MEDICAL

United Healthcare
Your personalized website, myuhc.com®, features tools designed to help you:

• Find, price and save on care — you can save with Virtual Visits *and other tools.  You can save an average of 36%1 when you compare costs for providers and services 

• Get care from anywhere with Virtual Visits. A doctor can diagnose common conditions by phone or video 24/7

• Understand your benefits and the financial impact of care decisions

• Find tailored recommendations regarding providers, products and services. You can even generate an out-of-pocket estimate based on your specific health plan status

• Access claim details, plan balances and your health plan ID card quickly

• Follow through on clinical recommendations and access wellness programs

• Check your plan balances, and more 

 

 

	Complete Plan Tier 1	Balanced Plan Tier 1	Healthy Start
Calendar Year Deductible
Individual	$3,000	$5,000	N/A
Family	$8,500	$10,000
Calendar Year Out-Of-Pocket Maximum
Individual	$7,900	$8,550	$9,100
Family	$15,800	Unlimited	$18,200
	You Pay	You Pay	You Pay
Preventive Care	$0 Copay	$0 Copay	$0 Copay
Telemedicine	$0 Copay	$0 Copay	$0 Copay
Primary Care Physician	$20 Copay	$30 Copay	$25 Copay1
Specialist	$50 Copay	$60 Copay	$50 Copay1
Urgent Care	$75 Copay	$100 Copay	$150 copay (2/year)
Emergency Room	$500	$500	N/A
Coinsurance	30%	30%	N/A
Lab & X-Ray	Covered under Office Copay	Covered under Office Copay	1 testing day per year
Diagnostic Imaging (MRI/CT)	$200 Copay Freestanding Facility	$300 Copay Freestanding Facility	$50 Free standing. $150 Outpatient Hosp
Outpatient Services	$100 Copay2	$250 Copay2	Combined with $25 Copay
Inpatient/Hospital	$250 Copay	$500 Copay	Combined with $25 Copay
Services
Parmacy (RxBenefits)
Preferred Generic	$0 Copay	$0 Copay	$0 Copay ACA Rx
Non-Preferred Generic	$25	$30	N/A
Preferred Brand	$50	$60
Non-Preferred Brand	30% after Ded.
Specialty	50% after Ded.

 

Plan Information/Forms
Medical Plan SPD

If you have benefit questions, send them to psbenefits@clubcorp.com or call Benefits Department at 800.800.4615