Medical Benefits

Visit uhc.com/find-a-doctor to see in-network providers for our medical plans.

	In-Network Only
Member Coinsurance	20%
Deductible (Individual/Family)	$7,000/$14,000
Out-of-Pocket Max (Individual/Family)	$8,000/$16,000
Doctors Office Visits
Preventive Care	Covered at 100%
Primary Care	$0 Copay
Specialist Visit	$100 Copay
Hospital Care
Inpatient & Outpatient	Deductible + 20%
Major Diagnostics	Designated Network: Deductible + 20% In-Network: Deductible + 30%
Urgent Care	$50 Copay
Ambulance	Deductible + 20%
Emergency Room	Deductible + 20%
Prescriptions
Retail
Tier 1	$15 Copay
Tier 2	$40 Copay
Tier 3	$75 Copay
Mail Order Drugs
Tier 1	$37.50 Copay
Tier 2	$100 Copay
Tier 3	$187.50 Copay

Downloads

Visit uhc.com/find-a-doctor to see in-network providers for our medical plans.

	In-Network Only
Member Coinsurance	20%
Deductible (Individual/Family)	$4,000/$8,000
Out-of-Pocket Max (Individual/Family)	$6,500/$13,000
Doctors Office Visit
Preventive	Covered at 100%
Primary Care	$0 Copay
Specialist Visit	$100 Copay
Hospital Care
Inpatient & Outpatient	Deductible + 20%
Major Diagnostics	Designated Network: Deductible + 20% In-Network: Deductible + 30%
Urgent Care	$50 Copay
Ambulance	Deductible + 20%
Emergency Room	Deductible + 20%
Prescriptions
Retail
Tier 1	$15 Copay
Tier 2	$40 Copay
Tier 3	$75 Copay
Mail Order
Tier 1	$37.50 Copay
Tier 2	$100 Copay
Tier 3	$187.50 Copay

Downloads

Visit uhc.com/find-a-doctor to see in-network providers for our medical plans.

	In-Network	Out-of-Network
Member Coinsurance	20%	50%
Deductible (Individual/Family)	$3,500 / $7,000	$10,000 / $20,000
Out-of-Pocket Max (Individual/Family)	$7,000 / $14,000	$20,000 / $40,000
Doctors Office Visit
Preventive Care	Covered at 100%	Deductible + 50%
Primary Care	$40 Copay No Copay for covered dependents under 19	Deductible + 3050%
Specialist	$80 Copay	Deductible + 50%
Hospital Care
Inpatient & Outpatient	Deductible + 20%	Deductible + 50%
Major Diagnostics	Deductible + 30%	Deductible + 50%
Urgent Care	$20 Copay	Deductible + 50%
Ambulance	Deductible + 20%	Deductible + 20%
Emergency Room	Deductible + 20%	Deductible + 20%
Prescriptions
Retail
Tier 1	$15 Copay	N/A
Tier 2	$40 Copay	N/A
Tier 3	$75 Copay	N/A
Mail Order
Tier 1	$37.50 Copay	N/A
Tier 2	$100 Copay	N/A
Tier 3	$187.50 Copay	N/A

Downloads

Visit uhc.com/find-a-doctor to see in-network providers for our medical plans.

	In-Network	Out-of-Network
Member Coinsurance	20%	50%
Deductible (Individual/Family)	$2,000 / $6,000	$5,000 / $10,000
Out-of-Pocket Max (Individual/Family)	$6,000 / $12,000	$10,000 / $20,000
Doctors Office Visit
Preventive Care	Covered at 100%	Deductible + 50%
Primary Care	$30 Copay; No Copay for covered dependents under 19	Deductible + 50%
Specialist	Designated Network: $30 Copay In-Network: $60 Copay	Deductible + 50%
Hospital Care
Inpatient & Outpatient	Deductible + 50%	Deductible + 50%
Major Diagnostics	Deductible + 30%	Deductible + 50%
Urgent Care	$50 Copay	Deductible + 50%
Ambulance	Deductible + 20%	Deductible + 20%
Emergency Room	$250 Copay, Deductible + 20%	$250 Copay, Deductible + 20%
Prescriptions
Retail
Tier 1	$15 Copay	N/A
Tier 2	$40 Copay	N/A
Tier 3	$75 Copay	N/A
Mail Order
Tier 1	$37.50 Copay	N/A
Tier 2	$100 Copay	N/A
Tier 3	$187.50 Copay	N/A