Medical Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit uhc.com.

	In-Network	Out-of-Network
Deductible (Individual/Family)	$5,000 / $10,000	$10,000 / $20,000
Out-of-Pocket Max (Individual/Family)	$8,150 / $16,300	$16,300 / $32,600
Member Coinsurance (BCBS/You)	80% / 20%	50% / 50%
Office Visits
Primary Care Visit	$25 Copay	Deductible + 50%
Specialist Visit	$75 Copay	Deductible + 50%
Preventive Care	Fully Covered	Deductible + 50%
Virtual Visit via Healthiest You	$0 Copay	N/A
Hospital
Inpatient Hospitalization	Deductible + 20%	Deductible + 50%
Physician Services	Deductible + 20%	Deductible + 50%
Outpatient Surgery	Deductible + 20%	Deductible + 50%
Outpatient Diagnostics	Deductible + 20%	Deductible + 50%
Urgent Care	$50 Copay	Deductible + 50%
Emergency Room	$300 Copay then Deductible + 20%	$300 Copay then Deductible + 20%
Prescription Drugs	In-Network	Out-of-Network
Retail Prescriptions (30 day supply)
Tier 1	$10 Copay	$10 Copay
Tier 2	$35 Copay	$35 Copay
Tier 3	$75 Copay	$75 Copay
Tier 4	$250 Copay	$250 Copay
Mail Order Prescriptions (90 day supply)
Tier 1/2/3/4	2.5x Retail Copay	2.5x Retail Copay

	Per Pay Period Cost
Employee Only	$97.29
Employee + Spouse	$370.15
Employee + Child(ren)	$342.26
Employee + Family	$595.20

Downloads

Summary of Benefits

Summary of Benefits-Spanish

Healthiest You Flyer

MyUHC Member Portal

Vital Medication Program

	In-Network	Out-of-Network
Deductible (Individual/Family)	$3,500 / $7,000	$5,000 / $10,000
Out-of-Pocket Max (Individual/Family)	$8,150 / $16,300	$10,000 / $20,000
Member Coinsurance (BCBS/You)	80% / 20%	50% / 50%
Office Visits
Primary Care Visit	$25 Copay	Deductible + 30%
Specialist Visit	$75 Copay	Deductible + 30%
Preventive Care	Fully Covered	Deductible + 30%
Virtual Visits ivia Healthiest You	$0 Copay	N/A
Hospital
Inpatient Hospitalization	Deductible + 20%	Deductible + 30%
Physician Services	Deductible + 20%	Deductible + 30%
Outpatient Surgery	Deductible + 20%	Deductible + 30%
Outpatient Diagnostics	Deductible + 20%	Deductible + 30%
Urgent Care	$50 Copay	Deductible + 30%
Emergency Room	$300 Copay then Deductible + 20%	$300 Copay then Deductible + 20%
Prescription Drugs	Prescription Drugs	Prescription Drugs
Retail Prescriptions (30 day supply)
Tier 1	$15 Copay	$15 Copay
Tier 2	$45 Copay	$45 Copay
Tier 3	$85 Copay	$85 Copay
Tier 4	$200 Copay	$200 Copay
Mail Order Prescriptions (90 day supply)
Tier 1/2/3/4	3x Retail Copay	3x Retail Copay