Medical Plan
The company medical plan provides access to quality health care at reasonable costs through UnitedHealthcare and offers the choice of PPO or EPO coverage. (An Out-of-Area medical plan (OOA300 or OOA600) is available in those areas not covered by the UnitedHealthcare PPO network and offers benefits at the same level as the corresponding in-network PPO300 or PPO600 plan.) When comparing plans, keep in mind that you must select the same type of coverage - either a PPO300, PPO600, or EPO - for yourself and your eligible dependents. The medical plans available to you and your eligible dependents are based on your home zip code and will be printed on your Benefits Enrollment Form. (All plans may not be available in all areas.) PPO300 Plan – Choice Plus Network(Preferred Provider Organization)Participants in the PPO300 may select any physician at any time from UnitedHealthcare's nationwide network of physicians, or they can see physicians out-of-network at a higher cost. Here are plan highlights for in-network services and associated biweekly employee premiums: PPO300 Plan Highlights
Employee Premium Rates (biweekly)
PPO600 Plan – Choice Plus Network(Preferred Provider Organization) Participants in the PPO600 may select any physician at any time from UnitedHealthcare's nationwide network of physicians, or they can see physicians out-of-network at a higher cost.Here are plan highlights for in-network services and associated biweekly employee premiums: PPO600 Plan Highlights
Employee Premium Rates (biweekly)
Office Visit Copays – PPO300 and PPO600The PPO plan includes a copay for office visits to doctors participating in the PPO network. Your copay amount depends on the type of doctor you are seeing. When visiting a primary care physician you will pay the first $20; for visits to a specialty care physician, PPO300 participants pay the first $35; PPO600 participants pay the first $40. After the copay, the plan then pays 100% of the remaining charge for the office visit. Remember, the office visit copay does not apply when visiting an out-of-network doctor.Physician ServicesPrimary Care Physicians (PCP)PPO network providers who are considered primary care physicians include Internists/Internal Medicine, Pediatricians and General Practitioners/Family Practitioners. Benefits for outpatient rehabilitation for physical, speech and occupational therapy are also covered by the primary care office visit copay. You will pay a $20 office visit copay when visiting a primary care physician. Specialty Care PhysicianPPO network providers who are considered specialists include: Allergist, Chiropractor, Ear/Nose/Throat, Neurologist, OB/GYN, Orthopedic, Urologist. You will pay a $35/PPO300; $40/PPO600 office visit copay when visiting a specialty care physician.Finding A PPO ProviderTo locate participating PPO primary and specialty care providers, visit www.myuhc.com, enter username and password and conduct a provider search or call UnitedHealthcare at 800-520-0746, 8am–8pm (caller's local time). When calling to schedule your appointment, always double check with the provider to make sure they are part of the UnitedHealthcare PPO network.Importance Of Selecting An In-Network PPO ProviderWhen choosing a primary care or specialty care physician it is important to remember ... the office visit copay applies only when seeing an in-network PPO physician, and after satisfying your annual deductible the plan pays 90%/PPO300; 80%/PPO600 of other covered services and supplies provided during the office visit. However, if you select an out-of-network provider, the office visit copay will not apply and the plan pays only 60% for both PPO300 and PPO600 of the office visit and other covered services and supplies provided during the office visit after satisfying your annual deductible. If you live in an area where a PPO network is not available, you will be eligible to participate in the Out-Of-Area medical plan (OOA300 or OOA600) and benefits will be provided at the same level as the corresponding in-network PPO300 or PPO600 plan. (Subject to charges considered reasonable and customary by the plan.)Wellness Benefit (PPO300 and PPO600)For participants age 3 and above, routine preventive care expenses, such as those listed below under Well Child Care, Well Woman Care, and Well Man Care, are covered under your Wellness Benefit. Here is how your Wellness Benefit works. Visit a participating in-network Choice Plus provider, pay the office visit copay, and services and supplies provided during the office visit that are not covered by the copay may be applied to your Wellness Benefit—up to $350 per covered person per calendar year. (Office visit copays do not apply toward the Wellness Benefit.) Once you have used up your $350 Wellness Benefit, routine preventive care visits with in-network providers are covered as follows. Visit a participating in-network Choice Plus provider, pay the office visit copay and services and supplies provided during the office visit that are not covered by the copay are paid at 90 percent for PPO300 and 80 percent for PPO600 after the deductible is satisfied. (Wellness benefits provided by out-of-network providers are paid at 60 percent for both PPO300 and PPO600 after the deductible is satisfied, and the office visit copay does not apply.) The following services may be applied to your Wellness Benefit. Well Child Care — Age 3 to age 23 (through the end of the calendar year in which your child reaches age 23)
