Deductible

The amount of covered expenses that the insured must pay before a plan or insurance contract starts to pay.

$12500.0

Coinsurance

Most policies require the insured to pay some portion of the health care bills. A typical arrangement is that the insurer pays 80 percent and the insured 20 percent, up to $3,000 of covered expenses after the insured has paid the deductible. After the insured hits the maximum out-of-pocket limit, the insurance company pays 100 percent of covered expenses during the remainder of the calendar year, up to any applicable annual benefit or lifetime maximum of the policy.

70/30 to $15,000

Coinsurance Out-of-Pocket Maximum

The limit on the amount an individual is required to pay for health care services covered by his or her benefits plan after the deductibles and any copays are paid. Refers to care received from the network of participating physicians, hospitals, and health care professionals. Coinsurance Out-of-Pocket amounts are in addition to any Deductible amounts.

4500.00

Network

A group of doctors, hospitals and other health care providers and facilities that have, either, (i) contracted with a health insurer or health plan to provide medical services at negotiated or discounted rates, or (ii) for limited benefits supplemental coverage, contracted directly or indirectly with an underwriter to agree to reduced fees for medical services.

UnitedHealthcare Choice

Application Fee

$40 (one-time, non-refundable)

Doctor Office Visit, History and Exam only (no primary care physician/specialist referral required)

You pay: $50 copay for first 4 visits per person, per term (Subsequent visits subject to deductible and 30% coinsurance; copays are for injury and illness and cannot be used for preventive services.)

Preventive Care Benefits

You pay: $50 copay ($200 max benefit per person, per term, after 6-month waiting period for term 1 only)

Room and Board, Intensive Care Unit, Operating Room, Recovery Room, Prescription Drugs, Physician Visit, & Professional Fees of Doctors, Surgeons, Nurses

You pay: 30% after deductible

Deductible

Per person, per term, maximum of 2 per family

Plan Coverage

3 terms equal to 1 day less than 3 years

Underwriter

Golden Rule Insurance Company

Lifetime Maximum

$2 million per covered person, over 3 terms

Prescription Drugs

Tier 1 - $25 copay Tier 2, 3, 4 - combined $500 deductible per person, per term, then: Tier 2 - $55 copay Tier 3 - $75 copay Tier 4 - 50% coinsurance ($5,000 outpatient Rx covered expense per term max, per person)

Urgent Care Copay

$75 copay - no deductible

Emergency Room Fees - Illness

You pay: 30% after deductible (additional $500 deductible if not admitted)

Emergency Room Fees - Injury

You pay: 30% after deductible

Supplemental Accident Benefit

$12,500