Your medical benefits
The chart below lists the deductibles, coinsurance (your share), copayments and out-of-pocket maximums that currently apply under the UnitedHealthcare Choice and Value PPO plans and the Out-of-Area plan.
Amounts which you are required to pay as shown below in the chart below are based on eligible expenses or, for specific covered health services as described in the definition of "
Recognized Amount" in "
Medical plan definitions".
| |
UHC Choice PPO Plan
|
UHC Value PPO Plan
|
UHC Out-of-Area Plan
|
| |
In-Network
|
Out-of-Network
(MNRP guidelines apply)
|
In-Network
|
Out-of-Network
(MNRP guidelines apply)
|
Out-of-Area Plan
(R&C guidelines apply)
|
|
Annual deductible
|
|
Employee
|
$350
|
$700
|
$750
|
$1,500
|
$350
|
|
Employee + 1
|
$700
|
$1,400
|
$1,500
|
$3,000
|
$700
|
|
Family
|
$1,050
|
$2,100
|
$2,250
|
$4,500
|
$1,050
|
|
Your share in the cost of covered services-after deductible unless noted
|
|
Office visit copayment-primary care
|
$25; not subject to deductible
|
40%
|
$25; not subject to deductible
|
40%
|
20%
|
|
Physician, Lab & X-ray services
|
20%
|
40%
|
20%
|
40%
|
20%
|
|
Office visit copayment-specialist
|
$40; not subject to deductible
|
40%
|
$40; not subject to deductible
|
40%
|
20%
|
|
Preventive care
|
|
Office visits
|
$0 (Plan pays 100% of eligible expenses)
|
40%; not subject to deductible
|
$0 (Plan pays 100% of eligible expenses)
|
40%; not subject to deductible
|
$0 (Plan pays 100% of eligible expenses)
|
|
Other covered services
|
$0 (Plan pays 100% of eligible expenses)
|
40%; not subject to deductible
|
$0 (Plan pays 100% of eligible expenses)
|
40%; not subject to deductible
|
$0 (Plan pays 100% of eligible expenses)
|
|
Emergency room visits-after deductible unless noted
|
|
Facility and physician charges
|
$150; not subject to deductible
|
$150; not subject to deductible
|
$150; not subject to deductible
|
$150; not subject to deductible
|
$150; not subject to deductible
|
|
Inpatient hospital care
|
20%
|
40%
|
20%
|
40%
|
20%
|
|
Inpatient mental health and substance-related and addictive disorder treatment
|
20%
|
40%
|
20%
|
40%
|
20%
|
|
Annual out-of-pocket maximum
|
|
Employee
|
$2,950
|
$5,900
|
$4,250
|
$8,500
|
$2,950
|
|
Employee + 1
|
$5,900
|
$11.800
|
$8,500
|
$17,000
|
$5,900
|
|
Family
|
$6,250
|
$12,500
|
$9,250
|
$18,500
|
$6,250
|
The chart below lists the deductibles, coinsurance (your share), and out-of-pocket maximums that currently apply under the UnitedHealthcare Basic and Premium HSA Plans
Deductibles, coinsurance and out-of-pocket maximums — HSA Plans
| |
UHC Premium HSA Plan
|
UHC Basic HSA Plan
|
| |
In-Network
|
Out-of-Network
(MNRP guidelines apply)
|
In-Network
|
Out-of-Network
(MNRP guidelines apply)
|
|
Annual deductible
|
|
Employee
|
$1,500
|
$3,000
|
$2,500
|
$5,000
|
|
Employee + 1
|
$3,000
|
$6,000
|
$5,000
|
$10,000
|
|
Family
|
$3,000
|
$6,000
|
$5,000
|
$10,000
|
|
Your share in the cost of covered services-after deductible unless noted
|
|
Office visit copayment-primary care
|
20% after deductible
|
40% after deductible
|
30% after deductible
|
50% after deductible
|
|
Office visit copayment-specialist
|
20% after deductible
|
40% after deductible
|
30% after deductible
|
50% after deductible
|
|
Preventive care
|
|
Office visits
|
$0 (Plan pays 100% of eligible expenses)
|
40% after deductible
|
$0 (Plan pays 100% of eligible expenses)
|
50% after deductible
|
|
Other covered services
|
$0 (Plan pays 100% of eligible expenses)
|
40% after deductible
|
$0 (Plan pays 100% of eligible expenses)
|
50% after deductible
|
|
Emergency room visits-after deductible
|
|
Facility and physician charges
|
20% after deductible
|
20% after deductible
|
30% after deductible
|
30% after deductible
|
|
Inpatient hospital care
|
20% after deductible
|
40% after deductible
|
30% after deductible
|
50% after deductible
|
|
Inpatient mental health and substance-related and addictive disorder treatment
|
20% after deductible
|
40% after deductible
|
30% after deductible
|
50% after deductible
|
|
Annual out-of-pocket maximum
|
|
Employee
|
$5,000
|
$10,000
|
$6,450
|
$12,900
|
|
Employee + 1
|
$10,000
|
$20,000
|
$12,900
|
$25,800
|
|
Family
|
$10,000
|
$20,000
|
$12,900
|
$25,800
|
|
2023 HSA contribution from Stryker*
|
|
Employee
|
$600
|
$300
|
|
Employee + 1
|
$1,200
|
$600
|
|
Family
|
$1,200
|
$600
|
* Refer to the Health Savings Account section for additional details. Direct Temps and employees scheduled to work less than 20 hours who have measured as eligible for medical coverage during their measurement period are not eligible for the company contribution. Also, employees hired between December 2 and December 31 are not eligible to receive the company contribution. In addition, the company contribution is not guaranteed each year and will be reviewed on an annual basis.