New Mexico RHCA Retirees – Review Plan Benefits
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) Plan I - 13651

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UnitedHealthcare® Group Medicare Advantage
(PPO) Plan II - 13650

Benefits and costs UnitedHealthcare Group Medicare Advantage (PPO) – Plan I - 13651 UnitedHealthcare Group Medicare Advantage (PPO) – Plan II - 13650

Annual medical deductible

$0

$0
Annual out-of-pocket maximum $2,500 $2,800
Office and clinic visits $5 copay for primary care

$25 copay for specialist visit
 
$5 copay for primary care

$25 copay for specialist visit
 
Hospital services (inpatient) $250 copay per stay
 
$250 copay per stay
Hospital services (outpatient) $100 copay $100 copay
Prescription drug coverage

Retail

Tier 1: $15 copay
Tier 2: $35 copay
Tier 3: $70 copay
Tier 4: $70 copay


Mail Order

Tier 1: $30 copay
Tier 2: $70 copay
Tier 3: $140 copay
Tier 4: $140 copay

The UnitedHealthcare Group Medicare Advantage PPO Plan I offers additional coverage during the Coverage Gap stage of the Prescription Drug Plan. After your total drug costs reach $4,130, the plan continues to pay its share of the cost of your drugs and you pay your share of the cost (your copay) until you reach the Catastrophic Coverage stage. Please see Plan guide for details.

Retail

Tier 1: $10 copay
Tier 2: $20 copay
Tier 3: $35 copay
Tier 4: $35 copay

Mail Order 

Tier 1: $20 copay
Tier 2: $40 copay
Tier 3: $70 copay
Tier 4: $70 copay

The UnitedHealthcare Group Medicare Advantage PPO Plan II offers standard coverage during the Coverage Gap stage of the Prescription Drug Plan. After your total drug costs reach $4,130, you pay 25% of the price for brand name and generic drugs until you reach the Catastrophic Coverage stage. Please see Plan Guide for details.

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New Mexico Retiree Health Care Authority


Group retiree benefits for NMRHCA

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IMPORTANT DATES

2021 Open Enrollment Period

Began: 10/01/2020
Ended: 10/30/2020

 

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Last updated: 08.30.2021 at 12:01 AM CT  H2001_020121EMR