Unified Fire Authority 2024-2025 Employee Benefit Guide | Page 7

Unified Fire Authority
Medical Benefits
Administered by SelectHealth
Comprehensive healthcare provides peace of mind . In case of an illness or injury , you and your family are covered with an excellent medical plan through Unified Fire Authority .
Unified Fire Authority offers one medical plan design through SelectHealth that allows employees a choice between two networks- SelectHealth Med or SelectHealth Care . The base network is SelectHealth Med and the buy-up network is SelectHealth Care . With both networks employees may access IHC Facilities .
Both plans will provide access to providers from two tiers of networks which gives you additional flexibility and potential for cost savings . While there are two tiers of networks in each plan , you only have one deductible and out-of-pocket maximum to satisfy . You can move between Tier 1 and Tier 2 throughout the year as needed and the in-network costs spent between the two tiers will go towards your one deductible and out of pocket maximum .
The health plan deductible is based on a plan year ; therefore your deductible will reset every July 1 . Pre-authorizations are required for certain services .
Value Network
Care Network
Out-of-Network
SelectHealth Care and Value Networks
Tier 1
In-Network
Tier 2
Out-of-Network
Annual Deductible
( per person / family )
$ 1,000 /$ 2,000
$ 1,000 /$ 2,000
$ 2,000 /$ 4,000
Annual Out-of-Pocket Maximum
( per person / family )
$ 3,000 /$ 6,000
$ 3,000 /$ 6,000
$ 6,000 /$ 12,000
Coinsurance
20 % AD
20 % AD
40 %
DOCTOR ’ S OFFICE
Office Visits ( PCP / SCP )
$ 15 / $ 20 Copay
$ 15 / $ 20 Copay
40 % After Deductible
Preventive Care
Covered 100 %
Covered 100 %
Not Covered
PRESCRIPTION DRUGS
Retail - 30 day supply
Tier 1
$ 10
Tier 2
$ 25
Tier 3
$ 45
Tier 4
$ 100
Retail or Mail Order - 90 day supply
Maintenance Tier 1
$ 10
Maintenance Tier 2
$ 50
Maintenance Tier 3
$ 135
HOSPITAL SERVICES
Emergency Room
$ 75 After Deductible
Urgent Care
$ 30 Copay
$ 30 Copay
40 % After Deductible
Inpatient Services
20 % After Deductible
20 % After Deductible
40 % After Deductible
Outpatient Surgery
20 % After Deductible
20 % After Deductible
40 % After Deductible
Ambulance Service
20 % After Deductible
MENTAL HEALTH SERVICES
Office Visits
Covered 100 %
Covered 100 %
Covered 100 % After Deductible
Inpatient Services
20 % After Deductible
20 % After Deductible
40 % After Deductible
Outpatient Services
20 %
20 %
40 % After Deductible
SUBSTANCE ABUSE SERVICES
Office Visits
Covered 100 %
Covered 100 %
Covered 100 % After Deductible
Inpatient Services
20 % After Deductible
20 % After Deductible
40 % After Deductible
Outpatient Services
20 %
20 %
40 % After Deductible
OTHER SERVICES
Maternity Services
20 % After Deductible
20 % After Deductible
40 % After Deductible
Home Health Care
20 % After Deductible
20 % After Deductible
40 % After Deductible
Outpatient Rehab Therapy : Physical , Speech , Occupational
$ 20 After Deductible
$ 20 After Deductible
40 % After Deductible
Connect Care
Covered 100 %
Covered 100 %
Not Available
7