Health Investor HMOs
Health Investor HMOs require you to use network providers to receive
benefits - no benefits are paid when you use out-of-network providers
unless it's a medical emergency. Health Investor HMOs cover all the same
services and supplies as their Standard HMO counterparts and use
the same provider networks (for example, the UnitedHealthcare Standard
HMO and UnitedHealthcare Health Investor HMO have the same network).
There are some key differences under the Health Investor HMO:
- If you contribute toward the cost of your coverage, your monthly insurance
premiums are lower.
- For specific preventive care services, there's no deductible. For
other health services or prescription drugs, you meet the deductible
before benefits begin.
- The deductible applies before anything but preventive care is covered.
- You may open a Health Savings Account with a contribution from the
state and can add your own contributions, as long as you do not have
health coverage outside the state.* You can use the HSA to pay out-of-pocket
expenses like your deductible and coinsurance - now or in the future.
View a list of Health Investor HMOs that
will be offered in 2009 and the areas where each is available. The 2009
Benefit Statement you receive will show the specific HMO options available
to you. Use the Health Plan Cost Estimator
to help you compare.
Plan Highlights
| Covers care received in network only |
|
You meet annual deductible
|
|
- Individual coverage (before anything but preventive care is
covered)
|
$1,250
|
- Family coverage (before anything but preventive care is covered
for the family)
|
$2,500
|
|
What you pay for care received after deductible
|
|
|
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20%
|
|
|
|
- generic and preferred brand
|
30%
|
|
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50%
|
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Annual out-of-pocket maximum (after deductible)
|
|
|
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$3,000
|
|
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$6,000
|
| |
After you reach your out-of-pocket maximum, the plan pays 100%
up to allowable cost for most covered care for the rest of the calendar
year
|
|
Preventive care: some routine physical exams, health screenings
and immunizations
|
Same as standard HMOs; no deductible required
|
- routine annual physicals
- screenings at published intervals
|
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Lifetime benefit maximum
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Unlimited
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*For purposes of determining whether you may open a Health Savings Account,
"other coverage" includes coverage through your spouse's employer's
plan, Medicare, Medicaid, a Healthcare Flexible Spending Account that
covers medical expenses (like the state's Medical Reimbursement Account),
or any other medical plan. You may participate in an HSA if you have a
Limited Purpose Medical Reimbursement Account or enroll in the supplemental
cancer, hospital or intensive care policies available to you as a state
employee.
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