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2016 Benefits Guide
6
Benefit Plan
QHDHP
In-Network
QHDHP
Out-of-Network
Deductible
(calendar year)
Single
$3,000
$6,000
Family
$6,000
$12,000
Coinsurance
(plan pays/you pay)
80% / 20%
60% / 40%
Out-of-Pocket Limit
(including the deductible + coinsurance)
Single
$6,000
$12,000
Family
$12,000
$24,000
Copayments
Primary Physician Visit
Deductible, then plan pays 80%
Deductible, then plan pays 60%
Specialist Physician Visit
Deductible, then plan pays 80%
Deductible, then plan pays 60%
Preventive Care
Plan pays 100%
Not Covered
Emergency Room Visit
Deductible, then plan pays 80%
Deductible, then plan pays 80%
Urgent Care Center Visit
Deductible, then plan pays 80%
Deductible, then plan pays 60%
Prescription Drug Coverage
Retail Pharmacy
Deductible, then plan pays 80%
Deductible, then plan pays 60%
Mail Order Pharmacy
Deductible, then plan pays 80%
Not Covered
UnitedHealthcare QHDHP with the option to open an HSA
2016 Employee Medical
Plan Contributions
Employee Monthly Cost
Employee
$165
Employee & Spouse
$352
Employee & Child(ren)
$302
Employee & Family
$419
To the left are the monthly premiums associated with the medical
plan option being offered in 2016. Please note that your premiums
will be withheld from you paycheck on a pre-tax basis for medical,
dental and vision insurance. This can save you considerable money
as the savings are based upon your individual tax bracket.
Medical Insurance