MEDICAL AND PHARMACY COVERAGE
JBC Contractors offers the following plans through UnitedHealthCare.
Insurance Carrier:
UnitedHealthCare Medical Insurance
Medical Plan:
Plan Option 1
Plan Option 2
In-Network: Primary Care Visits Specialist Care Visits
$25 Copay $75 Copay $50 Copay
$25 Copay $75 Copay $50 Copay
Urgent Care
Emergency Room Care
Deductible; then $300 Copay
Deductible; then $300 Copay
Preventative Care Visit
$0
$0
Plan Coinsurance
100%
100%
Employee Deductible Family Deductible
$3,000 $6,000
$5,000 $10,000
Employee Out-of-Pocket Max Family Out-of-Pocket Max
$5,500 (includes deductible) $11,000 (includes deductible)
$8,150 (includes deductible) $16,300 (includes deductible)
Inpatient Hospital
Deductible; then 0% Coinsurance
Deductible; then 0% Coinsurance
Outpatient Hospital or Facility
Deductible; then 0% Coinsurance
Deductible; then 0% Coinsurance
Out-of-Network: Plan Coinsurance
50%
50%
Employee Deductible Family Deductible
$6,000 $12,000 $11,000 $22,000
$10,000 $20,000 $16,300 $32,600
Employee Out-of-Pocket Max Family Out-of-Pocket Max
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$10 Copay $35 Copay $75 Copay
$10 Copay $35 Copay $75 Copay
Tier 2 - Preferred
Tier 3 - Non-Preferred
Tier 4 - Specialty
$250 / $500 Copay
$250 / $500 Copay
Employee Weekly Deduction Employee Only
$78.97 $290.15 $251.76 $462.94
$52.39 $234.33 $201.25 $383.19
Employee + Spouse Employee + Child(ren)
Family
4 | JBC Contractors 2024 Benefits Guide
Made with FlippingBook - professional solution for displaying marketing and sales documents online