16
HOW THE HEALTH PLAN WORKS
Save money by using
doctors that are in-network.
While both plans allow you
to receive services from any
provider, you pay less if
you use a provider in the
UHC network.
Benefits Department • 800-562-6210, ext. 2495
Then, HRA pays
until funds are
depleted
You pay
100% of
medical expenses
(except preventive
care)
Deductible is met
Coinsurance —
you and the plan
split the cost
of medical
expenses
Out-of-pocket
Maximum is met
Plan pays
100% of qualified
medical expenses
Each year, you must meet a
deductible, which is the amount
you must pay for your medical care
before the plan starts paying. Eligible
medical expenses, like doctors’ visits,
go toward the annual deductible.
Once you meet your annual deductible,
you and the plan split the cost of your
medical care. The coinsurance is the
percentage you pay for medical expenses.
The Out-of-pocket Maximum is the
maximum amount you will be
responsible for paying for covered
medical expenses in a plan year.
Once you pay that amount (which
includes your deductible, prescription
copays and coinsurance), the plan will
pay 100% of your covered medical
expenses for the rest of the year.
Plan pays 100% of preventive
care expenses before deductible.
Preventive care includes medical
care or tests done to help prevent
disease. Use an in-network provider,
and PFJ health plans pay 100% of
most preventive care.
First,
FSA pays
(if applicable)
To access ID cards and
health plan information,
including HRA balance,
claims data, or in-network
providers, go to:
myuhc.com or download the
Health4Me app
Payments for qualified medical
expenses that apply to your
deductible:
FSA payments
HRA payments
Direct payments
Copays do not apply to your
deductible but they do apply to your
Out-of-pocket Maximum
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/myuhc.com
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