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United Healthcare - Plan Designs
Features
PPO Base Plan
PPO Buy-Up Plan
In-Network
Out-of-Network
In-Network
Out-of-Network
Deductible
(Individual / Family)
$2,000 / $4,000
$6,000 / $12,000
$1,500 / $3,000
$3,000 / $6,000
Coinsurance
90%
60%
90%
60%
Out-of-Pocket Maximum
(Individual / Family)
$5,000 / $10,000
$10,000 / $20,000
$3,500 / $7,000
$16,000/ $32,000
Office Visit Co-Pay
(Primary Care physician / Specialist)
$25 / $50
Deductible/
Coinsurance
$20 / $40
Deductible/
Coinsurance
Preventive Care
$0
Deductible/
Coinsurance
$0
Deductible/
Coinsurance
Hospital Services
Deductible/
Coinsurance
Deductible/
Coinsurance
Deductible/
Coinsurance
Deductible/
Coinsurance
Urgent Care
$75
Deductible/
Coinsurance
$100
Deductible/
Coinsurance
Emergency Room
$300
$300
$200
$200
Prescription Drug
Retail
Mail Order (90-Day Supply)
$10/$35/$70
$25/$87.50/$175
In-Network copay plus
any difference in cost
$10/$35/$70
$25/$87.50/$175
In-Network copay plus
any difference in cost
Features
Health Savings Account (HSA)
Qualified Plan
In-Network
Out-of-Network
Deductible
(Individual / Family)
$3,500 / $7,000
$6,000 / $12,000
Coinsurance
100%
70%
Out-of-Pocket Maximum
(Individual / Family)
$3,500 / $7,000
$12,000 / $24,000
Office Visit Co-Pay
(Primary Care physician / Specialist)
Deductible/
Coinsurance
Deductible/
Coinsurance
Preventive Care
$0
Deductible/
Coinsurance
Hospital Services
Deductible/
Coinsurance
Deductible/
Coinsurance
Urgent Care
Deductible/
Coinsurance
Deductible/
Coinsurance
Emergency Room
Deductible/
Coinsurance
Deductible/
Coinsurance
Prescription Drug
Retail
Mail Order (90-Day Supply)
Deductible/
Coinsurance
Deductible/
Coinsurance