Medical Plan Overview
Your health care options for 2007 will include a choice of the following:
• UnitedHealthcare Choice Plus
• UnitedHealthcare Choice Plus H
• Opt out of medical coverage
UnitedHealthcare Choice Plus
This plan offers in- and out-of-network benefits, and you do not need to choose
a primary care physician (PCP) or obtain a referral to see a network specialist.
Your cost for care is lower when you use network providers. You can receive care
from providers outside of the network, but your share of the cost is higher and
you are responsible for paying any expenses that exceed the “Eligible
Expense”. (The “Eligible Expense” is a percentage of the published
rates allowed by Medicare for the same or similar services.)
You pay a set fee, or co-payment, for in-network physician office visits under
this plan. When you use network providers, you often pay only a co-payment for
covered services. Network services have lower deductibles and out-of-pocket costs. However,
the co-payments and deductibles are higher for in-network benefits under this
plan as compared to the United Healthcare Choice Plus H plan.
After you meet the annual deductible, the plan shares a percentage of covered
medical expenses up to the “Eligible Expense” limits. Your share
of the expenses is the coinsurance. For hospital stays, surgeries, extensive
tests, lab tests and X-rays, you pay your annual deductible, the coinsurance
and any separate hospital co-payments or confinement deductibles, if applicable.
Once you reach the annual out-of-pocket maximum, the POS pays for certain covered
expenses at 100% of “Eligible Expense” limits. Network care expenses
are based on the contracted fees with that network provider.
UnitedHealthcare Choice Plus H
This plan works similar to the UnitedHealthcare Choice Plus plan. Under the UnitedHealthcare
Choice Plus H plan, the co-payments and deductibles for in-network benefits are
less. There are out-of-network benefits under this plan, but at a substantially
higher out-of-pocket cost to you. This plan is intended for the person who wants
richer in-network benefits.
How to Receive Plan Benefits
Each time you need medical care, you decide the level of benefits by choosing
in- or out-of-network providers. If you want in-network benefits, be sure to
confirm that your provider is part of the United Healthcare network before you
receive care. If your provider is not part of the network, ask if he or she would
be willing to join.
When you use an in-network provider, you do not have to file a claim – your
provider files a claim directly with UnitedHealthcare. Depending on the type
of service you receive, you will pay a co-payment amount or coinsurance and the
plan pays the remaining covered amount. When you use an out-of-network provider,
you pay the full cost to the provider and file a claim to be reimbursed a percentage
of the covered expenses for medically necessary services, after you meet your
annual deductible.
To compare these two plans, see the medical
plan comparison chart. Your personal enrollment worksheet lists the options
available to you, along with each option's cost
per pay period.
If you choose to opt out of Medical coverage because you have coverage under
another plan, you will receive a monthly credit. A credit of $50 per month will
be paid to 12-month employees; 10-month employees receive a $60 monthly credit.
This amount will be included in the last paycheck of each month, as taxable wages.
Employees will receive separate ID
Cards, one for the medical benefit plan and one for the prescription drug
benefit.
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