Medical and Prescription Drug Overview

 

This is a summary of In-Network Benefits for our UnitedHealthcare medical and prescription drug plans for the upcoming plan year January 1, 2018 to December 31, 2018. Our plans allow you the freedom to use providers in and out-of-network; however, charges are paid at a lower percentage for out-of-network providers. Prior authorization is required for certain services, tests, and procedures; your provider will coordinate any necessary prior authorization. Additional information about UnitedHealthcare plans is available on the RCPS Intranet website, Human Resources page. Or you may call the  phone number on your UnitedHealthcare medical card.

 

 

HDHP with HSA

HRA

Traditional

Deductible

-  Individual

-  Family

 

$3,000

$6,000

 

$2,000

$4,000

 

$500

$1,000

Out-of-Pocket Max

-  Individual

-  Family



$5,000

$10,000



$4,000

$8,000

 

$2,000

$4,000

Preventive Care

0%

0%

0%

Virtual Visit

$39-$40 Before Deductible 20% After Deductible

$25

$20

Office Visit

-  Primary Care

-  Specialist

 

20% After Deductible

 

$25

$50

 

$20

$40

In office Lab & X-ray

 

20% After Deductible

 

20% After Deductible

 

20% After Deductible

Outpatient Facility (surgery, etc.)

 

20% After Deductible

 

20% After Deductible

 

20% After Deductible

Inpatient Hospitalization

 

20% After Deductible

 

20% After Deductible

 

20% After Deductible

Emergency Room

 

20% After Deductible

 

20% After Deductible

 

20% After Deductible

Prescription Drugs

-  Retail (31 day supply)

-  Mail Order (90 day supply)

-  Deductible

 

20% After Deductible

 

(combined with Medical Deductible)

 

$10/30/60/80*

$20/60/120

 

*The 4th tier is for Specialty Drugs.

 

$10/20/40/60*

$20/40/80



*The 4th tier is for Specialty Drugs.

Medical and Prescription Drug Overview

This is a summary of In-Network Benefits for our UnitedHealthcare medical and prescription drug plans for the upcoming plan year January 1, 2016 to December 31, 2016. Our plans allow you the freedom to use providers in and out-of-network; however, charges are paid at a lower percentage for out-of-network providers. Additional information about UnitedHealthcare plans is available on the Benefit Enrollment Hub on the RCPS website, Human Resources page.

 

HDHP with HSA
HRA
Traditional

Deductible

-  Individual

-  Family

 

$3,000

$6,000

 

$2,000

$4,000

 

$500

$1,000

Out-of-Pocket Max

-  Individual

-  Family



$5,000

$10,000



$4,000

$8,000

 

$2,000

$4,000

Preventive Care

0%

0%

0%

Virtual Visit

$39-$40 Before Deductible 20% After Deductible

$25

$20

Office Visit

-  Primary Care

-  Specialist

 

20% After Deductible

 

$25

$50

 

$20

$40

In office Lab & X-ray

 

20% After Deductible

 

20% After Deductible

 

20% After Deductible

Outpatient Facility (surgery, etc.)

 

20% After Deductible

 

20% After Deductible

 

20% After Deductible

Inpatient Hospitalization

 

20% After Deductible

 

20% After Deductible

 

20% After Deductible

Emergency Room

 

20% After Deductible

 

20% After Deductible

 

20% After Deductible

Prescription Drugs

-  Retail (31 day supply)

-  Mail Order (90 day supply)

-  Deductible

 

20% After Deductible

 

(combined with Medical Deductible)

 

$10/30/60

$20/60/120

 

 

$10/20/40

$20/40/80

N/A

- See more at: http://www.rcps.info/cms/One.aspx?portalId=468655&pageId=9297354#sthash.wjYafwFq.dpuf
3057 Colonial Avenue SW, Roanoke, VA24015 Phone 540-853-2931