Compare health plan details
Check out benefits and what’s covered in each different plan. The comparison table here highlights only the network benefit amounts. To see network and out-of-network benefits, please review your enrollment materials.
Choose from 2 health plan options
You have 2 plan options from UnitedHealthcare: the Choice HMO Plan and a High Deductible Health Plan (HDHP).
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Choice HMOView Plan Details |
HDHPView Plan Details |
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Deductible | ||
Individual | No deductible | $1,650 |
Family | No deductible | $3,300 |
Coinsurance (plan pays) | 100% | 80% after deductible |
Medical out-of-pocket maximum (includes covered medical expenses only) |
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Individual | $1,500 | $3,000 |
Family | $3,000 | $6,000 |
Global out-of-pocket maximum (includes covered medical and prescriptions drugs) |
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Individual | $9,450 | $3,000 |
Family | $18,900 | $6,000 |
Choice HMOView Plan Details |
HDHPView Plan Details |
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Preventive care | ||
Adult | $0 copay | 100% covered |
Well visits | $0 copay | 100% covered |
Routine mammograms | $0 copay | 100% covered |
Colorectal cancer screenings | $0 copay | 100% covered |
Medical services | ||
PCP visits (in person or virtual) | $20 copay per visit | 20% coinsurance after deductible has been met |
Specialist visits (in person, virtual or telehealth) | $40 copay per visit | 20% coinsurance after deductible has been met |
Allergy injections | $0 copay | 20% coinsurance after deductible has been met |
24/7 Virtual Visits (teleheath) UHC-approved providers | $0 copay | 20% coinsurance after deductible has been met |
Urgent care | $25 copay per visit | 20% coinsurance after deductible has been met |
Convenience care clinics | $25 copay per visit | 20% coinsurance after deductible has been met |
Emergency room visit | $100 copay per visit, waived if admitted | 20% coinsurance after deductible has been met |
Ambulance | $0 copay | 20% coinsurance after deductible has been met |
Inpatient hospital | $250 copay per admission, covered at 100% after copay | 20% coinsurance after deductible has been met |
Outpatient hospital | $0 copay | 20% coinsurance after deductible has been met |
Maternity | ||
Inpatient | $250 copay per admission, covered at 100% after copay | 20% coinsurance after deductible has been met |
Outpatient | $40 copay, first visit only | 20% coinsurance after deductible has been met |
Mental health/substance use | ||
Inpatient | $250 copay per admission, covered at 100% after copay | 20% coinsurance after deductible has been met |
Outpatient | $20 copay per visit | 20% coinsurance after deductible has been met |
Other services | ||
Diagnostic lab | $0 copay | 20% coinsurance after deductible has been met |
Diagnostic X-ray | $0 copay | 20% coinsurance after deductible has been met |
Complex imaging (MRI, MRA, CT) | $0 copay | 20% coinsurance after deductible has been met |
Outpatient surgery | $0 copay | 20% coinsurance after deductible has been met |
Skilled nursing facility | $0 copay | 20% coinsurance after deductible has been met |
Home health care | $0 copay | 20% coinsurance after deductible has been met |
Durable medical equipment | $0 copay | 20% coinsurance after deductible has been met |
Diabetic supplies | Pharmacy cost-sharing applies | 20% coinsurance after deductible has been met |
Spinal manipulation therapy* | $40 copay per visit | 20% coinsurance after deductible has been met |
Outpatient short-term rehab therapy* | $40 copay per visit | 20% coinsurance after deductible has been met |
Infertility | Not covered | Not covered |
Hospice (inpatient or outpatient) | $0 copay | 20% coinsurance after deductible has been met |
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