| Deductible |
$200/policy year In-Network$400/policy year Out-Network |
| Out of Pocket Maximum |
$5,000/covered person/policy year In-Network$10,000/covered person/policy year Out-Network |
| Primary Care & Specialty Physician Visit |
$20 co-pay |
| ER |
$100 co-pay |
| Urgent Care |
$50 co-pay |
| Prescriptions |
$30 co-pay brand name, $10 co-pay generic, $1600
yearly maximum |
| Inpatient Hospital |
100% in-Network, 70% Out-Network |
| Outpatient Hospital |
100% in-Network, 70% Out-Network |
| Other Expenses Including Ambulance, Home Health
Care, Equipment, Supplies, Maternity, Complications of Pregnancy, Accidental
Dental Injury and Hospice Care |
100% in-Network, 70% Out-Network |
| Network |
United Health Care Choice Plus |
| Plan Maximum |
$200,000/year$800,000/lifetime |
| Web siteĀ
Find a network physician |
www.myuhc.com |
| Long Term
Disability Benefit |
$1,500 per
month is paid for the first 5 years if you are unable to continue as student;
after 5 years, if you are unable to secure an occupation or employment
commensurate with your education and training, benefits continue until Social
Security Normal Retirement Age |
| 90 Day
Waiting Period |
your
benefits become payable after you are continuously disabled for 90 days |
| Pre-Existing
Conditions |
if a
preexisting condition is present at any time during 6 months prior to the
coverage effective date, your benefits begin after 12 months of coverage |
| Assisted
Living Benefit |
up to
$1,500 is payable upon meeting requirements |
| Work
Earnings or Income Offset |
you may
earn up to $3,000 per month while disabled without a reduction in benefits |
| Rehabilitation
Plan Benefit |
while
disabled, expenses for training, education, family care work and job search
in connection with returning to work or school can be covered |
| Lump Sum
Benefit |
$5,000 is
paid when you meet the requirements for Permanent and Total Disability |
| Student
Loan Repayment Benefit |
up to
$200,000 is paid to cover qualifying loans for college and medical school
tuition, living expenses, fees, and textbooks |
| Survivor
Benefit |
up to
$7,500 is paid to your beneficiary if you die after receiving Long Term
Disability for at least 180 days |
| Continuation
of Coverage |
$2,000/$2,500
monthly coverage will be available on a guaranteed issue basis while you are
in residency training |
