Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers.
Anyone enrolling in the Bronze plan is required to select PCP upon enrollment.
Medical Plan Comparison
| UnitedHealthcare | Bronze Plan | Silver Plan – HSA | Gold Plan |
|---|---|---|---|
| In-Network | In-Network | In-Network | |
| Calendar Year Deductible (Individual/Family) | $4,000 / $8,000 | $2,500 / $5,000** | $1,000 / $2,000 |
| Out-of-Pocket Maximum (Individual/Family) | $8,550 / $17,100 | $5,500** / $11,000 | $4,500 / $9,000 |
| Preventive Care | $0 | $0 | $0 |
| Primary Care Visit | Tier 1: $25 copay | 20%* | $25 copay |
| Tier 2: $55 copay | |||
| Specialist Visit | Tier 1: $50 copay | 20%* | $50 copay |
| Tier 2: $100 copay | |||
| Urgent Care | $50 copay | 20%* | $50 copay |
| Emergency Room | 20%* | 20%* | $500 copay |
| Retail Rx (Up to 30-Day Supply) | |||
| Tier 1 | $10 | $10* | $10 |
| Tier 2 | $35 | $35* | $35 |
| Tier 3 | $70 | $60* | $60 |
| Tier 4 | $250 | Not covered | $100 |
| Mail-Order Rx (Up to 90-Day Supply) | |||
| Tier 1 | 2.5x copay | 2.5x copay | 2.5x copay |
| Tier 2 | 2.5x copay | 2.5x copay | 2.5x copay |
| Tier 3 | 2.5x copay | 2.5x copay | 2.5x copay |
| Tier 4 | 2.5x copay | Not covered | 2.5x copay |
* After Calendar Year Deductible (CYD)
** Calendar Year Deductible (CYD) for Silver Plan when enrolled as a family is considered a true family deductible, meaning no one covered under the plan is eligible to receive benefits until the family annual deductible is satisfied.
** Calendar Year Maximum out-of-pocket is per individual. No individual within a family will have to pay more than the individual maximum of $5,500.
In-Network benefits illustrated only. This is not a full list of covered benefits. Please refer to the Summary Plan Documents for full plan details and exclusions.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums – the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Plan Documents
Review the plan summaries to learn more about out-of-network coverage.
Contact Information
Contact Information
https://myuhc.com
866-290-5416
Bronze Plan: Find a Provider
To choose a primary care provider (PCP) in your network, follow these steps at myuhc.com:
Log in or register.
- Select Find a Provider → Medical Directory → Employer Plan.
- Choose NexusACO → NexusACO OAP.
- Enter your ZIP code under Change Location.
- Search for a PCP by name or select Primary Care.
- Look for a Tier 1 Provider and note the 14-digit Provider ID.
PCP Requirements:
- Each family member can choose their own PCP or share one.
- Must be near your home.
- Must be a general practice, family practice, pediatrician or internal medicine physician.
At Enrollment:
- Provide your selected provider’s first and last name, address, and 14-digit Provider ID from com.
- If your provider has multiple locations, use the Provider ID for your preferred location.
- If you don’t select a PCP, one will be assigned to you.
Silver and Gold Plan: Find a Provider
Easily find doctors, hospitals, labs and other providers in your network by visiting uhc.com/find-a-doctor. Follow these steps:
- Click Start your search under Search our general provider list.
- Select Medical Directory as your provider type.
- Choose Employer and Individual Plans.
- Under What plan are you looking for?, select Select Plus.
Enter your location and search for the provider that fits your needs.
Medical Plan Costs Per Pay Period
Medical Bronze Plan
Employee Only: $49.51
Employee and Spouse: $168.36
Employee and Child(ren): $129.24
Employee and Family: $282.26
Medical Silver Plan HSA
Employee Only: $54.92
Employee and Spouse: $179.16
Employee and Child(ren): $138.97
Employee and Family: $298.45
Medical Gold Plan
Employee Only: $154.87
Employee and Spouse: $379.06
Employee and Child(ren): $318.87
Employee and Family: $598.31