The following chart displays a comparison of plan provisions and benefits when seeing a participating provider1.
Printer Friendly| Plan Provisions | UHA 3000 | UHA 600 |
| Annual Deductible2 | $200 per person $600 per family |
None |
| Annual Co-payment maximum | $2,500 per person $7,500 per family |
$2,500 per person $7,500 per family |
| Lifetime Maximum3 | Unlimited | Unlimited |
| Dependent coverage | Up to age 26 | Up to age 26 |
Medical Services |
UHA 3000 You Pay |
UHA 600 You Pay |
| PREVENTIVE CARE SERVICES | ||
| Physical exam (office visit) once per calendar year |
No co-payment | No co-payment |
| Preventive screening services: Mammography, Pap Smear, PSA Test |
No co-payment | No co-payment |
| Well child care visit | No co-payment | 10% of EC |
| Immunizations | No co-payment | No co-payment |
| Laboratory | No co-payment | 20% of EC |
| MATERNITY SERVICES | ||
| Maternity care4 | No co-payment | 10% of EC |
| Birthing room | No co-payment | No co-payment |
| Newborn nursery | No co-payment | 10% of EC |
| DISEASE MANAGEMENT PROGRAMS | ||
| Smoking cessation, Nutrition counseling Disease education |
No co-payment | No co-payment |
| PHYSICIAN SERVICES | ||
| Physician office visit | $12 | 10% of EC |
| HOSPITAL SERVICES | ||
| Room & Care (semi-private room) | 20% of EC | 10% of EC |
| Operating Room & Supplies | 20% of EC | 10% of EC |
| Laboratory & pathology (inpatient) | 20% of EC | 10% of EC |
| EMERGENCY SERVICES | ||
| Emergency Room Services | 20% of EC | 10% of EC |
| Ambulance Services – Ground/Air | 20% of EC | 20% of EC |
| ADDITIONAL BENEFITS | ||
| Complimentary Alternative Medicine (CAM) Benefit |
$10 co-payment per visit First set of x-rays @ 50% of EC |
|
| Chiropractic/Acupuncture | $500 combined maximum per calendar year | |
- Not all plans are listed. Check with Member Services for more benefit plan information.
- Annual deductible does not apply to all services. Refer to your Medical Benefits Guide to verify which services apply.
- Annual maximum of $2,000,000 per member per calendar year with no lifetime maximum.
- Maternity care does not include related services such as nursery care, labor room, hospital room and board, diagnostic testing, and other lab work and radiology. Please refer to the specific benefits for more information on those services.
EC = Eligible Charge. Refer to your Medical Benefits Guide for detailed definition.
The information above is intended to provide a condensed explanation of UHA medical plan benefits. Please refer to the appropriate Medical Benefits Guide (MBG) for complete information on benefits and provisions. In case of a discrepancy between this comparison and the language contained in the MBG, the MBG will take precedence.
