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: 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: $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 – $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
UHC Marketplace Notice
UHC 2012 Mid-Year New Certificate Changes

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: $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

$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
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

2008 Point-of-Service (POS) Plan C
2009 & 2010 Point-of-Service (POS) Plan C
2011 Point-of-Service (POS) Plan C