Well Woman Care — Employee or dependent spouse
Well Man Care — Employee or dependent spouse
Well Baby Care – Birth Through 36 Months Well baby care has no limit. Once your newborn is enrolled in the company medical plan, all routine pediatric and preventive care, including immunizations, is covered at 100 percent after the office visit copay, up through 36 months. Therefore, to ensure that your child’s three-year checkup is covered, be sure to visit your pediatrician before your child’s third birthday. Beginning on your baby’s third birthday, routine preventive care, such as immunizations, vaccinations, and booster shots, will be covered under Well Child Care (age 3 to age 23). EPO Plan – Choice Network(Exclusive Provider Organization)EPO participants are not required to get a referral from a PCP in order to see a specialist in the EPO network, however you must use EPO network providers for services to be covered. This should reduce the amount of time and cost incurred when employees require specialist care. Here are plan highlights for EPO network services and associated biweekly employee premiums: EPO Plan Highlights
Employee Premium Rates (biweekly)
Office Visit Copays - EPOWhen you join the EPO plan, you choose a Primary Care Physician (PCP) for yourself and each member of your family covered under the plan. Your PCP provides basic and routine care and keeps track of all the care you receive, however you are not required to get a referral from a PCP in order to see a specialist in the EPO network. When visiting a primary care physician you will pay the first $25; for visits to a specialty care physician, EPO participants pay the first $50. After the copay, the plan then pays 100% of the remaining charge for the office visit.Physician ServicesPrimary Care Physician (PCP)You and each dependent enrolled in the EPO must select a Primary Care Physician (PCP) from one of the following areas of care: Internists/Internal Medicine, Pediatricians and General Practitioners/Family Practitioners. Benefits for outpatient rehabilitation for physical, speech and occupational therapy are also covered by the primary care office visit copay. EPO participants pay a $25 office visit copay when visiting a primary care physician.Specialty Care PhysicianEPO network providers who are considered specialists include: Allergist, Chiropractor, Ear/Nose/Throat, Neurologist, OB/GYN, Orthopedic, Urologist. EPO participants pay a $50 office visit copay when visiting a specialty care physician.Finding An EPO ProviderTo locate participating EPO primary and specialty care providers, visit www.myuhc.com, enter username and password and conduct a provider search or call UnitedHealthcare at 800-520-0746, 8am–8pm (caller's local time). When calling to schedule your appointment, always double check with the provider to make sure they are part of the UnitedHealthcare EPO network.Wellness Benefit (EPO)For participants age 3 and above, routine preventive care office visits with Choice network providers for well child care, well woman care, and well man care are covered at 100 percent after you pay the applicable office visit copay. The following provides a closer look at what may be included in a routine preventive care visit: Well Child Care — Age 3 to age 23 (through the end of the calendar year in which child reaches age 23)
Well Woman Care — Employee or dependent spouse
Well Man Care — Employee or dependent spouse
Well Baby Care – Birth Through 36 Months Well baby care has no limit. Once your newborn is enrolled in the company medical plan, all routine pediatric and preventive care, including immunizations, is covered at 100 percent after the office visit copay, up through 36 months. Therefore, to ensure that your child’s three-year checkup is covered, be sure to visit your pediatrician before your child’s third birthday. Beginning on your baby’s third birthday, routine preventive care, such as immunizations, vaccinations, and booster shots, will be covered under Well Child Care (age 3 to age 23). Emergency Room VisitsEmergencies are sudden and unexpected illnesses or injuries in which loss of life, limb, or severe and permanent medical complications could result if care is not received immediately. Here are some examples:• Seizures If you see any of these symptoms, If you are vacationing, traveling on business or can't reach your