasses, exams, laser eye surgery, Contact lenses & solution
• Vasectomy • Wheelchairs • Etc.
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