Roanoke & Atlanta Union Medical

Medical Plans

BGDC offers the Enhanced PPO Plan and High Deductible Health (HDHP) Plan with HSA to Roanoke and Atlanta Union members. The coverage is administered by United Healthcare and includes prescription drug coverage through OptumRx. The network of providers is the United Healthcare Choice Plus national network.

The plans will give you the choice of going to see any physician or hospital you choose, but you receive the maximum level of benefits if you receive care from in-network providers. While this plan allows you to receive services in- and out-of-network, it remains your responsibility to make sure you are using in-network providers in order to receive the benefits of the plan’s in-network benefit schedule. If your out-of-network provider charges more than the “Maximum Allowable Amount”, as determined by United Healthcare, you may be subject to balance billing and higher deductibles and out of pocket maximums.

Please refer to the summary plan description for complete plan details. Find an in-network provider and review cost estimates at myuhc.

Medical Plan Comparison

Enhanced Plan

The Enhanced Plan has the highest Associate premium contribution, but the lowest out-of-pocket costs compared to the Standard and Basic Plans. The Enhanced Plan has a copay for Primary Care Provider (PCP) office visits, and your preventive care services are covered at 100% when you use an in-network provider. The plan pays 80% in-network and 50% out-of-network after your deductible is met.

High Deductible Health (HDHP) Plan with HSA

The HDHP Plan has some of the highest deductible and out-of-pocket costs, but has the lowest Associate premium contribution of all the medical plan options. On the HDHP Plan your preventive care services are covered at 100% when you use an in-network provider but due to IRS guidelines for having a Health Savings Account (HSA), all other services including prescription drugs will not be paid by the plan until the deductible is met. The plan will pay 80% in-network and 60% out-of-network after your deductible is met.

Prescription Drug Coverage

You will receive prescription drug coverage administered by OptumRx. The plan covers both generic and brand-name medications. OptumRx offers a nationwide network of participating pharmacies and mail order services.

The prescription drug plan in the Enhanced have a separate prescription out-of-pocket (OOP) maximum. Once you hit the maximum your remaining prescription drug expenses will be paid at 100%. The Basic Plan does not have a separate prescription out-of-pocket maximum. Your prescription expenses will count towards the medical out-of-pocket maximum.

United Healthcare Online Resources

Once the plan year starts you can log on to your individual United Healthcare account at www.myuhc.com by clicking “Register Now” and following the step-by-step instructions. The UHC website offers many features and allows you to:

• Locate an in-network UHC provider
• Request a new ID card
• View and manage your benefits and health
• Review and print an Explanation of Benefits (EOB)

Medical Plan Overview

	UHC Enhanced Plan
	UHC Enhanced Plan
	In-Network	Out-of-Network
Annual Deductible
Individual	$1,500	$3,675
Family	$3,000	$7,350
*Maximum Out-of-Pocket (includes deductibles and copays)**
Individual	$2,500	$7,350
Family	$5,000	$14,700
Coinsurance
Coinsurance (Plan pays after deductible is met)	80%	50%
Preventive Care
Well Adult and Well Child Visits	Covered in Full	50% after ded.
Physician Office Visits
Primary Care	$30 copay	50% after ded.
Specialty Care	$40 copay	50% after ded.
Diagnostic Services
X-ray and Lab Tests	20% after ded.	50% after ded.
Urgent Care	$50 copay	50% after ded.
Emergency Room	20% after ded.	50% after ded.
Inpatient Facility	20% after ded.	50% after ded.
Outpatient Facility / Surgical	20% after ded.	50% after ded.
Mental Health
Inpatient	20% after ded.	50% after ded.
Outpatient	Office: $30/visit Other: 20% after ded	50% after ded.
Retail Pharmacy (30 Day Supply)
Annual Pharmacy Out of Pocket Maximum (Single / Family)	Individual: $2,500 Family: $5,000
Generic (Tier 1)	$10 copay	Not covered
Preferred (Tier 2)	30%, $150 max	Not covered
Non-Preferred (Tier 3)	40%, $200 max	Not covered
Preferred Specialty (Tier 4)	30%	Not covered
Mail Order Pharmacy (90 Day Supply) (90 Day at Retail is available as well)
Generic (Tier 1)	$25 copay	Not covered
Preferred (Tier 2)	30%, $275 max	Not covered
Non-Preferred (Tier 3)	40%, $500 max	Not covered
Preferred Specialty (Tier 4)	30%	Not covered

UHC High Deductible Health Plan
	UHC High Deductible Health Plan
	In-Network	Out-of-Network
Annual Deductible
Individual	$5,000	$10,000
Family	$10,000	$20,000
*Maximum Out-of-Pocket (includes deductibles)**
Individual	$7,500	$15,000
Family	$15,000	$30,000
Coinsurance
Coinsurance (Plan pays after deductible is met)	80%	60%
Preventive Care
Well Adult and Well Child Visits	Covered in Full	40% after ded.
All Other Medical Services
Primary Care / Specialty Care	20% after ded.	40% after ded.
Urgent Care / Emergency Room	20% after ded.	40% after ded.
X-ray and Lab Tests	20% after ded.	40% after ded.
Inpatient Facility	20% after ded.	40% after ded.
Outpatient Facility / Surgical	20% after ded.	40% after ded.
Retail Pharmacy (30 Day Supply)	Pharmacy Accumulates to Your Deductible & Medical Out-of-Pocket Maximum
All Tiers of Prescriptions	20% after ded.	40% after ded.
Mail Order Pharmacy (90 Day Supply) (90 Day at Retail is available as well)
All Tiers of Prescriptions	20% after ded.	40% after ded.

Welcome Guide (UHC)

Personal Health Support Toolkit Poster (UHC)

Provider Search Member Flyer (UHC)

Digital Engagement (UHC)

Disabled Dependent Child Certification Form (UHC)

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Get To Know Your Care Options

How much you pay for care can depend on where you get it. For serious or life-threatening conditions, call 911 or go to an emergency room. For everything else, it may be best to contact your PCP first. If seeing your PCP isn’t possible, it’s important to know your other care options, especially before heading to the emergency room.