Medical Plans

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Medical Plan Options
Medical Plan Contributions
Comparison of Plan Features
Decision Support Tool
Summaries of Benefits & Coverage (SBCs)
Summary Plan Descriptions (SPDs)

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 Plan
UHC Choice Plus Advantage 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 at myuhc.com. First time users will need the member ID number from their UHC ID card to register for access (PDF: 275 KB).

UHC Medical and Mental Health Well-Being Resources:

2023 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	Value	Advantage	HDHP + HSA
Employee	$20	$66	$31
Employee + Spouse / Domestic Partner	$172	$294	$132
Employee + Child(ren)	$154	$268	$121
Employee + Spouse / Domestic Partner + Child(ren)	$245	$419	$189

Tier 2: Base Salary $50,000 - $74,999	Value	Advantage	HDHP + HSA
Employee	$74	$129	$57
Employee + Spouse / Domestic Partner	$263	$398	$180
Employee + Child(ren)	$238	$361	$163
Employee + Spouse / Domestic Partner + Child(ren)	$373	$573	$260

Tier 3: Base Salary $75,000 - $124,999	Value	Advantage	HDHP + HSA
Employee	$128	$193	$87
Employee + Spouse / Domestic Partner	$373	$532	$241
Employee + Child(ren)	$341	$487	$218
Employee + Spouse / Domestic Partner + Child(ren)	$537	$761	$343

Tier 4: Base Salary $125,000 - $174,999	Value	Advantage	HDHP + HSA
Employee	$171	$238	$109
Employee + Spouse / Domestic Partner	$511	$694	$315
Employee + Child(ren)	$462	$630	$285
Employee + Spouse / Domestic Partner + Child(ren)	$732	$991	$447

Tier 5: Base Salary $175,000 +	Value	Advantage	HDHP + HSA
Employee	$216	$284	$136
Employee + Spouse / Domestic Partner	$586	$786	$348
Employee + Child(ren)	$529	$711	$315
Employee + Spouse / Domestic Partner + Child(ren)	$836	$1,121	$497

Medical Plan Comparison of Key Features

Key Features	Value	Value	Advantage	Advantage	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.

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 Decision Support Tool instructions (Google Doc: 37 KB) 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.

Tip: Consider HDHP + HSA Plan

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.

Summaries of Benefits & Coverage (SBCs)

Summary Plan Descriptions (SPDs)

No Surprises Act

Learn about the No Surprises Act and Transparency in Coverage Rule (Google Doc: 9 KB). UnitedHealthcare creates and publishes the Machine-Readable Files on behalf of New York University. Members can login to their myuhc.com account to find care and compare costs.