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UnitedHealthcare - HSA Choice Plus - $2,600 QHDHP
Benefit Plan
In-Network
Out-of-Network
Deductible
(calendar year)
Single
$2,600
$5,000
Family
$5,200
$10,000
Coinsurance
(plan pays/you pay)
80% / 20%
60% / 40%
Out-of-Pocket Limit
(including the deductible + coinsurance + copayments)
Single
$5,000
$10,000
Family
$10,000
$20,000
Copayments
Primary Physician Visit
Deductible, then you pay 20%
Deductible, then you pay 40%
Specialist Physician Visit
Deductible, then you pay 20%
Deductible, then you pay 40%
Preventive Care
Plan pays 100%
Not Covered
Emergency Room Visit
Deductible, then you pay 20%
Deductible, then you pay 20%
Urgent Care Center Visit
Deductible, then you pay 20%
Deductible, then you pay 40%
Prescription Drug Coverage
Retail Pharmacy
Deductible, then you pay 20%
Deductible, then you pay 20%
Mail Order Pharmacy
Deductible, then you pay 20%
Not Covered
MEDICAL INSURANCE OPTIONS
$2,600 QHDHP
Actives
Monthly
EE Cost
Employee Only
$0.00
Employee & Spouse
$311.45
Employee & Child(ren)
$186.66
Employee & Family
$531.32
2 City EEs Married/Dom Part w/full
family coverage
$41.23
$2,600 QHDHP
Pre 65 Retirees
Monthly
Cost
Single Only
$719.45
Single & Spouse
$1,467.69
Single & Child(ren)
$1,194.30
Full Family
$2,086.42
When you select the UnitedHealthcare HSA Choice Plus
$2,600 Deductible Plan also known as a Qualified High
Deductible Plan (QHDHP), you are eligible to open a Health
Savings Account (HSA). An HSA is an account set up where
employee pre-tax payroll contributions along with the City of
Columbia contributions can be used by you to pay for current
or future medical expenses.
The City of Columbia
contributes $1,500 per year for single coverage and
$3,000 per year family coverage.
The employee
contribution limits for 2017 are $1,850 for single and $3,750
for family. In an HSA, funds roll over and accumulate from
year to year if not spent. (The HSA is explained in more
detail on Page 7.)