Health Insurance
United Healthcare
P.O. Box 30555
Salt Lake City, UT 84130-0555
Customer Service: 1-866-633-2446
Website: www.myuhc.com
(Website provides account access, provider directory, along with other great information.)
Current Plan Type: PPO- Preferred Provider Organization
In Network Deductible: $1,000 Individual / $2,000 Family
Out of Network Deductible: $2,000 Individual / $4,000 Family
In Network Co-Insurance: 20% after deductible is met
Out of Network Co-Insurance: 40% after deductible is met
Annual In Network Out-of-pocket Maximum: $3,000 Individual / $6,000 Family
Annual Out of Network Out-of-pocket Maximum: $10,000 Individual / $20,000 Family
Prescription & Physician Copays
Tier 1 - $10
Tier 2 - $35
Tier 3 - $50
Primary Care - $20
Specialist - $35
UHC Current Benefits Summary
PPO Frequently Asked Questions
UHC Preventive Care Brochure
UHC 2012 Mid Year Choice Plus Plan Certificate
Current PPO Plan - Monthly Rates
|
Plan |
12 Month |
9 Month |
| Employee Only |
$51.00 |
$68.00 |
| Employee/Spouse |
$272.00 |
$362.68 |
| Employee/Children |
$185.82 |
$247.76 |
| Family |
$432.98 |
$577.32 |
| Special Family* |
$202.06 |
$269.42 |
* Both spouses are full-time employees at UCA
Health Savings Plan Option:
In Network Deductible: $1,000 Individual / $2,000 Family
Out of Network Deductible: $2,000 Individual / $4,000 Family
In Network Co-Insurance: 20% after deductible is met
Out of Network Co-Insurance: 40% after deductible is met
Annual In Network Out-of-pocket Maximum: $3,000 Individual / $6,000 Family
Annual Out of Network Out-of-pocket Maximum: $10,000 Individual / $20,000 Family
Prescription & Physician Copays
Tier 1 - Deductible/ Co-insurance
Tier 2 - Deductible/ Co-insurance
Tier 3 - Deductible/ Co-insurance
Primary Care - Deductible /Co-insurance
Specialist - Deductible /Co-Insurance
HSA Plan - Monthly Rates
|
Plan |
12 Month |
9 Month |
HSA Match |
| Employee Only |
$26.00 |
$34.68 |
Up to $50 |
| Employee/Spouse |
$197.00 |
$262.68 |
Up to $100 |
| Employee/Children |
$135.82 |
$181.10 |
Up to $100 |
| Family |
$332.98 |
$443.98 |
Up to $100 |
| Special Family* |
$152.06 |
$202.76 |
Up to $100 |
* Both spouses are full-time employees at UCA
HSA- Benefit Summary
HSA- Account & Beneficiary Form
HSA- Frequently Asked Questions
HSA- Top 10 Reasons to Have an Health Savings Account (HSA)
To Find Mental Health Care Providers:
https://www.lww-trans.com/PreClinicianSearchAction.do
UHC Forms
UHC Enrollment/Change Form
Address Change Form
Prescription Claim Form
Medco By Mail Order Form
Health Claim Transmittal
Statement of Other Benefit Coverage for Dependent Child under age 26
Certificate of Coverage
2006 & 2007 Point-of-Service (POS) Plan A
2006 & 2007 Point-of-Service (POS) Plan B
2008 Point-of-Service (POS) Plan C
2009 & 2010 Point-of-Service (POS) Plan C
2011 Point-of-Service (POS) Plan C