What comes out of my pay?How much will I pay out of my own pocket?What is Traeger contributing?What will I pay after I meet my deductible?Will my doctor be in-network?
Plan Options: Traditional Copay Plan or High Deductible Health Plan
You’ve built a trusting relationship and you want to keep it. But, did you know that you can also save money by using an in-network provider? You can confirm whether your doctor is in-network by going to the UnitedHealthcare website.
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Medical Plans |
Regence BlueCross BlueShield
Traditional Copay Plan
Preferred BlueOption (PBO) or FocalPoint Network
Traditional Copay Plan
Preferred BlueOption (PBO) or FocalPoint Network
Regence BlueCross BlueShield
High Deductible Health Plan (HDHP)
Preferred BlueOption (PBO) or FocalPoint Network
High Deductible Health Plan (HDHP)
Preferred BlueOption (PBO) or FocalPoint Network
In-Network
Out-of-Network
In-Network
Out-of-Network
Annual Deductible
You pay up to
$1,000 per individual
$3,000 per family
$1,000 per individual
$3,000 per family
You pay up to
$2,000 per individual
$6,000 per family
$2,000 per individual
$6,000 per family
You pay up to
$1,500 per individual
$3,000 per family
$1,500 per individual
$3,000 per family
You pay up to
$3,000 per individual
$6,000 per family
$3,000 per individual
$6,000 per family
Accumulator Period
January 1 – December 31
January 1 – December 31
January 1 – December 31
January 1 – December 31
Coinsurance
You pay
20% AD
20% AD
You pay
40% AD
40% AD
You pay
20% AD
20% AD
You pay
50% AD
50% AD
Out-of-pocket Maximum
No more than
$3,000 per individual
$6,000 per family
$3,000 per individual
$6,000 per family
No more than
$6,000 per individual
$12,000 per family
$6,000 per individual
$12,000 per family
No more than
$3,000 per individual
$6,000 per family
$3,000 per individual
$6,000 per family
No more than
$6,000 per individual
$12,000 per family
$6,000 per individual
$12,000 per family
Preventive Services
You pay $0 according to government guidelines
You pay
40% AD
40% AD
You pay $0 according to government guidelines
You pay
50% AD
50% AD
Office Visits
Primary Care
Specialist
Primary Care
Specialist
You pay
$20 copay
$40 copay
$20 copay
$40 copay
You pay
40% AD
40% AD
40% AD
40% AD
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
50% AD
50% AD
50% AD
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
You pay
$20 copay
20% AD
$20 copay
20% AD
You pay
40% AD
40% AD
40% AD
40% AD
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
50% AD
50% AD
50% AD
Emergency Services
Urgent Care
Emergency Room
Ambulance
Urgent Care
Emergency Room
Ambulance
You pay
$40 copay
$200 copay + 20% AD
20% AD
$40 copay
$200 copay + 20% AD
20% AD
You pay
40% AD
Covered as In-Network
Covered as In-Network
40% AD
Covered as In-Network
Covered as In-Network
You pay
20% AD
20% AD
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
Covered as In-Network
Covered as In-Network
50% AD
Covered as In-Network
Covered as In-Network
Inpatient & Outpatient
Inpatient Hospital
Outpatient Surgery
Inpatient Hospital
Outpatient Surgery
You pay
20% AD
20% AD
20% AD
20% AD
You pay
40% AD
40% AD
40% AD
40% AD
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
50% AD
50% AD
50% AD
Generic / Preferred / Non-preferred / Specialty
Generic / Preferred / Non-preferred
Prescription Medication
Retail (30-day supply)
Mail Order (90-day supply)
Retail (30-day supply)
Mail Order (90-day supply)
You pay
$15 / $35 / $65 / $100
Up to2.5x Retail
$15 / $35 / $65 / $100
Up to2.5x Retail
You pay
40% AD
40% AD
40% AD
40% AD
You pay
$10 AD / $35 AD / $60 AD
Up to2.5x Retail
$10 AD / $35 AD / $60 AD
Up to2.5x Retail
You pay
50% AD
50% AD
50% AD
50% AD
Health Care Account
Flexible Spending Account (FSA)
Health Savings Account (HSA)
AD: After Deductible
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
Preferred BlueOption (PBO)
FocalPoint Network
Traditional Copay Plan
