Choice Plus Plans
- You are responsible for obtaining precertifications from UHC before most non-office visit treatment begins (unless it is an emergency). If you do not request precertification before having inpatient or outpatient surgery and/or certain treatment, you will be subject to a $500 penalty. If you are having trouble finding providers and/or services in the network, please call UHC at 800-232-9357. In an emergency, if you or your covered dependent is admitted to a non-network hospital, you must contact UHC within 48 hours of admission or you will be subject to a $500 penalty.
- Before the Plan starts to pay anything for out-of-network services, you must meet your out-of-network deductible.
- Then the Plan pays coinsurance of 60%* of remaining covered charges up to a maximum of 190% of the Medicare Maximum Allowable Charge (MAC).
- If you reach the out-of-network out-of-pocket maximum, the Plan will pay 190% of the Medicare MAC.
Note: Your out-of-network expenses can be used to satisfy the in-network deductible and in-network out-of-pocket maximum.
* 70% for outpatient mental health/substance abuse services.
Travel Vaccination Coverage
If you are traveling out of the country, travel vaccinations will be covered under the medical plan (for the Choice Plus 80 plan, deductible and coinsurance will apply).
If you newly enroll in medical benefits, you will receive a UHC ID card. This card will include member information for medical and prescription drug coverage. It takes approximately three weeks for new hires to receive an ID card. If you need a temporary ID card sooner, go to www.myuhc.com two weeks after you complete your benefits enrollment to download and print your temporary card.
Medicare Maximum Allowable Charge (MAC)
- If you had not met the out-of-network annual deductible, you would be responsible to pay the full $200, and $95.87 would be applied to the out-ofnetwork deductible.
- If you had already met the out-of-network annual deductible, the Plan would pay the coinsurance of 60% of $95 87, which is $57.22. Your share of the coinsurance is 40% of $95.87, which is $38.35. You are also responsible to pay the amount in excess of the 190% of the Medicare MAC; that is $200 - $95.87 = $104.13. In total, you would pay $38.35 + $104.13 = $142.48, and $38.35 would be applied to your out-of-network out-of-pocket maximum.
- If you had met the out-of-network annual out-of-pocket maximum, the medical carrier would pay 190% of the Medicare MAC ($95.87), and you would be responsible for the balance ($104.13).
Charges in excess of 190% of the Medicare MAC (in this example, $104.13) do not count toward the out-of-network out-of-pocket maximum.
For information on specific Medicare MAC(s) talk to your physician or his/her office staff.
Providers can bill you for any unpaid balance for amounts above these limits, and you are solely responsible for these payments.
- Any charges exceeding plan limits do not count toward the out-of-pocket maximum, including any charges exceeding 190% of the Medicare MAC.
- You can find out how much you will be reimbursed for out-of-network services before you seek treatment by first asking your physician for the medical “procedure code” along with the associated fee. Then, call UHC’s member services to request an estimate of their reimbursement.