United Health Care Documents
Page 5 UNITED HEALTHCARE Quote:
DEDUCTIBLE 250/500 maximum - this applies per year for each person under cover?
The first deductible on the left, $250 in this case, pertains to the deductible applicable to an individual in network; the deductible on the right, $500, applies to the individual out of network. Below that you will find $750 / $1500 which means the same thing but for family’s instead.
OUT OF POCKET 2500/5000 – can you please provide a detail definition of what this means.
Once the individual pays their deductible, they are then subject to 10% coinsurance (your percentage of responsibility for applicable services rendered) and United Healthcare would cover the other 90% in network. However, you pay 10% to a maximum of $2250 in network which on top of the $250 deductible makes your total out of pocket maximum $2500 for and individual in network. Out of network, $5000 is an individual’s maximum out of pocket which would mean one would be subject to 50% coinsurance to a maximum of $4500 after the $500 out of network deductible.
IND HRA CONTRIBUTION RANGE $50 – $125.00 — what is this?
This is a health reimbursement account in which an employer must contribute a minimum of $50 and a maximum of $125 to an account that can be used when an employee submits a claim.
Deductible applies to all medical visits, treatments, tests, etc., correct?
I have attached the benefit details for this plan only in which will more clearly state where the deductible applies and furthermore, what copayments apply for specific services, etc. In general, you’ll find that you will be subject to a $20 copay at your Primary care physician’s office, and $35 at a specialist’s office. This would cover all routine exams and annual check-ups including routine labs; the deductible would apply to any inpatient or outpatient benefits such as hospital admissions, CT scans, MRI, etc. But please review the attachment for further details.
It is important to note that out of network, your out of network deductible of $500 would apply first and then 50% coinsurance for all services rendered.
Does this include a Major Medical Limit and when does it go into effect ?
Please correct me if I misunderstood, but I believe you are referring to the maximum policy benefit which would be a combined network and non-network maximum of 5 million per covered person; that would be the maximum of how much United Healthcare would pay during the entire period the person is covered under the policy.
Office visit copay/coinsurance $20.00 – this is all we have to pay per visit for both a primary physician as well as a specialist visit?
As noted in a previous answer, it is $35 at a specialist’s office.
Does this insurance cover Vision? If so, what is the premium and is it included on the premium quoted?
Page 12 indicates the respective premiums for the two vision plans available which would be in addition to the premiums illustrated under the medical plans. I’ve gone ahead and attached the two documents illustrating vision benefit details for these plans as well.
Does this plan cover us anywhere in the USA and with any doctor/hospital we choose or are there restrictions, and what are they?
Yes the United Healthcare choice plus network is national and I have gone ahead and attached a map illustrating network accessibility as well as an Orlando market network facts document which offers further details regarding number of physicians, hospitals, reimbursement methods, etc.
Do we need to have prior authorization from a primary doctor in order to visit a specialist?
No you do not need any referrals from a primary to visit a specialist since it is a PPO plan.
On Page 14 , do this points apply only to an HMO or does it also apply to a POS Plan?
These are actually just benefit details for state mandated basic and standard plans that would not apply to you.
- This $200.00 copay per test (PET scans, CAT scans, MRI’s, Nuclear Medicine) applies to the POS Plan?
- Is this $200.00 copay additional to the deductible?
UNITEDHEALTHCARE NETWORK FACTS
PRACTICAL INNOVATION. AFFORDABLE SOLUTIONS.
At UnitedHealthcare, success is measured by how well we help customers achieve convenient access to affordable, high-quality health care at the best contracted rate. Our network is truly national, with access across the country. We leverage the purchasing power of 38 million Americans and over $60 billion of annual health spending to pursue the highest quality and most cost-effective relationships with facilities, physicians and other health care professionals.
UnitedHealthcare listens to the needs of our customers through consultative account management and service. We have responded with innovative products and powerful network strategies to deliver practical solutions to the health care affordability challenge.
A NATIONAL LEADER
~ Products for all employer and employee segments – including new consumer-driven plans, voluntary specialty products, discount programs for non-covered services, and basic medical coverage for part-time workers.
~ National network access: over 4,800 hospitals, 62,000 pharmacies and 563,000 physicians and other health care professionals. Consistent benefit plan designs and access anywhere for companies with multiple locations.
~ Wellness programs: The UnitedHealth WellnessSM program is a portfolio of online and on-site programs designed to help individuals make healthier choices – and directly address a key driver of medical trend.
~ Care management and outreach programs: UnitedHealthcare works to improve the health and well-being of those with chronic conditions. Using our tightly integrated notification, assessment and predictive modeling capabilities, we can proactively contact the top high risk population, encouraging 50% of them to take action. We provide proactive support to individuals whether they are staying healthy, getting healthy, or living with chronic illness.
~ Practical Innovation: Simple online administration with Employer eServices. Educational and self-service tools for individuals at myuhc.com. Voice-activated self-service telephone systems for automated information. Electronic claims submission for physicians through unitedhealthcareonline.com.