Medical Plans: Comprehensive coverage for you and your family.

2021 Medical Plan Options

You are eligible to participate in the following three UnitedHealthcare (UHC) medical plans:

  • UHC Choice Plus Point of Service (POS) Plan
  • UHC Choice Plus Value Point of Service (POS) Plan
  • UHC High Deductible Health Plan (HDHP) with Health Savings Account (HSA)

The UHC plans provide for care received both in-network and out-of-network. If covered by the UHC Value or HDHP with HSA plans, 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 access additional resources, view plan coverage, check the status of a claim, search for a provider, and print a temporary identification card, visit myuhc.com. (First time users will need the member ID number from their medical ID card to register for access.)

Key Features Choice Plus POS Choice Plus POS Value POS Value POS 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 $200

Family $400

Individual $800

Family $1,600

Individual $500

Family $1,000

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) $20 copay 30% after deductible $30 copay 50% after deductible 10% after deductible**** 30% after deductible****
Specialist Office Visit $30 copay 30% after deductible $40 copay 50% after deductible 10% after deductible**** 30% after deductible****
Coinsurance (Your portion after you meet the deductible. Coinsurance does not apply to services with copays.) 10% after deductible 30% after deductible 20% after deductible 50% after deductible 10% after deductible 30% after deductible
Mental Health and Substance Abuse – Inpatient Services 10% after deductible 30% after deductible 20% after deductible 50% after deductible 10% after deductible 30% after deductible
Mental Health and Substance Abuse – Outpatient Services $20 copay 30% after deductible
$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 $2,000

Family $4,000

Individual $6,000

Family $12,000

Individual $3,500

Family $6,000

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

* Reasonable and Customary (R&C) out-of-network charges are the maximum charges that the plan will consider for a particular service in a particular area when you use an out-of-network provider. R&C limits are generally determined by geography, as charges can vary for the same service in different parts of the country. Your total out-of-pocket cost may include provider charges that are above the plan’s R&C allowance.

** 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. 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.                                                                                                                                                    Back to top

2021 Medical Plan Contributions

Your monthly medical plan contributions are based on the plan you choose and your level of coverage. The University pays the majority of the cost of health care coverage for all eligible employees.

Coverage Category
UHC Choice Plus POS UHC Value POS UHC HDHP + HSA
Employee $60 $45
$25
Employee + Spouse / Domestic Partner $120 $95 $50
Employee + Child(ren) $100 $70 $35
Employee + Spouse / Domestic Partner + Child(ren) $140 $110 $70

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 (Google Doc) 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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