UnitedHealthcare®
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Review plan benefits & costs

Get a quick overview of your plan benefits and costs and find more detailed information about additional coverage and benefit services.

UnitedHealthcare® Group Medicare Advantage
(PPO)

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Benefits and costs

UnitedHealthcare® Group Medicare Advantage (PPO)

Annual medical out-of-pocket maximum

$1,500 in-network

Physician services

$10 copay primary care
$10 copay specialist visit

Emergency room

$50 copay
Waived if admitted to the hospital within 24 hours for the same condition

Urgently needed care
(contracted providers)

$25 copay
Waived if admitted to the hospital within 24 hours for the same condition

Prescription drug coverage

Retail:
Tier 1: $5 copay
Tier 2: $20 copay
Tier 3: $50 copay
Tier 4: $20 copay

Mail Service:
Tier 1: $10 copay
Tier 2: $40 copay
Tier 3: $100 copay
Tier 4: $40 copay

Questions? We're here to help.
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CalPERS

Group retiree benefits for CalPERS retirees

This is not my group.
Back to uhcretiree.com »

IMPORTANT DATES

2020 Open Enrollment Period

Began: September 9, 2019
Ended: October 4, 2019

Benefits effective January 1, 2020.

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Last updated: 11.27.2019 at 12:01 AM CT  H2001_112719AMR