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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

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Benefits and costs UnitedHealthcare® Group Medicare Advantage 
Annual medical deductible $0
Annual  out-of-pocket maximum $6,700
Office and clinic visits $10 copay for primary care
$15 copay for specialist visit
$0 copay for Virtual Doctor Visit
Behavioral health $14 copay in office
$14 copay for Virtual Behavioral Health Visit
Urgent care $24 copay
Emergency $80 copay
Hospital services (inpatient) $0 copay 
Hospital services (outpatient) $0 copay 
Diabetic supplies and monitors

In-network: $0 copay
Out-of-network: $0 copay

For diabetes monitoring supplies, the plan covers the following brands of blood glucose monitors and test strips: OneTouch® Ultra® 2, OneTouch® Verio™, OneTouch® UltraMini™, ACCU-CHEK® Aviva, ACCU-CHEK® Compact, ACCU-CHEK® SmartView. Other brands are not covered by our plan.

If you use a brand of supplies that is not covered by our plan, you should speak with your doctor to get a new prescription for a covered brand.

Prescription drug coverage

Tier 1 Generic – up to 30-day supply: $3 copay

Tier 2* Preferred Brand – up to 30-day supply: $23 copay

Tier 3 Non-Preferred Brand – up to 30-day supply: $53 copay

Tier 4 Specialty Tier – up to 30-day supply: $53 copay

Questions? We're here to help.
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SEIB


Group retiree benefits for SEIB

If you're not a SEIB retiree, click the link below.
Back to uhcretiree.com »

IMPORTANT DATES

2020 Open Enrollment Period

Began: 11/1/2019
Ended: 11/30/2019

 

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Last updated: 09.16.2019 at 12:01 AM CT   H2001_091619BMR_M