What You Need To Know
Deductible. Coinsurance. Copays. Figuring out medical plans can be tricky. The most important thing to know is that all our plans offer comprehensive care that protects your and your family’s health. The differences come down to things like how much you pay for coverage through your paycheck and how much you pay when you receive care.
Medical Plan Options
You have three medical plans to choose from through UnitedHealthcare (UHC) — two are preferred provider organization (PPO) plans and one is a high-deductible health plan (HDHP):
- Plan One — PPO plan
- Plan Two — PPO plan
- Plan Three — high-deductible health plan (HDHP) with health savings account (HSA)
Local Medical Plans
Depending on where you live, you may be eligible to enroll in a local medical plan through Kaiser, Blue Cross Blue Shield of Alabama, or SIMNSA. If you’re eligible, these local medical plans will appear under the medical plan section as an enrollment option on the Benefits Service Center website.
For more details For more details, review the Summary of Benefits and Coverage.
How Medical Insurance Works
When paying for health care costs with medical coverage, the process typically follows three stages.
Stage 1: Before You Meet the Deductible
Stage 1: Before You Meet the Deductible
The first stage is that you must pay for all your medical costs until you reach your deductible. This means you’ve paid for care equal to your medical plan’s deductible amount. Copays will still apply while you continue to meet your deductible.
Stage 2: After You Meet the Deductible
Stage 2: After You Meet the Deductible
After you meet your medical plan deductible, you will share costs with your medical plan’s insurance carrier. This means you pay part (like copays or coinsurance), and your insurance carrier pays the rest.
Stage 3: Once You Reach the Out-of-Pocket Maximum
Stage 3: Once You Reach the Out-of-Pocket Maximum
Once you’ve paid enough after the deductible to reach your out-of-pocket maximum, your insurance carrier pays for everything else for the rest of the year.
As a reminder, the deductible is what you pay before insurance helps, and the out-of-pocket maximum is the most you’ll pay in a year, not counting your monthly premium.
In-Network Plan Benefits at a Glance
Here’s how the plans differ for in-network coverage. While all plans provide out-of-network coverage, it will be a lot more expense and we encourage you to stay in-network. Full medical plan summaries with in- and out-of-network benefits can be found through the Summary of Benefits Coverage documents on the Benefits Service Center website.
Big Picture
Big Picture
| Feature | Plan One | Plan Two | Plan Three |
|---|---|---|---|
| Cost per paycheck | $$$ | $$ | $ |
| Cost when receiving healthcare | $ | $$ | $$$ |
| Deductible (individual / family) | $1,000 / $2,000 | $1,250 / $2,500 | $3,000 / $6,000 |
| Coinsurance (amount plan pays after you pay deductible) | Plan pays 90% after deductible | Plan pays 80% after deductible | Plan pays 70% after deductible |
| Primary care / specialty | $25 / $40 | $25 / $40 | Plan pays 70% after deductible |
| Inpatient / Emergency room (ER) | $400 + coinsurance | $400 + coinsurance | Plan pays 70% after deductible |
| Out-of-pocket maximum for medical + pharmacy (individual / family) | $5,000 / $10,000 | $5,500 / $11,000 | $6,500 / $13,000 |
| Feature: Prescription drugs (retail / mail) | Plan One | Plan Two | Plan Three |
|---|---|---|---|
| Tier 1: Generic | $20 / $40 | $20 / $40 | Plan pays 70% after deductible, combined with medical |
| Tier 2: Brand formulary | $55 / $110 | $55 / $110 | Plan pays 70% after deductible, combined with medical |
| Tier 3: Brand non-formulary | $85 / $170 | $85 / $170 | Plan pays 70% after deductible, combined with medical |
The Details
The Details
| Feature | Plan One | Plan Two | Plan Three |
|---|---|---|---|
| Preventive care | Plan pays 100% | Plan pays 100% | Plan pays 100% |
| Office visit (primary / specialist) | $25 / $40 | $25 / $40 | Plan pays 70% after deductible |
| Mental health visit | $40 | $40 | Plan pays 70% after deductible |
| Inpatient mental health treatment | $400 + coinsurance | $400 + coinsurance | Plan pays 70% after deductible |
| Virtual visits | $15 | $15 | Plan pays 70% after deductible |
| Diagnostic and X-ray, MRI, CAT scan | Plan pays 90% after deductible | Plan pays 80% after deductible | Plan pays 70% after deductible |
| Urgent care | $25 | $25 | Plan pays 70% after deductible |
| Emergency room | $400 + coinsurance | $400 + coinsurance | Plan pays 70% after deductible |
| Physical and occupational therapy (limit 60 visits) | $40 | $40 | Plan pays 70% after deductible |
| Speech therapy | $40 | $40 | Plan pays 70% after deductible |
| Outpatient surgery | $40 | $40 | Plan pays 70% after deductible |
| Hospitalization | $400 + coinsurance | $400 + coinsurance | Plan pays 70% after deductible |
| Feature: Prescription drugs (retail / mail) | Plan One | Plan Two | Plan Three |
|---|---|---|---|
| Tier 1: Generic | $20 / $40 | $20 / $40 | Plan pays 70% after deductible, combined with medical |
| Tier 2: Brand formulary | $55 / $110 | $55 / $110 | Plan pays 70% after deductible, combined with medical |
| Tier 3: Brand non-formulary | $85 / $170 | $85 / $170 | Plan pays 70% after deductible, combined with medical |
Types of Care through Your Medical Coverage
Your Republic Services medical coverage offers many types of care, including preventive and virtual care options.
Preventive Care
Preventive care is all about building healthy habits and catching problems early on. It helps identify health problems like high blood pressure, diabetes and certain cancers in their early stages, when they’re most treatable. And tackling health issues early helps you get or stay on a healthy track, reducing the risk of developing other health conditions.
This type of care — such as your annual physical, checkups, screenings and immunizations — is fully covered at no cost to you through your Republic Services medical plan. However, if a condition is diagnosed during a preventive visit, any future testing or treatment related to that condition will be considered diagnostic care. Depending on your specific medical plan, you may have out-of-pocket costs for diagnostic care services your doctor recommends.
Virtual Care
When you aren’t feeling your best — physically, mentally or emotionally — or you need guidance managing a health condition, help is available. You can have a virtual video visit with a doctor 24/7 for common health issues and annual wellness visits. Care for mental and emotional health is available by appointment.
Where To Get Preventive and Virtual Care Services
If you’re enrolled in a UHC plan, log on to the MyUHC website and search for in-network providers. If you haven’t enrolled, you can visit UHC’s preenrollment website. For more information on virtual health care services, watch this video.
Which Plan Is Right for Me?
The plans generally cover the same types of health care services and supplies but differ in how you pay for expenses, including the amount of copays, coinsurance and your deductible. There’s also a difference in how much you pay for coverage through your contributions deducted from each paycheck.
Plan One or Plan Two (PPO plans) may be better for you and your family if you:
- Want to pay less when you receive care, even if it means you pay more each paycheck.
- Are frequent users of medical care.
Plan Three (HDHP with HSA) may be a better fit for you and your family if you:
- Want to pay less each paycheck, even if it means you may have to pay more out of pocket for care before you meet your deductible.
- Want to take advantage of the tax benefits and company contributions to a health savings account (HSA).
- Are healthy and interested in using an HSA to save or invest money.
- Aren’t frequent users of medical care — an annual checkup and a few other visits are usually it for the year.
