MEDICAL COVERAGE
Page Scrantom offers the following plans through UnitedHealthcare.
Insurance Carrier:
UnitedHealthcare Medical Insurance
Medical Plan:
$2,000 Copay Plan
$5,000 HDHP Plan
In-Network: Primary Care Visits
$25 Copay
Deductible met; then $0 Copay
Specialist Care Visits
$75 Copay
Deductible met; then $0 Copay
Urgent Care
$50 Copay
Deductible met; then $0 Copay
Emergency Room Care
$300 copay; then 20% Coinsurance
Deductible met; then $0 Copay
Preventative Visit Copay
$0
Deductible met; then $0 Copay
Diagnostic Testing (X-Ray / Blood Work)
20% Coinsurance
Deductible met; then $0 Copay
Advanced Imaging
20% Coinsurance
Deductible met; then $0 Copay
Plan Coinsurance
20%
100%
Employee Deductible
$2,000
$5,000
Family Deductible
$4,000
$10,000
Employee Out-of-Pocket Max
$5,000
$5,000
Family Out-of-Pocket Max
$10,000
$10,000
Inpatient Hospital
20% Coinsurance
Deductible met; then $0 Copay
Outpatient Hospital or Facility
20% Coinsurance
Deductible met; then $0 Copay
Out-of-Network Plan Coinsurance
50%
50%
Employee Deductible
$4,000
$10,000
Family Deductible
$8,000
$20,000
Employee Out-of-Pocket Max
$10,000
$20,000
Family Out-of-Pocket Max
$20,000
$40,000
Prescription Drugs 30-day supply Tier 1 - Generic
$10 Copay
Deductible met; then $0 Copay
Tier 2 - Preferred
$35 Copay
Deductible met; then $0 Copay
Tier 3 - Non-Preferred
$75 Copay
Deductible met; then $0 Copay
Tier 4 - Specialty
$250 Copay
Deductible met; then $0 Copay
4 | Page Scrantom 2025 Benefits Guide
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