Medical and Pharmacy Coverage
Neel, Robinson & Stafford offers the following Medical plans through United HealthCare and offers “in and out-of-network” benefits. Insurance Carrier:
United HealthCare Medical Insurance
Medical Plan:
P2000i80LXES21B
HPVV5000ES22B
In-Network: Office Visit Copay - Primary Care
$25
Deductible; then 0% Coinsurance
Office Visit Copay - Specialist Care
$75
Deductible; then 0% Coinsurance
Urgent Care Copay
$50
Deductible; then 0% Coinsurance
Emergency Room Care
$300 Copay; then Deductible + Coinsurance
Deductible; then 0% Coinsurance
Preventative Visit Copay
$0
$0
Diagnostic Testing & Blood Work
Deductible; then 20% Coinsurance
Deductible; then 0% Coinsurance
Advanced Imaging
Deductible; then 20% Coinsurance
Deductible; then 0% Coinsurance
Plan Coinsurance
80%
100%
Employee Deductible
$2,000
$5,000
Family Deductible
$4,000
$10,000
Employee Out-of-Pocket Max
$5,000 (includes deductible)
$5,000 (includes deductible)
Family Out-of-Pocket Max
$10,000 (includes deductible)
$10,000 (includes deductible)
Inpatient Hospital
Deductible; then 20% Coinsurance
Deductible; then 0% Coinsurance
Outpatient Hospital or Facility
Deductible; then 20% Coinsurance
Deductible; then 0% Coinsurance
Out-of-Network: 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; then 0% Coinsurance
Brand Deductible
$0
Paid Under Medical
Tier 2 - Preferred
$35 Copay
Deductible; then 0% Coinsurance
Tier 3 - Non-Preferred
$75 Copay
Deductible; then 0% Coinsurance
Tier 4 - Specialty
$250 Copay
Deductible; then 0% Coinsurance
Semi-Monthly Rates:
Employee Only
$92.51
$53.64
Employee + Spouse
$392.26
$310.63
Employee + Child(ren)
$337.76
$263.91
Family
$637.51
$520.90
4 NEEL, ROBINSON & STAFFORD 2024 BENEFITS GUIDE
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