Overview
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UnitedHealthcare is a network model Health Maintenance Organization (HMO). It contracts with doctors who are in private practice or are part of established Medical Groups. You choose a participating Medical Group and from that Medical Group you must select a primary care physician (PCP). Your PCP will be responsible for all of your healthcare needs, and will refer you to a specialist when necessary. Note that certain providers allow for annual enrollments only.
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Lifetime Maximum
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No plan maximum
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Annual Copayment Maximums
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$1,000/individual
3 individual maximum per family
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Inpatient Hospital Charges
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Paid in Full
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Outpatient Office Visits and Most Outpatient Services
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Your copayment is: $5
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Other Outpatient Services
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- Ambulance - Paid in Full
- Cochlear Implants - Paid in Full
- Health Education Services - Paid in Full
- Home Health Care Visits (Up to 100 per calendar year) - Paid in Full
- Hospice Care (Prognosis of life expectancy of one year or less) - Paid in Full
- Laboratory and Radiology - Paid in Full
- Maternity Care, Tests and Procedures - Paid in Full
- Outpatient Surgery at a participating Free-Standing or Outpatient Facility - Paid in Full
- Well-Baby Care - Paid in Full
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Emergency Services and Urgently Needed Services when Out of Service Area
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$50 Copayment unless admitted to hospital.
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Chiropractic
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The Chiropractic benefits covers the services described in this section when performed by a Participating ACN Group, Inc. Chiropractor and authorized when necessary by ACN Group, up to the Annual maximum Benefit listed.
- Copayments for Each Visit - $5.00
- Annual Maximum Benefit - 30 Visits
- Annual Maximum Benefit for Chiropractic Appliances - $50.00
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Prescriptions
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Not covered through UnitedHealthcare. See the Prescription BenefitTab.
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Additional Info
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Phone: 1-800-624-8822
Web Site: www.uhcwest.com
Summary Schedule of Benefits
Group #:
Active - 144786
Early Retiree - 144787
Non-medicare - 144788
Medicare - 4257
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