The following chart displays a comparison of plan provisions and benefits when seeing a participating provider1.
Printer Friendly| Plan Provisions | UHA 3000 | UHA 600 |
| Annual Deductible2 | $200 per person $600 per family |
None |
| Annual Co-payment maximum | $2,500 per person $7,500 per family |
$2,500 per person $7,500 per family |
| Lifetime Maximum3 | Unlimited | Unlimited |
| Full-time Student Coverage | Up to age 25 | Up to age 25 |
Medical Services |
UHA 3000 You Pay |
UHA 600 You Pay |
| PREVENTIVE CARE SERVICES | ||
| Physical exam (office visit) once per calendar year |
No co-payment | No co-payment |
| Preventive screening services: Mammography, Pap Smear, PSA Test |
No co-payment | No co-payment |
| Well child care visit | No co-payment | 10% of EC |
| Immunizations | No co-payment | No co-payment |
| Laboratory | No co-payment | 20% of EC |
| MATERNITY SERVICES | ||
| Maternity care and delivery | No co-payment | 10% of EC |
| Birthing room | No co-payment | No co-payment |
| Newborn nursery | No co-payment | 10% of EC |
| DISEASE MANAGEMENT PROGRAMS | ||
| Smoking cessation, Nutrition counseling Disease education |
No co-payment | No co-payment |
| PHYSICIAN SERVICES | ||
| Physician office visit | $12 | 10% of EC |
| HOSPITAL SERVICES | ||
| Room & Care (semi-private room) | 20% of EC | 10% of EC |
| Operating Room & Supplies | 20% of EC | 10% of EC |
| Laboratory & pathology (inpatient) | 20% of EC | 10% of EC |
| EMERGENCY SERVICES | ||
| Emergency Room Services | 20% of EC | 10% of EC |
| Ambulance Services – Ground/Air | 20% of EC | 20% of EC |
| ADDITIONAL BENEFITS | ||
| Complimentary Alternative Medicine (CAM) Benefit |
$10 co-payment per visit First set of x-rays @ 50% of EC |
|
| Chiropractic/Acupuncture | $500 combined maximum per calendar year | |
- Not all plans are listed. Check with Member Services for more benefit plan information.
- Annual deductible does not apply to all services. Refer to your Medical Benefits Guide to verify which services apply.
- Annual maximum of $2,000,000 per member per calendar year with no lifetime maximum.
EC = Eligible Charge. Refer to your Medical Benefits Guide for detailed definition.
The information above is intended to provide a condensed explanation of UHA medical plan benefits. Please refer to the appropriate Medical Benefits Guide (MBG) for complete information on benefits and provisions. In case of a discrepancy between this comparison and the language contained in the MBG, the MBG will take precedence.