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 - No deductible

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UnitedHealthcare® Group Medicare Advantage
(PPO) plan - With deductible

Benefits and costs UnitedHealthcare® Group Medicare Advantage (PPO) plan - No deductible UnitedHealthcare® Group Medicare Advantage (PPO) plan - With deductible
Annual medical deductible $0 $500
Annual  out-of-pocket maximum

$500 for Durable Medical Equipment (DME)

$6,700* total for all Medicare expenses (includes DME out-of-pocket costs)

$500 for Durable Medical Equipment (DME)

$6,700* total for all Medicare expenses (includes DME out-of-pocket costs)

Office and clinic visits $0 copay $0 copay
Hospital services (inpatient) $0 copay $0 copay
Hospital services (outpatient) $0 copay $0 copay
Emergency room services $60 copay $60 copay
  * Refer to your Prescription Drug Plan benefit details at etf.wi.gov/IYC2019 for more information on your annual maximum out-of-pocket amount.

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State of Wisconsin EFT

Group Medicare Advantage
benefits for State of Wisconsin
Group Health Insurance
Program Participants

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IMPORTANT INFORMATION


Aren’t able to attend a meeting in person? Watch an e-learning about Medicare Advantage.


2019 Open Enrollment Period

Begins: October 1, 2018
Ends: October 26, 2018


Making a payment
If you pay your premiums directly to UHC, you may visit our website to make a one-time payment, complete the ACH form online for recurring payments from your bank account and set up recurring payments from your credit card or debit card.

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Last updated: 10.11.2018 at 12:01 AM CT   H2001_181008_042400