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 | $1,600 |
| Family | No deductible | $3,200 |
| 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, virtual or telehealth) | $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 |
| 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 |
| Infertility | Not covered | Not covered |
| Hospice (inpatient or outpatient) | $0 copay | 20% coinsurance after deductible has been met |
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