The Group Indemnity Health Plan offers a broad network of doctors, allowing you the ability to select almost any doctor or hospital. By selecting a network doctor, lower coinsurance and deductibles are available. However, non-network care is still partially covered on the PPO plan. A prescription drug plan is offered with the Group Indemnity Plan. Prescription drugs must be included on the plan formulary in order to be covered.

The EPO plan offers the same national network and basic drug list as the PPO but with no deductible or coinsurance  to help minimize out of pocket cost to you. However, the EPO does not offer a separate out-of-network benefit like the PPO plan.

PPO Deductibles

A deductible is the portion of eligible medical expenses that the participant must pay before the plan will make any benefit payments. For example, with a $250 deductible, if the eligible amount of your first medical expense is $150, you will be responsible for the entire amount, and $150 will be applied towards your deductible. If then eligible amount of your second medical expense is $250, you will be responsible for the first $100, which will be applied toward your deductible. The remaining $150 would then be eligible for payment by the plan.

PPO Coinsurance

Coinsurance is a percentage that the patient is required to pay on all eligible medical expenses, after the deductible has been met. For example, if your deductible has been met and you have an eligible medical expense of $200, your coinsurance (10%) would be $20, and the plan's responsibility (90%) would be $180. The patient's coinsurance on out-of-network expenses is 30%.

PPO Out-of-Pocket Maximum

An annual out-of-pocket maximum is the maximum amount of coinsurance and copayments you pay for eligible medical expenses in any single calendar year. Once you have paid the out-of-pocket maximum, the plan pays 100% of eligible expenses.

Blue Access MobileSM

Blue Access Mobile makes it easy for you to access your information while on the go. You can view coverage details, health and wellness information, check claim status and access ID card information. You can also sign up to get text or email alerts and tips for:
• Claims Information — Get alerts when a claim status changes.
• Exercise and Fitness — Get weekly tips to help improve your workouts.
• Prescription Drugs — Sign up for alerts to check blood sugar, take a medication or a multivitamin.
• Diabetes Diet — Get weekly diet management tips to help stabilize insulin levels.
• Heart Healthy Diet and Basic Care Management — Get weekly messages with heart healthy diet management and basic care tips.

Pharmacy Benefits

Coverage of prescription medications on the Group Indemnity Plan is provided by Prime Therapeutics. 

Prime Therapeutics also provides a mail order prescription drug program.  

Primary Care Physician (PCP)

Each family member may choose a PCP from one of the doctors listed in UnitedHealthcare's provider directory. The doctors are listed according to the city where they are located. Members may change their PCP up to once a month by contacting a UnitedHealthcare customer service representitive. PCP changes will take effect the first of the following month. For example, if a member calls September 30th the PCP change will take effect on October 1st. Also, members do not have to stay within a certain network of physicians. For example, if your PCP is with Mercy and you wish to see a St. Anthony specialist, you may. Additionally, if you are with a Mercy PCP and want to move to a St. Anthony PCP the next month, you may.

Copays

A copay is the amount you're required to pay directly to the provider each time you use medical services. For example, you pay a small copay each time you visit the doctor's office. Under UnitedHealthcare HMO, you should only have to pay the specified copay amount for covered services. You will not be billed for additional amounts on covered services.

Specialty Care

Members do not have to have a referral to see a specialist as long as the specialist is contracted with UnitedHealthcare HMO.

Authorized Inpatient and Outpatient (Hospital) Care

The PCP and/or the specialist determines required inpatient and outpatient care, and he/she will work together to arrange these covered services. All inpatient and out-of-area outpatient services, except emergency and urgent care services, must be pre-authorized by the PCP at an inplan facility (contracting hospital, clinic, etc.).

Emergency Care

Emergency care is a serious medical condition which arises suddenly and requires immediate care and/or treatment. UnitedHealthcare participants with an emergency care need should immediately seek treatment at the nearest emergency facility. You must contact UnitedHealthcare or your PCP within 48 hours of the emergency.

Urgent Care

Urgent care services are medically necessary health care services required to prevent the serious deterioration of a member's health resulting from an unforeseen illness or injury for which treatment cannot be delayed. UnitedHealthcare participants with an urgent care need should contact their PCP. If their PCP is unable to see them, they should contact UnitedHealthcare to find an urgent care facility in their area.