High Deductible Health Plan (HDHP)
Traditional Copay Plan
High Deductible Health Plan (HDHP)
Employee (EE) Only
$43.20
$36.83
$31.52
$29.03
EE + Spouse
$119.12
$101.55
$91.15
$79.35
EE + Child(ren)
$93.22
$79.05
$67.05
$58.56
EE + Family
$171.27
$146.15
$134.35
$117.35
Regence BlueCross BlueShield
Traditional Copay Plan
Preferred BlueOption (PBO) Network
Traditional Copay Plan
Preferred BlueOption (PBO) Network
Regence BlueCross BlueShield
High Deductible Health Plan (HDHP)
Preferred BlueOption (PBO) Network
High Deductible Health Plan (HDHP)
Preferred BlueOption (PBO) Network
In-Network
Out-of-Network
In-Network
Out-of-Network
Annual Deductible
You pay up to
$1,000 per individual
$3,000 per family
$1,000 per individual
$3,000 per family
You pay up to
$2,000 per individual
$6,000 per family
$2,000 per individual
$6,000 per family
You pay up to
$1,500 per individual
$3,000 per family
$1,500 per individual
$3,000 per family
You pay up to
$3,000 per individual
$6,000 per family
$3,000 per individual
$6,000 per family
Accumulator Period
January 1 – December 31
January 1 – December 31
January 1 – December 31
January 1 – December 31
Coinsurance
You pay
20% AD
20% AD
You pay
40% AD
40% AD
You pay
20% AD
20% AD
You pay
50% AD
50% AD
Out-of-pocket Maximum
No more than
$3,000 per individual
$6,000 per family
$3,000 per individual
$6,000 per family
No more than
$6,000 per individual
$12,000 per family
$6,000 per individual
$12,000 per family
No more than
$3,000 per individual
$6,000 per family
$3,000 per individual
$6,000 per family
No more than
$6,000 per individual
$12,000 per family
$6,000 per individual
$12,000 per family
Preventive Services
You pay $0 according to government guidelines
You pay
40% AD
40% AD
You pay $0 according to government guidelines
You pay
50% AD
50% AD
Office Visits
Primary Care
Specialist
Primary Care
Specialist
You pay
$20 copay
$40 copay
$20 copay
$40 copay
You pay
40% AD
40% AD
40% AD
40% AD
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
50% AD
50% AD
50% AD
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
You pay
$20 copay
20% AD
$20 copay
20% AD
You pay
40% AD
40% AD
40% AD
40% AD
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
50% AD
50% AD
50% AD
Emergency Services
Urgent Care
Emergency Room
Ambulance
Urgent Care
Emergency Room
Ambulance
You pay
$40 copay
$200 copay + 20% AD
20% AD
$40 copay
$200 copay + 20% AD
20% AD
You pay
40% AD
Covered as In-Network
Covered as In-Network
40% AD
Covered as In-Network
Covered as In-Network
You pay
20% AD
20% AD
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
Covered as In-Network
Covered as In-Network
50% AD
Covered as In-Network
Covered as In-Network
Inpatient & Outpatient
Inpatient Hospital
Outpatient Surgery
Inpatient Hospital
Outpatient Surgery
You pay
20% AD
20% AD
20% AD
20% AD
You pay
40% AD
40% AD
40% AD
40% AD
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
50% AD
50% AD
50% AD
Generic / Preferred / Non-preferred / Specialty
Generic / Preferred / Non-preferred
Prescription Medication
Retail (30-day supply)
Mail Order (90-day supply)
Retail (30-day supply)
Mail Order (90-day supply)
You pay
$15 / $35 / $65 / $100
Up to2.5x Retail
$15 / $35 / $65 / $100
Up to2.5x Retail
You pay
40% AD
40% AD
40% AD
40% AD
You pay
$10 AD / $35 AD / $60 AD
Up to2.5x Retail
$10 AD / $35 AD / $60 AD
Up to2.5x Retail
You pay
50% AD
50% AD
50% AD
50% AD
Health Care Account
Flexible Spending Account (FSA)
Health Savings Account (HSA)
AD: After Deductible
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
Preferred BlueOption (PBO)
Traditional Copay Plan (PPO)
High Deductible Health Plan (HDHP)
Employee (EE) Only
$43.20
$36.83
EE + Spouse
$119.12
$101.55
EE + Child(ren)
$93.22
$79.05
EE + Family
$171.27
$146.15
This information is designed to help you choose a benefit plan for 2024 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations, and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
