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UnitedHealthcare

UHC Gold Advantage+ Extra ($3 Rx + Dental + Vision + 3 Free Primary Care & 3 Free Virtual Visits)

Plan Overview

Combined Medical and Drug Deductible
  • Individual: $2,000
  • Family: $4,000
  • Per Person: $2,000
Combined Medical and Drug Out of Pocket Maximum
  • Individual: $8,500
  • Family: $17,000
  • Per Person: $8,500

Office Visit

Primary Doctor
  • CoPay: $10.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: First 3 in-person visits $0. First 3 virtual urgent care visits $0. See SBC for additional cost share details. Virtual Primary Care limited to age 18 and older.
Specialist
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered

Prescription Drug Information

Preferred Brand Drugs
  • CoPay: $55.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Limit Quantity: 30
  • Limit Unit : Days per Month
  • Benefit Explanation: 90-day supplies available at a Preferred Retail Pharmacy or Home Delivery. Covers outpatient self-administered prescription legend drugs from a participating network pharmacy. Quantity limits per prescription may apply.
Non Preferred Brand Drugs
  • CoPay: Not Applicable
  • CoInsurance: 40.00% Coinsurance after deductible
  • Covered: Covered
  • Limit Quantity: 30
  • Limit Unit : Days per Month
  • Benefit Explanation: 90-day supplies available at a Preferred Retail Pharmacy or Home Delivery. Covers outpatient self-administered prescription legend drugs from a participating network pharmacy. Quantity limits per prescription may apply.
Generic Drugs
  • CoPay: $3.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Limit Quantity: 30
  • Limit Unit : Days per Month
  • Benefit Explanation: See SBC for Non-Preferred Pharmacy Cost Share and (non-preferred) Generic Cost Share. 90-day supplies available at a Preferred Retail Pharmacy or Home Delivery. Covers outpatient self-administered prescription legend drugs from a participating network pharmacy. Quantity limits per prescription may apply.
Specialty Drugs
  • CoPay: Not Applicable
  • CoInsurance: 50.00% Coinsurance after deductible
  • Covered: Covered
  • Limit Quantity: 30
  • Limit Unit : Days per Month
  • Benefit Explanation: Covers outpatient self-administered prescription legend drugs from a participating network pharmacy. Quantity limits per prescription may apply.

Inpatient Coverage

Hospital Services
  • CoPay: Not Applicable
  • CoInsurance: 20% Coinsurance after deductible
  • Covered: Covered
Inpatient Services
  • CoPay: Not Applicable
  • CoInsurance: 20% Coinsurance after deductible
  • Covered: Covered

Emergency and Urgent Care

Emergency Room
  • CoPay: No Charge after deductible
  • CoInsurance: 20% Coinsurance after deductible
  • Covered: Covered
Urgent Care Facility
  • CoPay: $50.00
  • CoInsurance: Not Applicable
  • Covered: Covered

Maternity

Labor and Delivery Hospital Stay
  • CoPay: Not Applicable
  • CoInsurance: 20% Coinsurance after deductible
  • Covered: Covered
Pre and Postnatal Office Visit
  • CoPay: Not Applicable
  • CoInsurance: No Charge
  • Covered: Covered

Vision

Routine Eye Exams For Children
  • CoPay: Not Applicable
  • CoInsurance: No Charge
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Exam(s) per Year

Major Dental Care

Routine Dental Checkups for Children
  • CoPay: Not Applicable
  • CoInsurance: No Charge
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Visit(s) per 6 Months
Routine Dental Checkups for Adults
  • CoPay: No Charge
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Limit Quantity: 1000
  • Limit Unit : Dollars per Year
  • Benefit Explanation: $1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults; Excluded from In-Network Out-of-Pocket Limit
Basic Dental Care - Adult
  • CoPay: Not Applicable
  • CoInsurance: 50.00%
  • Covered: Covered
  • Limit Quantity: 1000
  • Limit Unit : Dollars per Year
  • Benefit Explanation: $1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults; Excluded from In-Network Out-of-Pocket Limit
Basic Dental Care - Child
  • CoPay: Not Applicable
  • CoInsurance: 20% Coinsurance after deductible
  • Covered: Covered
Major Dental Care - Adult
  • CoPay: Not Applicable
  • CoInsurance: 50.00%
  • Covered: Covered
  • Limit Quantity: 1000
  • Limit Unit : Dollars per Year
  • Benefit Explanation: $1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults; Excluded from In-Network Out-of-Pocket Limit
Major Dental Care - Child
  • CoPay: Not Applicable
  • CoInsurance: 20% Coinsurance after deductible
  • Covered: Covered

Medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization, Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc.; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in LA, TN and AL; Optimum Choice, Inc. in VA and MD; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of Texas, Inc.; and UnitedHealthcare of Oregon, Inc. in WA. Administrative Services provided by United HealthCare Services, Inc. or their affiliates.

Plan specifics and benefits may vary by coverage area and by plan category. Please review the plan details to learn more. This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable). By responding to this offer, you agree that a representative may contact you.

You are required to select a Primary Care Physician (PCP) within our network. Your PCP refers you to specialists when necessary. If you use a specialist without a referral or see a provider who is not in your network, you may have to pay the full cost of the benefits and services. Emergency services received by an out-of-network provider are covered.

Health Maintenance Organization, Inc. in Colorado and UnitedHealthcare Insurance Co. in Tennessee. Administrative Services provided by United HealthCare Services, Inc. or their affiliates.

Plan specifics and benefits may vary by coverage area and by plan category. Please review the plan details to learn more. This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable). By responding to this offer, you agree that a representative may contact you.

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