Medical
and Prescription Drug Overview
This is a summary of In-Network
Benefits for our UnitedHealthcare medical and prescription drug plans for the
upcoming plan year January 1, 2023 to December 31, 2023. Our plans allow you
the freedom to use providers in and out-of-network; however, charges are paid
at a lower percentage for out-of-network providers.
Prior authorization is required for certain services, tests,
and procedures; your provider will coordinate any necessary prior authorization. Additional information
about UnitedHealthcare plans is available on the RCPS Intranet website, Human
Resources page. Or you may call the phone number on your UnitedHealthcare medical card.
|
|
HDHP with HSA
|
HRA
|
Traditional
|
|
Deductible
- Individual
- Family
|
$3,000
$6,000
|
$2,000
$4,000
|
$500
$1,000
|
|
Out-of-Pocket Max
- Individual
- Family
|
$5,000
$10,000
|
$4,000
$8,000
|
$2,000
$4,000
|
|
Preventive
Care
|
0%
|
0%
|
0%
|
|
Virtual
Visit
|
$49
Before Deductible 20% After Deductible
|
$25
|
$20
|
|
Office Visit
- Primary Care
- Specialist
|
20% After Deductible
|
$25
$50
|
$20
$40
|
|
In
office Lab & X-ray
|
20%
After Deductible
|
20%
After Deductible
|
20%
After Deductible
|
|
Outpatient
Facility (surgery, etc.)
|
20%
After Deductible
|
20%
After Deductible
|
20%
After Deductible
|
|
Inpatient Hospitalization
|
20%
After Deductible
|
20%
After Deductible
|
20%
After Deductible
|
|
Emergency
Room
|
20%
After Deductible
|
20%
After Deductible
|
20%
After Deductible
|
|
Prescription Drugs - Express Scripts
- Retail (31 day supply)
- Mail Order (90 day supply)
- Deductible
|
20% After Deductible
(combined with Medical Deductible)
|
$10/30/60/80*
$20/60/120
*The 4th tier is for Specialty Drugs.
|
$10/20/40/60*
$20/40/80
*The 4th tier is for Specialty Drugs.
|
Medical and Prescription Drug Overview
This
is a summary of In-Network Benefits for our UnitedHealthcare medical
and prescription drug plans for the upcoming plan year January 1, 2016
to December 31, 2016. Our plans allow you the freedom to use providers
in and out-of-network; however, charges are paid at a lower percentage
for out-of-network providers. Additional information about
UnitedHealthcare plans is available on the Benefit Enrollment Hub on the
RCPS website, Human Resources page.
|
HDHP with HSA
|
HRA
|
Traditional
|
|
Deductible
- Individual
- Family
|
$3,000
$6,000
|
$2,000
$4,000
|
$500
$1,000
|
|
Out-of-Pocket Max
- Individual
- Family
|
$5,000
$10,000
|
$4,000
$8,000
|
$2,000
$4,000
|
|
Preventive Care
|
0%
|
0%
|
0%
|
|
Virtual Visit
|
$39-$40 Before Deductible 20% After Deductible
|
$25
|
$20
|
|
Office Visit
- Primary Care
- Specialist
|
20% After Deductible
|
$25
$50
|
$20
$40
|
|
In office Lab & X-ray
|
20% After Deductible
|
20% After Deductible
|
20% After Deductible
|
|
Outpatient Facility (surgery, etc.)
|
20% After Deductible
|
20% After Deductible
|
20% After Deductible
|
|
Inpatient Hospitalization
|
20% After Deductible
|
20% After Deductible
|
20% After Deductible
|
|
Emergency Room
|
20% After Deductible
|
20% After Deductible
|
20% After Deductible
|
|
Prescription Drugs
- Retail (31 day supply)
- Mail Order (90 day supply)
- Deductible
|
20% After Deductible
(combined with Medical Deductible)
|
$10/30/60
$20/60/120
|
$10/20/40
$20/40/80
N/A
|
- See more at: http://www.rcps.info/cms/One.aspx?portalId=468655&pageId=9297354#sthash.wjYafwFq.dpuf