What comes out of my pay?How much will I pay out of my own pocket?What is Crumbl Cookies contributing?What will I pay after I meet my deductible?Will my doctor be in-network?
Network Options: Choice Plus
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? That’s why you will be able to choose a provider network that is right for you and your family’s health and wellbeing.
(866) 414-1959 | myuhc.com
 |
Medical Plans |
Traditional $1,500 Copay Plan
With this Traditional $1,500 PPO Plan you will only have access to the Choice Plus Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with UnitedHealthcare to see if your provider is in the Choice Plus Network so that you can take advantage of greater discounts on care for you and your family.
With this Traditional $1,500 PPO Plan you will only have access to the Choice Plus Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with UnitedHealthcare to see if your provider is in the Choice Plus Network so that you can take advantage of greater discounts on care for you and your family.
TRADITIONAL $1,500 COPAY PLAN
CHOICE PLUS NETWORK
CHOICE PLUS NETWORK
In-Network
Out-of-Network*
Annual Deductible
Embedded
June 1 — May 31
Embedded
June 1 — May 31
You pay up to
$1,500 per individual
$1,500 per member / $3,000 per family
$1,500 per individual
$1,500 per member / $3,000 per family
You pay up to
$3,000 per individual
$3,000 per member / $6,000 per family
$3,000 per individual
$3,000 per member / $6,000 per family
Coinsurance
You pay 10% AD
You pay 50% AD
Out-of-pocket Maximum
Embedded
June 1 — May 31
Embedded
June 1 — May 31
No more than
$4,500 per individual
$4,500 per member / $9,000 per family
$4,500 per individual
$4,500 per member / $9,000 per family
No more than
$10,000 per individual
$10,000 per member / $20,000 per family
$10,000 per individual
$10,000 per member / $20,000 per family
Preventive Services
You pay
$0 according to government guidelines
$0 according to government guidelines
You pay
50% AD
50% AD
Office Visits
Primary Care
Specialist
UHC Telemedicine
Primary Care
Specialist
UHC Telemedicine
You pay
$30 copay
$30 copay
Covered 100%
$30 copay
$30 copay
Covered 100%
You pay
50% AD
50% AD
Not Covered
50% AD
50% AD
Not Covered
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
You pay
$30 copay
10% AD
$30 copay
10% AD
You pay
50% AD
50% AD
50% AD
50% AD
Emergency Services
Urgent Care
Emergency Room
Urgent Care
Emergency Room
You pay
$75 copay
$250 copay
$75 copay
$250 copay
You pay
50% AD
Covered as In-Network
50% AD
Covered as In-Network
Inpatient & Outpatient
Inpatient Hospital
Outpatient Surgery
Inpatient Hospital
Outpatient Surgery
You pay
10% AD
10% AD
10% AD
10% AD
You pay
50% AD
50% AD
50% AD
50% AD
Prescription Medication
Tier 1 / Tier 2 / Tier 3
Retail (30-day supply)
Mail Order (90-day supply)
Mail Order (90-day supply)
You pay $10 / $35 / $70
You pay up to 2.5x retail
You pay up to 2.5x retail
AD: After Deductible
* Providers may charge more than the plan allows when you receive services out-ofnetwork. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2023-2024 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.
* Providers may charge more than the plan allows when you receive services out-ofnetwork. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2023-2024 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.
Traditional $2,000 Copay Plan
With this Traditional $2,000 PPO Plan you will only have access to the Choice Plus Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with UnitedHealthcare to see if your provider is in the Choice Plus Network so that you can take advantage of greater discounts on care for you and your family.
With this Traditional $2,000 PPO Plan you will only have access to the Choice Plus Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with UnitedHealthcare to see if your provider is in the Choice Plus Network so that you can take advantage of greater discounts on care for you and your family.
