How the Plan Works

• Under the Traditional Plan, you pay a flat dollar copay for most eligible practitioner services. For example:
  • Most office visits have a copay, which is the amount you pay out of pocket. In 2012, all other services provided in the office including diagnostics and facility charges are subject to deductible and coinsurance.
  • Urgent care and emergency services have higher copay amounts than office visits.

• If you choose to receive your care out of network, you will be responsible for paying an annual deductible in 2011 of $1,000 individual/$2,000 family and coinsurance. You will also be responsible for paying any amount above reasonable and customary charges as determined by the plan administrator.

In 2012:

• The emergency room visit copay is increasing to $250.
• The annual deductible for all services is increasing to $400 individual/$800 family (Tier 1 UHACO in-network) and $1,500 individual/ $3,000 family (out-of-network).
• The annual out-of-pocket maximum for out-of-network care is increasing to $10,000 individual/$20,000 family.
• Coinsurance of 15% after the deductible will apply to most services, except preventive care and services requiring a copay like office visits.

See the Schedule of Benefits for how the plan pays for preventive care and other covered services.

2011 Schedule of Benefits

• If you live inside the UHACO Service Area, click here.
• If you live outside the UHACO Service Area, click here.

2012 Schedule of Benefits

• If you live inside the UHACO Service Area, click here.
• If you live outside the UHACO Service Area, click here.