PCP:Get the care you need. You may have to pay at the time of treatment but you can submit receipts of payments for reimbursement minus any applicable copays. Notify UnitedHealthcare Personal Health Support within 48 hours. Call UnitedHealthcare at 800-520-0746 (the toll free number on your UnitedHealthcare ID card) and follow the prompts to reach Personal Health Support.If you're admitted to the hospital:Call UnitedHealthcare Personal Health Support within 48 hours. Call UnitedHealthcare at 800-520-0746 (the toll free number on your UnitedHealthcare ID card) and follow the prompts to reach Personal Health Support.PPO300 and PPO600 Benefits:In-network: $100/PPO300; $100/PPO600 copay per Emergency Room visit (copay waived if admitted), then plan pays 90% after calendar year deductible.Out-of-network: $100/PPO300; $100/PPO600 copay per Emergency Room visit (copay waived if admitted), then plan pays 90% after calendar year deductible. Except if not a true emergency, then the plan pays 60% for both PPO300 and PPO600, after copay and calendar year deductible EPO Benefits:$100 copay per Emergency Room visit (copay waived if admitted), then plan pays 90%.Except if not a true emergency, then the plan pays 60% after copay. Urgent Care Center ServicesUrgent care situations are defined as injuries or illnesses that require prompt medical attention, but are not life-threatening emergencies. Here are some examples:• Minor burns PPO300 and PPO600 Benefits:In-network: $40/PPO300; $50/PPO600 copay per Urgent Care Center visit (copay waived if admitted), then plan pays 90% after calendar year deductible.Out-of-network: $40/PPO300; $50/PPO600 copay per Urgent Care Center visit, (copay waived if admitted), then plan pays 90% after calendar year deductible. Except if not a true urgent care situation, then plan pays 60% for both PPO300 and PPO600, after copay and calendar year deductible. EPO Benefits:$50 copay per Urgent Care Center visit (copay waived if admitted), then plan pays 90%. Except if not a true urgent care situation, then plan pays 60% after copay.Healthy Pregnancy Program — Call 800-411-7984The UnitedHealthcare Healthy Pregnancy Program offers personal support through all stages of pregnancy and delivery for PPO300, PPO600 and EPO participants. Whether this is your first pregnancy or you have other children, this program provides the information you need to make healthy choices during your pregnancy, birth, delivery and afterward.The Healthy Pregnancy Program features:• The Healthy Pregnancy Web site• Pregnancy assessment to identify your special needs • 24-hour, toll-free access to experienced nurses for help with your questions or concerns • Education and support for prenatal and postpartum care, including information on nutrition and exercise, prenatal testing, fetal development, discomforts of pregnancy, childbirth, infant feeding options, family planning options and newborn care • Identification of pregnancy risk factors and enhanced health care needs • Health education materials concerning your pregnancy • Information about your baby's and your own health care needs after delivery • Referrals to UnitedHealthcare's Personal Health SupportCare to help coordinate any additional services • No charge to enroll in this program To get the best possible benefit from this program, you should enroll in the first 12 weeks of pregnancy. But you can enroll anytime it is convenient, up to your 34th week of pregnancy. To enroll, simply call the Healthy Pregnancy Program at 800-411-7984. Registered nurses are available 24 hours a day to answer your pregnancy and new baby questions. Call 800-411-7984 and press or say 4 to reach a Healthy Pregnancy Nurse. NurseLine Services — 24 Hour Health Information LineSpeak With A Registered NurseCall NurseLine Services any time at 866-549-8604, 24 hours every day for information and support on many health situations and concerns, including: • Minor injuries Health Information LibraryVisit www.myuhc.com for a copy of the NurseLine Services brochure that lists the Health Information Library topics and the corresponding 4-digit category numbers.Simply call 866-549-8604 (toll-free), press 2 to reach the library, enter PIN 641, and key in the topic's 4-digit category number. (TTY/TDD callers, please call the National Relay Center at 1-800-855-2880 and ask for 1-866-549-8604.) How To Report Health Care FraudIf you suspect medical fraud with your claims contact:Ingenix Anti-Fraud and Abuse Hotline 866-242-7727. Be prepared to provide the following information: • Physician/provider's name, phone number and office location |
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Forms, Resources and Web Sites
Medical Claim Form (PDF)
Benefit Issue Resolution Request Form (PDF)
Provider Referrals (PDF)
Notice Of Privacy (PDF)
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1-800-520-0746
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