Agenda - 09-11-2014 - 2 - Laserfiche WebLink

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K UHC Insured 2013 Renewal: UHC Self-funUbd 2014 Current POS Current HSA Current POS Current HSA In- Network In- Network In- Network In- Network Primary Care Physician Visits $20 Deduct /20% $20 Deduct /20% Specialist Physician Visits $40 Deduct /20% $40 Deduct /20% Preventive Care 100% 100% 100% 100% Deductible $500 $1,500 $500 $1,500 Deductible - Family Maximum $1,500 $3,000 $1,500 $3,000 Out of Pocket Limit (includes deductible) $1,500 $3,500 $1,500 $3,500 Out of Pocket Limit - Family Max $4,500 $5,000 $4,500 $5,000 Radiology Deduct /20% Deduct /20% Deduct /20% Deduct /20% Minor Surgery in Office Office Copay Deduct /20% Office Copay Deduct /20% Hospital Services Deduct /20% Deduct /20% Deduct /20% Deduct /20% Urgent Care $50 Deduct /20% $50 Deduct /20% Emergency Room $150 Deduct /20% $150 Deduct /20% Pharmacy $4/$25/$45 Deduct /20% $4/$25/$45 Deduct /20% Vision Hardware Not covered Not covered Not covered Not covered HSA $1,237.20 $1,237.20 Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Difference 0% K