The Medical Plan Comparison Chart below summarizes the Plan provisions. For detailed information, please review the Summary of Benefits and Coverage (SBC) and Summary Plan Description (SPD).
|Benefit||Choice Plus 100|
|Annual Deductible (per person)||N/A||$600|
|Coinsurance (% paid by the Plan)||100%||60% after deductible|
|Out-of-Pocket Maximum (Individual)||$3,500||$4,000|
|Out-of-Pocket Maximum (Family)||$7,000||$8,000|
|Preventive Care||100%||Not covered|
|Physician Office Visits, including specialists||$30 copay||60% after deductible|
|Laboratory/Radiology Services, including services rendered in a physician’s office||100% if non-hospital location; $150 copay if hospital**|
60% after deductible
|Inpatient Hospital Care||$500 copay per admission||60% after deductible;|
|Outpatient Hospital Care||$150 copay (including lab and radiology**)||60% after deductible;|
|Mental Health and Substance Abuse – Inpatient care||$500 copay per admission||60% after deductible;|
|Mental Health and Substance Abuse – Outpatient programs||$30 copay||70% after deductible for facility|
based care, including intensive outpatient programs; precertification required
|Mental Health and Substance Abuse – Outpatient Counseling||$30 copay||70% after deductible|
|Emergency Room ||$150 copay (waived if admitted)||$150 copay (waived if admitted)|
|Basic and Comprehensive Infertility Treatment||Unlimited 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 OptumRx||Retail (30-days):|
• Generic: $10 copay
• Single-source brand: $25 copay
•Multi-source brand: $45 copay
•Generic: $15 copay
•Single-source brand: $50 copay
•Multi-source brand: $90 copay
*Out-of-Network coinsurance reimbursement is indexed to 190% of the Medical Maximum Allowance Charge (MAC), including expenses in excess of the out-of-network out-of-pocket maximum.
**No copay for Lab and Radiology at certain designated NYP locations. See the list of NYP participating locations at http://hr.columbia.edu/forms-docs/nyp-outpatient-laboratory-locations.
Remember: The medical and prescription drug 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.
Important 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.