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 HSA Employer 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 |
Annual Deductible | $2,000 individual / $2,800 family | $3,000 individual / $5,000 family | $2,800 individual / $4,000 family | $4,000 individual / $8,000 family | $500 individual / $1,000 family | $500 individual / $1,000 family |
Copayments/ Coinsurance Primary Care office visit Specialist office visit |
You pay 20% after dedctible | You pay 40% after deductible | You pay 10% after deductible | You pay 30% after deductible | $20 copay $20 copay |
You pay 50% You pay 50% |
Family Deductible Type** | Aggregate | Embedded | Embedded | |||
Annual Out-of-Pocket Maximum*** | $4,000 individual / $6,550 family | $8,000 individual / $13,000 family | $3,400 individual / $4,800 family | $8,000 individual / $16,000 family | $5,000 individual / $10,000 family | $10,000 individual / $20,000 family |
Preventive Care | You pay 0% Deductible waived |
Not covered | You pay 0% Deductible waived |
Not covered | You pay 0% | 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% |
ER (true emergency) | 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 |
* 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.
** Learn more about aggregate and embedded deductibles and see how these deductibles work within each plan in the callout box below.
***All plans have an embedded Out-of-Pocket Maximum.
Click here for machine-readable files (MRFs) listing in-network rates and out-of-network allowed amounts.