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.
Deductibles, Coinsurance, Copayments and Out-of-Pocket Maximums -- PPO and Out-of-Area Plans
 
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 (for a true medical emergency)
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
2021 HSA Contribution from Stryker*
Employee
$500
$250
Employee + 1
$1,000
$500
Family
$1,000
$500
* 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.