Benefits Book 2018

201 8 Benefits Book

B e well informed about the health and wellness benefits that the City of Greensboro offers to keep you and your family fit and protected from injury and illness. UnitedHealthcare (UHC) administers the City of Greensboro’s Health Plan. Health Plan Options There are two Health Plan options: • Choice Plan (offers in- network only benefits for covered services). • Choice Plus Plan (offers in-network and out- of-network benefits for covered services .) (PPOs) and offer the largest network of physicians and hospitals. The plans do not require referrals; however by selecting in network providers, the plan will pay a higher level of benefit. Health Plan These plans are preferred provider organizations

Health Benefits At A Glance

Medical

ChoicePlan Network

ChoicePlus Plan Network/Non-network

AnnualDeductible Employee

$500

$500 / $750

Family

$1,000

$1,000/$1,500

Out-of -Pocket Limit* Employee

$3,000

$2,500/$2,900

$6,000 (includes medical, pharmacy copays. and deductible)

$5,000/$6,500 (includes medical, pharmacy copays. and deductible)

Family

Lifetimemaximum Covered Services Doctors&Specialists Primary Care/ Specialist

Unlimited

Unlimited

$25 PCP/$50 SPEC

$25 PCP/$50/80%

OutpatientMental Health

$25

$25/80%

Preventive care

Well-child visits Mammogram Immunizations Annual Physical

100% 100%/ NotcoveredOON 100% 100%/ NotcoveredOON 100% 100%/ NotcoveredOON 100% 100%/ NotcoveredOON

Urgent andEmergency Care Urgent Care Visit

$30

$30/80%

Emergency Room Visit

$200

$200

Virtual Visits

100%

N/A

Hospital care

80% after deductible 80% after deductible 80% after deductible 80% after deductible

Outpatient surgery

80% after deductible

Lab&X-Ray

90% after deductible/80%out of network

Hospital Stay

80% after deductible

Maternity stay

80% after deductible

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