Medical and Pharmacy Coverage
Page Scrantom offers the following plans through UnitedHealthcare and offers “in and out-of- network” benefits.
Insurance Carrier:
UnitedHealthcare Medical Insurance
Medical Plan:
$2,000 Copay Plan
$5,000 HDHP Plan
In-Network: Office Visit Copay - Primary Care
$25 Copay $75 Copay $50 Copay
Deductible met; then $0 Copay Deductible met; then $0 Copay Deductible met; then $0 Copay Deductible met; then $0 Copay Deductible met; then $0 Copay Deductible met; then $0 Copay Deductible met; then $0 Copay
Office Visit Copay - Specialist Care
Urgent Care Copay
Emergency Room Care
$300 Copay; then 20% Coinsurance
Preventative Visit Copay
No Copay
Diagnostic Testing (X-Ray / Blood Work)
20% Coinsurance 20% Coinsurance
Advanced Imaging
Coinsurance
20%
100%
Employee Deductible
$2,000 $4,000 $5,000 $10,000
$5,000
Family Deductible
$10,000
Employee Out-of-Pocket Max
$5,000
Family Out-of-Pocket Max
$10,000
Inpatient Hospital
20% Coinsurance 20% Coinsurance
Deductible met; then $0 Copay Deductible met; then $0 Copay
Outpatient Hospital or Facility
Out-of-Network: Coinsurance
50%
50%
Employee Deductible
$4,000 $8,000 $10,000 $20,000
$10,000 $20,000 $20,000 $40,000
Family Deductible
Employee Out-of-Pocket Max
Family Out-of-Pocket Max
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$10 $35 $75
Deductible met; then $0 Copay Deductible met; then $0 Copay Deductible met; then $0 Copay Deductible met; then $0 Copay
Tier 2 - Preferred
Tier 3 - Non-Preferred
Tier 4 - Specialty
$250
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PAGE SCRANTOM 2024 BENEFITS GUIDE
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