2018 Officers - Medical Plan Comparison Chart

Medical Plan Comparison Chart The Medical Plan Comparison Chart below summarizes the differences between each of the four University-provided medical plans. For detailed information, please review the Summary of Benefits and Coverage (SBC) and Summary Plan Description (SPD)

 

Medical Plan Comparison Chart 
BenefitHigh Deductible Health Plan (HDHP) Choice Plus 80Choice Plus 90Choice Plus 100
 In-NetworkOut-of-Network*In-NetworkOut-of-Network*In-NetworkOut-of-Network*In-NetworkOut-of-Network*
Annual Deductible 
  Individual 
  Family


$1500
$3,000


$2,900 per person


$600 per person**
 


$850 per person


$400 per person


$850 per person


$200 per person


$850 per person
Coinsurance90% after deductible60% after deductible80% after deductible60% after deductible90% after deductible60% after deductible100% after deductible90% after deductible
Out-of-pocket
Maximum 
   Individual
   Family


$3,550
$7,100


$6,850
$13,700


$3,750
$7,500


$5,250
$10,500


$3,250
$6,500


$5,250
$10,500


$4,750
$9,500


$5,250
$10,500 
Preventive Care100% Not covered100%Not covered100%Not covered100%Not covered
Physician Office Visits,
including specialists
90% after deductible
60% after deductible
$30 copay60% after deductible$30 copay60% after deductible$30 copay60% after deductible
Laboratory/ Radiology Services,
including services rendered
in a physician’s office
90% after deductible60% after deductible80% after deductible60% after deductible90% after deductible60% after deductible100% after deductible
if non-hospital location. 
$150 copay if hospital***
60% after deductible
Inpatient Hospital Care90% after deductible60% after deductible; Precertification required80% after deductible60% after deductible; Precertification required90% after deductible60% after deductible; Precertification required$500 copay per admission60% after deductible; Precertification required
Outpatient Hospital Care90% after deductible60% after deductible; Precertification required80% after deductible60% after deductible; Precertification required90% after deductible60% after deductible; Precertification required$150 copay (including
lab and radiology)***
60% after deductible; Precertification required
Mental Health and Substance Abuse—Inpatient care90% after deductible60% after deductible; Precertification required80% after deductible60% after deductible; Precertification required90% after deductible60% after deductible; Precertification required$500 copay per admission60% after deductible; Precertification required
Mental Health and Substance Abuse—Outpatient programs90% after deductible for facility-based care including intensive outpatient programs70% after deductible for facility-based care including intensive outpatient programs; Precertification required$30 copay70% after deductible for facility-based care including intensive outpatient programs; Precertification required$30 copay70% after deductible for facility-based care including intensive outpatient programs; Precertification required$30 copay****70% after deductible for facility-based care, including partial hospital/ day treatment and intensive outpatient programs Precertification required 
Mental Health and Substance Abuse—Outpatient counseling90% after deductible70% after deductible$30 copay70% after deductible$30 copay70% after deductible$30 copay70% after deductible
Emergency Room90% after in-network deductible90% after in-network deductible$150 copay (Waived if admitted)$150 copay (Waived if admitted)$150 copay (Waived if admitted)$150 copay (Waived if admitted)$150 copay (Waived if admitted)$150 copay (Waived if admitted)
Basic and Comprehensive Infertility TreatmentUnlimited benefit for diagnosis and basic medical treatment, including artificial insemination
Advanced Infertility Treatment$30,000 lifetime maximum for advanced treatments and Assisted Reproductive Technology including IVF, GIFT and ZIFT
Prescription Drug coverage with OptumRxNon-preventive prescription drugs are subject to an annual in-network deductible. Copays apply up to the annual in-network out-of-pocket maximum 
Retail (30 days) 
• Generic: $10 copay
• Single-source: $50 copay 
• Multi-source: $45 copay 
 
 
Mail-order (90 days)     
• Generic: $15 copay   
• Single-source: $25 copay    
• Multi-source: $90 copay
 

*  Out-of-network coinsurance reimbursement is indexed to 190% of the Medicare Maximum Allowable Charge (MAC), including expenses in excess of the out-of-network out-of-pocket maximum. 

** To meet the requirements of the U. S. Department of State, J-1 Visa holders will have a $500 per person deductible applied. 

***  No copay for lab and radiology at certain designated New York Presbyterian (NYP) locations. See the list of NYP participating locations

**** No copay for partial hospitalization/intensive outpatient treatment. 

REMEMBER: In the Choice Plus plans, in-network deductible, coinsurance and medical and prescription copays accumulate toward the in-network out-of-pocket maximum. In addition, out-of-network out-of-pocket expenses accumulate toward the in-network out-of-pocket maximum. In the HDHP, the in-network deductible, coinsurance and prescription copays accumulate toward the in-network out-of-pocket maximum.

 

ImportantImportant Notes: UHC’s Choice network is a national provider network and does not require a primary care physician or referrals to see specialists. UHC requires precertification for some services. If you use an in-network provider, your participating network physician or hospital generally handles the precertification process. However, it is your responsibility to confirm that your provider has obtained the necessary authorizations from UHC. If you see a provider who is out-of-network, you are responsible for obtaining precertification for most services except routine office visits.