Which Medical Plan is Right?
BGDC offers the Basic Plan and High Deductible Health (HDHP) Plan with HSA to VARS 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 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 the plans allow 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.
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 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 Comparison
Basic Plan
The Basic Plan has the highest out-of-pocket costs, but the lowest Associate premium contribution of the three medical plan options. The Basic 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 60% in-network and 40% 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.
United Health Care Basic Plan
| UHC Basic Plan | ||||
|---|---|---|---|---|
| UHC Basic Plan | ||||
| In-Network | Out-of-Network | |||
| Annual Deductible | ||||
| Individual | $5,850 | $17,550 | ||
| Family | $11,700 | $35,100 | ||
| Maximum Out-of-Pocket* (includes deductibles and copays) | ||||
| Individual | $7,350 | $22,050 | ||
| Family | $14,700 | $44,100 | ||
| Coinsurance | ||||
| Coinsurance (Plan pays after deductible is met) | 60% | 40% | ||
| Preventive Care | ||||
| Well Adult and Well Child Visits | Covered in Full | 40% after ded. | ||
| Physician Office Visits | ||||
| Primary Care | $50 copay | 40% after ded. | ||
| Specialty Care | $65 copay | 40% after ded. | ||
| Diagnostic Services | ||||
| X-ray and Lab Tests | 40% after ded. | 40% after ded. | ||
| Urgent Care | $75 copay | 40% after ded. | ||
| Emergency Room | 40% after ded. | 40% after ded. | ||
| Inpatient Facility | 40% after ded. | 40% after ded. | ||
| Outpatient Facility / Surgical | 40% after ded. | 40% after ded. | ||
| Mental Health | ||||
| Inpatient | 40% after ded. | 40% after ded. | ||
| Outpatient | Office: $50/visit Other: 40% after ded. | 40% after ded. | ||
| Retail Pharmacy (30 Day Supply) | ||||
| Annual Pharmacy Out of Pocket Maximum (Single / Family) | None – included with your Medical OOP Maximum | |||
| Generic (Tier 1) | $15 copay | Not covered | ||
| Preferred (Tier 2) | 40%, $250 max | Not covered | ||
| Non-Preferred (Tier 3) | 50%, $400 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) | $37.50 copay | Not covered | ||
| Preferred (Tier 2) | 40%, $500 max | Not covered | ||
| Non-Preferred (Tier 3) | 50%, $800 max | Not covered | ||
| Preferred Specialty (Tier 4) | 30% | Not covered | ||
United Health Care High Deductible Health Plan
| 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. | ||
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.
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.