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2016 Benefits Guide
6
Medical Insurance
UHC - Bronze Plan
Features
In-Network
Non-
Network
Deductible
(individual / family)
$5,000 /
$10,000
$10,000 /
$20,000
Coinsurance
80%
60%
Out-of-Pocket Maximum*
(individual / family)
$6,000 /
$12,000
$15,000 /
30,000
Office Visit
PCP and Specialist
Deductible /
Coinsurance
Deductible /
Coinsurance
Preventive Benefits
$0
Deductible /
Coinsurance
Inpatient Hospital
Deductible /
Coinsurance
Deductible /
Coinsurance
Outpatient Surgery
Deductible /
Coinsurance
Deductible /
Coinsurance
Urgent Care
Deductible /
Coinsurance
Deductible /
Coinsurance
Emergency Room
Deductible /
Coinsurance
70% after
Deductible
Retail Pharmacy
$10/35/60
Mail Order
Pharmacy (90 day supply)
*Out-of-Pocket Maximum—
All deductibles, coinsurance and copays
apply toward the out-of-pocket maximum.
The goal of this plan
is to provide medical coverage
after the participant meets a high deductible. Before
coverage under this plan begins, a significant deductible
must be met. This plan offers the lowest payroll
deductions but requires the participant to pay more of
the initial cost of medical expenses than the other plans.
This plan does offer covered preventive benefits at no
charge to the participant.
$25/87.50/150
X-Ray and Lab
Deductible /
Coinsurance
Deductible /
Coinsurance
UHC - Gold Plan
Features
In-Network
Non-
Network
Deductible
(individual / family)
$2,500 /
$5,000
$5,000 /
$10,000
Coinsurance
80%
50%
Out-of-Pocket Maximum*
(individual / family)
$5,500 /
$11,000
$9,000 /
18,000
Office Visit Co-pay
PCP and Specialist
$25/50
Deductible /
Coinsurance
Preventive Benefits
$0
Deductible /
Coinsurance
X-Ray and Lab
100%
Deductible /
Coinsurance
Inpatient Hospital
Deductible /
Coinsurance
Deductible /
Coinsurance
Outpatient Surgery
Deductible /
Coinsurance
Deductible /
Coinsurance
Urgent Care
$50
Deductible /
Coinsurance
Emergency Room
$200
Retail Pharmacy
$10/35/60
Mail Order
Pharmacy (90 day supply)
*Out-of-Pocket Maximum—
All deductibles, coinsurance and copays
apply toward the out-of-pocket maximum.
The goal of this plan
is to provide medical coverage at
a reasonable price. Deductibles, co-insurance and out-of
-pocket maximums are not as expensive under this plan
when compared to the Bronze Plan but not as rich as the
Enhanced Plan. This plan has slightly higher payroll
deductions but has lower out-of-pocket costs for medical
expenses. This plan also offers covered preventive
benefits at no charge to the participant.
$25/87.50/150