This is the percentage of the cost you pay when you receive certain healthcare services. Example: For in-network services under the Choice Plus plan, plan participants pay 20% and the County pays 80% of covered expenses for most services. The 20% share is the employee’s coinsurance.
This is the flat-dollar amount you pay when you receive certain medical care services. Co-pays are typically due at the time you receive service. Example: Enrollees in the plan pay a $30 co-pay for in-network doctor’s office visits.
This is the amount you are required to pay each year before the plan begins to pay benefits. You begin accumulating expenses toward the satisfaction of your deductible at the beginning of each year (January 1). Example: With each new benefit year, employees who elect self-only coverage under the Choice Plus Plan pay the first $1,250 toward services subject to the plan's deductible. Employees who elect coverage for themselves and their spouse pay the first $1,250 per individual, up to a maximum of $2,500 per family, toward services subject to the plan’s deductible.
This is care or services provided by doctors, hospital, labs or other facilities that participate in the network of providers assembled by United Healthcare. Generally, you pay less when you receive care in-network because the providers in the network agree to charge a pre-negotiated, lower fee. This reduces your out-of-pocket cost and claims costs.
This is the care or services furnished by doctors, hospitals, labs or other facilities that DO NOT participate in the United Healthcare’s provider network. If you use an out-of-network provider, your share of the cost is based on the reasonable and customary charges allowed by the plan. Amounts charged over the reasonable and customary do not count toward annual deductibles and out-of-pocket maximums.
Be sure you understand the amount you will be required to pay out of your own pocket if you seek care out-of-network.
When you meet the annual out-of-pocket maximum, the plan will pay the full cost of covered expenses for the remainder of the calendar year. Covered expenses (e.g., deductible and coinsurance amounts) apply toward the out-of-pocket maximum. Prescription drug co-payments are not applied toward the out-of-pocket maximum. In addition, out-of-pocket costs incurred for non-covered services or supplies in excess of the plan’s covered expenses (e.g., expenses incurred for out-of-network that exceed the reasonable or customary changes allowed by the plan) are not applied toward the out-of-pocket maximum; these non-covered charges are the plan participant’s financial responsibility.