Medical Plans: Comprehensive coverage for you and your family.

2020 Medical Plan Options

NYU provides comprehensive medical coverage for you and your family. You may choose from the following UnitedHealthcare (UHC) medical plan options:

  • UHC Choice Plus Value Point of Service Plan
  • UHC Choice Plus Advantage Point of Service Plan
  • UHC High Deductible Health Plan (HDHP) with Health Savings Account (HSA)
The plans provide for care received both in-network and out-of-network. You must obtain prior authorization, as described in Section 4 of the plan's Summary Plan Description, to receive full benefits before receiving certain covered health services from a non-network provider. In general, if you visit a Network provider, that provider is responsible for obtaining prior authorization before you receive certain covered health services. See Section 6, Additional Coverage Details in the plan's Summary Plan Description, for further information. 
 
Tip: To view plan coverage, check claim status, search for a provider, and print a temporary ID card, visit UnitedHealthcare’s website. First time users will need the member ID number from their UHC ID card to register for access.

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Key Features Value Plan Value Plan Advantage Plan Advantage Plan HDHP + HSA HDHP + HSA
  In-network
Out-of-network*
In-network Out-of-network* In-network Out-of-network*
Deductible (The amount you pay for services before the plan begins paying benefits.)

Individual $500

Family $1,000

Individual $2,600

Family $5,200

Individual $400

Family $800

Individual $2,600

Family $5,200

Individual $1,600

Family $3,200**

Individual $1,600

Family $3,200**

Primary Care Doctor's Office Visit (other than routine physical) $30 copay 50% after deductible $30 copay 40% after deductible 10% after deductible*** 30% after deductible***
Specialist Office Visit $40 copay 50% after deductible $40 copay 40% after deductible 10% after deductible*** 30% after deductible***
Coinsurance (Your portion after you meet the deductible. Coinsurance does not apply to services with copays.) 20% after deductible 50% after deductible 10% after deductible 40% after deductible 10% after deductible 30% after deductible
Mental Health and Substance Abuse – Inpatient Services 20% after deductible 50% after deductible 10% after deductible 40% after deductible 10% after deductible 30% after deductible
Mental Health and Substance Abuse – Outpatient Services $30 copay
30% (deductible is waived) $30 copay
30% (deductible is waived) 10% after deductible 30% after deductible
Out-of-Pocket Maximum (The most you pay each calendar year for covered services; includes deductibles.)

Individual $3,500

Family $6,000

Individual $8,000

Family $15,000

Individual $2,000

Family $5,000

Individual $8,000

Family $15,000

Individual $3,000

Family $6,000

Individual $5,000

Family $10,000

Emergency Room $75 copay $75 copay $75 copay $75 copay 10% after deductible 10% after deductible

* IMPORTANT: Eligible expenses are determined based on 190% of the published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar service within the geographic market. Only the Medicare allowed amounts apply toward the deductible and out-of-pocket maximums. Any charges over the Medicare allowed amounts do not accumulate toward the deductible or out-of-pocket maximum. Your total out-of-pocket cost may include provider charges that are above the plan’s allowance.  

** One or more family members combined must meet the entire deductible that applies for family coverage before the Plan begins paying non-preventive care benefits, including prescription drug benefits.

*** Until the combined medical and prescription drug deductible is met, you will pay the full cost of your non-preventive medical expenses and non-preventive prescription drug expenses. Preventive drugs on the CVS/Caremark Preventive Drug Therapy List are not subject to the deductible. Coinsurance of 10% will apply.

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2020 Medical Plan Contributions

Monthly medical plan contributions are based on the plan you choose, the level of coverage, and your annual base salary. The University pays the majority of the cost of health care coverage for all eligible employees.  

Tier 1: Base Salary Under $50,000
UHC Value   UHC Advantage
UHC HDHP + HSA  
Employee $18 $60
$29
Employee + Spouse / Domestic Partner $157 $268 $124
Employee + Child(ren) $140 $244 $113
Employee + Spouse / Domestic Partner + Child(ren) $224 $381 $177
Tier 2: Base Salary $50,000 - $74,999
UHC Value   UHC Advantage
UHC HDHP + HSA  
Employee $67 $117
$53
Employee + Spouse / Domestic Partner $239 $363 $169
Employee + Child(ren) $217 $329 $153
Employee + Spouse / Domestic Partner + Child(ren) $340 $521 $244
Tier 3: Base Salary $75,000 - $124,999
UHC Value   UHC Advantage
UHC HDHP + HSA  
Employee $116 $175
$82
Employee + Spouse / Domestic Partner $340 $485 $227
Employee + Child(ren) $310 $443 $205
Employee + Spouse / Domestic Partner + Child(ren) $490 $693 $322
Tier 4: Base Salary $125,000 - $174,999
UHC Value   UHC Advantage
UHC HDHP + HSA
Employee $156 $217
$102
Employee + Spouse / Domestic Partner $466 $632 $296
Employee + Child(ren) $421 $573 $268
Employee + Spouse / Domestic Partner + Child(ren) $667 $902 $420
Tier 5: Base Salary $175,000 +
UHC Value   UHC Advantage
UHC HDHP + HSA
Employee $197 $258
$128
Employee + Spouse / Domestic Partner $534 $715 $327
Employee + Child(ren) $482 $647 $296
Employee + Spouse / Domestic Partner + Child(ren) $762 $1,021 $467

Decision Support Tool

The Decision Support Tool available through the Benefits Resource Center can be used to help you identify the plan that best fits your needs. When you arrive at the medical enrollment screen, a pop-up window will open that will ask if you would like help choosing the plan that is right for you. See the step-by-step instructions (PDF) on how to best utilize the Decision Support Tool.

You may also call Health Advocate at 866-695-8622 to review your benefit options with a Health Advocate representative.

Summaries of Benefits & Coverage (SBCs)

Summary Plan Descriptions (SPDs)

 

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Consider HDHP + HSA Plan

The consumer-driven health plan offered by NYU, the High Deductible Health Plan (HDHP) with Health Savings Account (HSA), provides 100% coverage of eligible in-network preventive care services and significantly lower payroll deductions than the other medical plan options.