Medical

Which Medical Plan is Right?

Evaluate Your Needs. Consider your prior health care usage and select plans and options that fit your lifestyle and needs.

  • Do you take regular prescription medications?
  • Are you anticipating surgery or non-preventive dental care?
  • Did you experience a qualifying life event this year?
  • Review your current plans to ensure you have the coverage you need.

Review this benefits website to learn about your new and existing plan options.

A little bit of planning will help you select the best plans, coverage levels, and financial programs for your unique situation.

Medical Plan Comparison

You have a choice of four medical plan options to help you and your family take charge of your health care and find the right fit. These plans have different copayments, coinsurance, deductibles, and out-of-pocket limits.

Each of the options includes prescription drug coverage.

Medical plans are administered by BlueCross.

Enhanced HSA Standard HSA Enhanced PPO Standard PPO
Deductibles, Out-of-Pocket Limits & Benefit Maximums
The following Deductibles, Out-of-Pocket Limits, and Benefit Maximums apply to all services. All copays are before deductible.
Deductibles
Individual (per Benefit Period) $1,500 (aggregate) $3,000 (embedded) $2,000 (embedded) $4,000 (embedded)
Family Member (per Benefit Period) $3,000 (aggregate) N/A
Family (per Benefit Period) $3,000 (aggregate) $6,000 (embedded) $4,000 (embedded) $8,000 (embedded)
Out-of-Pocket Limits
Individual (per Benefit Period) $2,500 (aggregate) $5,000 (embedded) $4,000 (embedded) $6,000 (embedded)
Family Member (per Benefit Period) $5,000 (aggregate) N/A
Family (per Benefit Period) $5,000 (aggregate) $10,000 (embedded) $8,000 (embedded) $12,000 (embedded)
Benefit Maximums
Lifetime Total Dollar Maximum Unlimited
Lifetime Infertility Benefit Maximum. Ovulation Induction Cycles. 3 Cycle Limits
Annual Benefit Maximums
Maximums apply to Home, Office and Outpatient Settings only, unless otherwise indicated. Maximums include both Habilitative and Rehabilitative services unless otherwise indicated. All maximums are on a combined In- and Out-of-Network basis per Member, per Benefit Period
Physical, Occupational and Chiropractic Therapies (combined) 30 visits
Speech Therapy 30 visits
Adaptive Behavior Treatment is covered for members, up to age 19 $40,000
Skilled Nursing Facility Stay 60 days
Provider Office visits for the evaluation and treatment of obesity (maximum does not apply to dietician/nutritional visits) 4
Physician Office Services
(see "Outpatient Services" for "outpatient clinic" or "hospital-based" services.)
Office Visit
Includes all Office Visits regardless of specialty or diagnosis (including medical, mental health, substance use disorder, infertility, therapies and pre-natal/post-delivery care unable to be included in the global delivery fee). Includes Office Surgery, Consultation, X-rays and Labs
Primary Care Provider 90% after deductible 70% after deductible $25 $35
Specialist 90% after deductible 70% after deductible $50 60% after deductible
Mental Health and Substance Use Disorder 90% after deductible 70% after deductible $10 $10
Preventive Care (Primary Preventive Diagnosis Only)
Primary Care Provider 100% no deductible 100% no deductible 100% no deductible 100% no deductible
Specialist 100% no deductible 100% no deductible 100% no deductible 100% no deductible
Urgent and Emergency Care
Ambulance 90% after deductible 70% after deductible 80% after deductible 60% after deductible
Emergency Room Visit 90% after deductible 70% after deductible $500 60% after deductible
Urgent Care Centers 90% after deductible 70% after deductible $50 $50
Inpatient Hospital Services
Includes all Inpatient Hospital Services regardless of diagnosis (including, but not limited to, medical, mental health, substance use disorder, infertility, therapies, transplants, deliveries, and surgeries.)
Inpatient Hospital Facility Services 90% after deductible 70% after deductible 80% after deductible 60% after deductible
Inpatient Hospital Professional Services 90% after deductible 70% after deductible 80% after deductible 60% after deductible
Outpatient Services
Hospital Based or Free-Standing Facility Services. (other than preventive services above) 90% after deductible 70% after deductible 80% after deductible 60% after deductible
Outpatient Diagnostic Services (Outpatient lab tests) 90% after deductible 70% after deductible 80% after deductible 60% after deductible
Preventive Mammography 100% no deductible 100% no deductible 100% no deductible - outpatient 100% no deductible - outpatient
Diagnostic Mammography 100% after deductible 100% after deductible 100% no deductible - outpatient 100% no deductible - outpatient
Outpatient X-rays, ultrasounds, and other diagnostic tests such as EEGs and EKGs 90% after deductible 70% after deductible 80% after deductible 60% after deductible
Other Services
Skilled Nursing Facility 90% after deductible 70% after deductible 80% after deductible 60% after deductible
Home Health Care and Hospice 90% after deductible 70% after deductible 80% after deductible 60% after deductible
Durable Medical Equipment, Prosthetics and Orthotics 90% after deductible 70% after deductible 80% after deductible 60% after deductible
CT Scans, MRIs, MRAs and PET scans in any location, including a physician's office 90% after deductible 70% after deductible 80% after deductible 60% after deductible

Note: Please consult plan documents for full benefits, exclusions, and limitations.

Enhanced HSA
Summary of Benefits
and Coverage
Standard HSA
Summary of Benefits
and Coverage
Enahnced PPO
Summary of Benefits
and Coverage
Standard PPO
Summary of Benefits
and Coverage
United HealthCare
Get the Most from your Benefits
UHC Contact Sheet
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