TRADITIONAL $2,000 COPAY PLAN
CHOICE PLUS NETWORK
CHOICE PLUS NETWORK
In-Network
Out-of-Network*
Annual Deductible
Embedded
June 1 — May 31
Embedded
June 1 — May 31
You pay up to
$2,000 per individual
$2,000 per member / $4,000 per family
$2,000 per individual
$2,000 per member / $4,000 per family
You pay up to
$4,000 per individual
$4,000 per member / $8,000 per family
$4,000 per individual
$4,000 per member / $8,000 per family
Coinsurance
You pay 20% AD
You pay 50% AD
Out-of-pocket Maximum
Embedded
June 1 — May 31
Embedded
June 1 — May 31
No more than
$6,000 per individual
$6,000 per member / $12,000 per family
$6,000 per individual
$6,000 per member / $12,000 per family
No more than
$10,000 per individual
$10,000 per member / $20,000 per family
$10,000 per individual
$10,000 per member / $20,000 per family
Preventive Services
You pay
$0 according to government guidelines
$0 according to government guidelines
You pay
50% AD
50% AD
Office Visits
Primary Care
Specialist
UHC Telemedicine
Primary Care
Specialist
UHC Telemedicine
You pay
$40 copay
$40 copay
Covered 100%
$40 copay
$40 copay
Covered 100%
You pay
50% AD
50% AD
Not Covered
50% AD
50% AD
Not Covered
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
You pay
$40 copay
20% AD
$40 copay
20% AD
You pay
50% AD
50% AD
50% AD
50% AD
Emergency Services
Urgent Care
Emergency Room
Urgent Care
Emergency Room
You pay
$100 copay
$250 copay
$100 copay
$250 copay
You pay
50% AD
Covered as In-Network
50% AD
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
50% AD
50% AD
50% AD
50% AD
Prescription Medication
Tier 1 / Tier 2 / Tier 3
Retail (30-day supply)
Mail Order (90-day supply)
Mail Order (90-day supply)
You pay $10 / $35 / $70
You pay up to 2.5x retail
You pay up to 2.5x retail
AD: After Deductible
* Providers may charge more than the plan allows when you receive services out-ofnetwork. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2023-2024 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.
* Providers may charge more than the plan allows when you receive services out-ofnetwork. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2023-2024 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.
UnitedHealthcare $3,000 High Deductible Health Plan (HDHP)
With this UnitedHealthcare $3,000 High Deductible Health Plan you you will have access to the Choice Plus. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with UnitedHealthcare to see if your provider is in the Choice Plus Network so that you can take advantage of greater discounts on care for you and your family.
With this UnitedHealthcare $3,000 High Deductible Health Plan you you will have access to the Choice Plus. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with UnitedHealthcare to see if your provider is in the Choice Plus Network so that you can take advantage of greater discounts on care for you and your family.
$3,000 HDHP PLAN
CHOICE PLUS NETWORK
CHOICE PLUS NETWORK
In-Network
Out-of-Network*
Annual Deductible
Embedded
June 1 — May 31
Embedded
June 1 — May 31
You pay up to
$3,000 per individual
$3,000 per member / $6,000 per family
$3,000 per individual
$3,000 per member / $6,000 per family
You pay up to
$6,000 per individual
$6,000 per member / $12,000 per family
$6,000 per individual
$6,000 per member / $12,000 per family
Coinsurance
You pay 20% AD
You pay 50% AD
Out-of-pocket Maximum
Embedded
June 1 — May 31
Embedded
June 1 — May 31
No more than
$6,000 per individual
$6,000 per member / $12,000 per family
$6,000 per individual
$6,000 per member / $12,000 per family
No more than
$12,000 per individual
$12,000 per member / $24,000 per family
$12,000 per individual
$12,000 per member / $24,000 per family
Preventive Services
You pay
$0 according to government guidelines
$0 according to government guidelines
You pay
50% AD
50% AD
Office Visits
Primary Care
Specialist
UHC Telemedicine
Primary Care
Specialist
UHC Telemedicine
You pay
20% copay
20% copay
You pay $49 copay AD
20% copay
20% copay
You pay $49 copay AD
You pay
50% AD
50% AD
Not Covered
50% AD
50% AD
Not Covered
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
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
Urgent Care
Emergency Room
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
Covered as In-Network
50% AD
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
50% AD
50% AD
50% AD
50% AD
Prescription Medication
Tier 1 / Tier 2 / Tier 3
Retail (30-day supply)
Mail Order (90-day supply)
Mail Order (90-day supply)
You pay $10 AD / $35 AD / $70 AD
You pay up to 2.5x retail
You pay up to 2.5x retail
AD: After Deductible
* Providers may charge more than the plan allows when you receive services out-ofnetwork. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2023-2024 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.
* Providers may charge more than the plan allows when you receive services out-ofnetwork. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2023-2024 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.
