Medical Plans
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.
To access additional resources, view plan coverage, check the status of a claim, search for a provider, and print a temporary identification card, visit UnitedHealthcare's website at myuhc.com. (First time users will need the member ID number from their medical ID card to register for access.)
UHC Medical and Mental Health Well-Being Resources:
|
Coverage Category |
UHC Choice Plus POS | UHC Value POS | UHC HDHP + HSA |
|---|---|---|---|
| Employee | $70 |
$55 |
$35 |
| Employee + Spouse / Domestic Partner | $140 | $115 | $70 |
| Employee + Child(ren) | $110 | $80 | $45 |
| Employee + Spouse / Domestic Partner + Child(ren) | $160 | $130 | $90 |
| Key Features | Choice Plus | Choice Plus | Value | Value | 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.
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 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.
Summaries of Benefits & Coverage (SBCs)
- 2023 UHC Choice Plus Plan SBC (PDF: 815 KB)
- 2023 UHC Value Plan SBC (PDF: 682 KB)
- 2023 UHC HDHP + HSA SBC (PDF: 671 KB)
Summary Plan Descriptions (SPDs)
- UHC Choice Plus Plan SPD (PDF: 2.1 MB)
- UHC Value Plan SPD (PDF: 2 MB)
- UHC HDHP + HSA SPD (PDF: 1.9 MB)
- Summary of Material Modifications (SMM) Effective 9-1-2022 (Google Doc: 8 KB)
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.