2024 Employee Benefits Guide | Página 3

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
$ 0
$ 0
Primary
10 % after deductible
$ 45 * or 20 % after deductible
Specialty
10 % after deductible
$ 65 * or 20 % after deductible
Copay Visit Combined Maximum *
Not applicable
12 copay visits per member per plan year
Virtual Health
$ 0 after deductible
$ 0 after deductible
Other visits Lab Services
10 % after deductible
20 % after deductible
Urgent Care
$ 75 , after deductible
$ 75
Emergency Room
10 % after deductible
20 % after deductible
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 + Prescription 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 %, maximum of $ 25
Tier 2 - Brand
10 % after deductible
25 %, maximum of $ 125
Tier 3 - Non-Preferred Brand
10 % after deductible
40 %
Tier 4 - Specialty
10 % after deductible
50 %
myHealhcare Cost Estimator Quickly and easily estimate your costs on the UHC Website or in the App !