2023 Employee Benefits Guide | Page 4

Medical

The City ' s Medical Insurance is provided by UnitedHealthcare ( UHC ). UHC ' s customer service team can assist both you and your doctor with navigating your care and coverage . The City offers two plans - the HDHP EPO Value Plan and the EPO Core Plan . Out-of-Network benefits are not covered under either plan . Spouses offered medical coverage through their own employer are not eligible for the City ' s medical plans . Please see below for the Medical Plan Summary :
Key Medical Benefits
HDHP EPO Value Plan
EPO Core Plan
Office Visits Preventive Care
$ 0
$ 0
Primary Care
10 % after deductible
20 % after deductible
Specialty
10 % after deductible
20 % after deductible
CareATC Clinic
$ 40 , $ 0 after deductible
$ 0
Virtual Health
$ 49 , 10 % after deductible
$ 49 , 20 % after deductible
Other visits Lab Services
10 % after deductible
20 % after deductible
Urgent Care
$ 50 , after deductible
$ 50
Emergency Room
$ 250 , after deductible
$ 250
Outpatient
10 % after deductible
20 % after deductible
Inpatient
10 % after deductible
20 % after deductible
Medical Coinsurance % You Pay After Deductible
10 %
20 %
Medical Annual Deductible Single
$ 2,250
$ 1,750
Family ( 2x Single )
$ 4,500
$ 3,500
Medical Annual Maximum Single
$ 6,000
$ 6,000
Family ( 2x Single )
$ 12,000
$ 12,000
Prescriptions Preventive
$ 0
$ 0
Tier 1 - Generic
10 % after deductible
15 %
Tier 2 - Brand
10 % after deductible
25 %
Tier 3 - Non-Preferred Brand
10 % after deductible
40 %
Tier 4 - Specialty
10 % after deductible
50 %