Health Benefits

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: POS-Point of Service
In Network Deductible: $1,500 Individual / $3,000 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: $4,000 Individual / $8,000 Family (Includes deductible)
Annual Out of Network Out-of-pocket Maximum: $10,000 Individual / $20,000 Family (Includes deductible)

Prescription & Physician Copays
Tier 1 – $10
Tier 2 – $40
Tier 3 – $60
Primary Care – $20
Specialist – $35

UHC 2016 Point-of-Service (POS) Benefits Summary
UHC 2017 Point-of-Service (POS) Benefits Summary
POS Frequently Asked Questions

Current POS Plan – Monthly Rates

Plan

12 Month

9 Month

Employee Only

$54.26

$72.34

Employee/Spouse

$289.40

$385.88

Employee/Children

$197.70

$263.60

Family

$460.68

$614.24

Special Family*

$214.98

$286.64

* Both spouses are full-time employees at UCA

Health Savings Plan Option:
In Network Deductible: $2,000 Individual / $4,000 Family
Out of Network Deductible: $4,000 Individual / $8,000 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: $4,000 Individual / $8,000 Family (Includes deductible)
Annual Out of Network Out-of-pocket Maximum: $12,000 Individual / $24,000 Family (Includes deductible)

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

$27.66

$36.88

Up to $50

Employee/Spouse

$209.60

$279.47

Up to $100

Employee/Children

$144.50

$192.67

Up to $100

Family

$354.28

$472.38

Up to $100

Special Family*

$161.78

$215.72

Up to $100

* Both spouses are full-time employees at UCA

HSA- Current Benefit Summary
*  Individual Coverage
*  Emp/Spouse, Emp/Children, Family Coverage
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
OPTUM Prescription Claim Form
OPTUM Prescription Mail Order Form
Maintenance Prescription Mail Order Program
Health Claim Transmittal
UHC Appeals Process and Forms

Certificate of Coverage

UHC 2016 Choice Plus 110 Plan