Medical and Prescription Drug Options
Provider access available through the UnitedHealthcare Choice Plus® Network, administered by UMR.
Plan Name | HDHP 1 | HDHP 2 | PPO | |||
---|---|---|---|---|---|---|
IN-NETWORK | OUT-OF-NETWORK | IN-NETWORK | OUT-OF-NETWORK | IN-NETWORK | OUT-OF-NETWORK | |
Annual Deductible | $2,000 individual / $3,000 family | $3,000 individual / $6,000 family | $3,000 individual / $6,000 family | $4,000 individual / $8,000 family | $500 individual / $1,000 family | $500 individual / $1,000 family |
Type of Family Deductible* | Aggregate | Embedded | Embedded | |||
Annual Out-of-Pocket Maximum | $4,000 individual / $6,550 family | $8,000 individual / $13,000 family | $3,500 individual / $7,000 family | $8,000 individual / $16,000 family | $5,000 individual / $10,000 family | $10,000 individual / $20,000 family |
Type of Family Out-of-Pocket Maximum | Embedded | Embedded | Embedded | |||
Genesys Annual HSA Contribution** | $750 individual* / $1,500 family* |
$750 individual* / $1,500 family* |
$750 individual* / $1,500 family* |
$750 individual* / $1,500 family* |
N/A | N/A |
Preventive Care | Covered in full | Not covered | Covered in full | Not covered | Covered in full | Not covered |
Physician Office Visit | You pay 20% after deductible | You pay 40% after deductible | You pay 10% after deductible | You pay 30% after deductible | $20 copay | You pay 50% |
Specialist Office Visit | You pay 20% after deductible | You pay 40% after deductible | You pay 10% after deductible | You pay 30% after deductible | $20 copay | You pay 50% |
Urgent Care | You pay 20% after deductible | You pay 40% after deductible | You pay 10% after deductible | You pay 30% after deductible | $50 copay | You pay 50% |
Emergency Room (copay waived if admitted) | You pay 20% after deductible | You pay 10% after deductible | You pay 30% | |||
Prescription Drug Retail (up to a 30-day supply) | ||||||
Tier 1 (Generic) | You pay 20% after deductible | You pay 20% after deductible plus any network cost difference | You pay 10% after deductible | You pay 10% after deductible plus any network cost difference | $8 copay | $8 copay plus any network cost difference |
Tier 2 (Brand-Preferred) | You pay 20% after deductible | You pay 20% after deductible plus any network cost difference | You pay 10% after deductible | You pay 10% after deductible plus any network cost difference | $30 copay | $30 copay plus any network cost difference |
Tier 3 (Brand Non-Preferred) | You pay 20% after deductible | You pay 20% after deductible plus any network cost difference | You pay 10% after deductible | You pay 10% after deductible plus any network cost difference | $50 copay | $50 copay plus any network cost difference |
Prescription Drug Mail Order (up to a 90-day supply) | ||||||
Tier 1 (Generic) | You pay 20% after deductible | N/A | You pay 10% after deductible | N/A | $20 copay | N/A |
Tier 2 (Brand-Preferred) | You pay 20% after deductible | N/A | You pay 10% after deductible | N/A | $75 copay | N/A |
Tier 3 (Brand Non-Preferred) | You pay 20% after deductible | N/A | You pay 10% after deductible | N/A | $125 copay | N/A |
* Learn more about aggregate and embedded deductibles and see how these deductibles work within each plan in the callout box below.
** One fourth of the annual Genesys contribution is deposited in your HSA account each calendar quarter, on or near the first business day of each quarter. Must be employed and enrolled in a High Deductible Health Plan by the 1st day of each calendar quarter (January 1, April 1, July 1 and October 1) in which the funding occurs in order to receive the employer contribution for that quarter.
Click here for machine-readable files (MRFs) listing in-network rates and out-of-network allowed amounts.