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Your share in the cost of covered services

The Plan pays a certain portion of covered medical expenses. The portion you must pay is your coinsurance percentage or a copayment, depending on the type of service provided:
  • Coinsurance is a percentage of a covered expense or the recognized amount when applicable (for example, with the UHC Choice and Value PPO plans, you pay 20% and the Plan pays 80%). You pay your coinsurance share in addition to the deductible.
  • A copayment is a fixed charge like $25 or $40 for an office visit under the UHC Choice and Value PPOs. When a flat dollar copayment is required, the covered expense is not subject to the annual deductible. For example, with the UHC Choice and Value PPOs, you pay $25 for an office visit with a primary care physician-the Plan pays the balance and the annual deductible does not apply. There are no copays in the Basic or Premium HSA medical plans.
Your coinsurance share or copayment requirement differs depending on the Plan you elect. If you are enrolled in a UnitedHealthcare PPO or HSA medical plan, your coinsurance share (and copayment, if applicable) requirements differ when you use in-network versus out-of-network providers. See the chart under "Your medical benefits" for specific coinsurance and copayment amounts.