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

UnitedHealthcare® Group Medicare Advantage (PPO)

Annual medical deductible $0

Annual out-of-pocket maximum

$2,500

Office and clinic visits

$15 copay for primary care
$20 copay for specialist visit

Hospital services (inpatient)

$100 copay per day for days 1-3
$0 copay for days 4 and beyond

Hospital services (outpatient)

$125 copay

Hearing aids $2,400 hearing aid allowance per calendar year
Calendar year pharmacy out-of-pocket maximum $6,350 per individual

Prescription drug coverage

Retail up to a 31-day supply:

Tier 1 – Preferred Generic: $8 copay
Tier 2 – Generic: $15 copay
Tier 3 – Preferred Brand: 40% coinsurance to $250 max per script
Tier 4 – Non-Preferred Drug: 40% coinsurance to $250 max per script
Tier 5 – Specialty: 40% coinsurance to $250 max per script
 

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PERS Health Insurance Program


Group retiree benefits for Oregon PERS Retirees

 

IMPORTANT DATES


2021 Plan Change Period

Begins: October 1, 2020
Ends: November 15, 2020

 

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Last updated: 08.05.2020 at 12:01 AM CT  H2001_080520DMR