Get a quick overview of your plan benefits and costs and find more detailed information about additional coverage and benefit services.
2021 plan materials
- Benefit Resource Guide(PDF)(5.9 MB)
- Summary of Benefits(PDF)(134.4 KB)
- Evidence of Coverage - Group 13800(PDF)(873.9 KB)
- Evidence of Coverage - Group 13801(PDF)(871.2 KB)
- Acupuncture Benefit Letter(PDF)(329.1 KB)
Agp pro universal slot. Check your directory for Participating Providers in your geographic area, or ask your provider. For Empire Plan Participating Providers in other areas and to check a provider's current status, call The Empire Plan toll-free at 1-877-7-NYSHIP (1-877-769-7447) and choose UnitedHealthcare or use the online Participating Provider Directory. Emergency room services $100 copay per visit Not covered -none-Emergency medical transportation No Charge 0% co-ins after ded -none-Urgent care $50 copay per visit Not covered If you receive services in addition to urgent care, additional copays, deductibles, or co-ins may apply. If you have a hospital stay $500 copay per day.
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Preventive services
The following preventive services are covered under your plan for a $0 copay when you visit your physician.
- Screening and counseling to reduce alcohol misuse
- Screening for depression in adults
- Screening for Sexually Transmitted infections (STIs) and high-intensity behavioral counseling to prevent STIs
- Intensive behavioral therapy to reduce cardiovascular disease risk
- Screening and counseling for obesity
For information about these preventive services, please call the Customer Service number on the back of your plan ID card.
Disclaimer
Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the costsharing that applies to out-of-network services.
Want to know what's changed in your plan?
Review the previous year's plan materials»
Review the previous year's plan materials»
United Healthcare Copay Amounts
Benefits and costs | UnitedHealthcare® Group Medicare Advantage (PPO) |
---|---|
Annual medical deductible | $150 |
Annual out-of-pocket maximum | $1,200 |
Office and clinic visits | 4% coinsurance after deductible |
Virtual medical visits | $0 copay Virtual Visit Introduction |
Hospital services (inpatient) | $200 copay per admission |
Hospital services (outpatient) | 4% coinsurance after deductible |
Urgent care | $25 copay |
Xpad. Emergency room | $120 copay |
Hearing aid | $500 reimbursement Hearing aid reimbursement claim form |
United Healthcare Waiver Of Copay
Group retiree benefits for Teachers' Retirement System of the State of Kentucky (TRS)
If you’re not a TRS retiree, click the link below.
Back to uhcretiree.com»
Back to uhcretiree.com»
BEAT THE BLUES
If the holidays get you down, you’re not alone. That’s why TRS has collaborated with UnitedHealthcare to offer all retired Kentucky teachers wellness inspiration, education and actions to take you through the new year and beyond. Read more»
Virtual Education Center
It’s all the information you need to help you understand and access your plan benefits — in one place, at any time, from your favorite device. Lets get started
PDF (Portable Document Format) files can be viewed with Adobe® Reader®. Msn edge not working. If you don’t already have this viewer on your computer, download it free from the Adobe Web site.
Unitedhealthcare Er Copay Card
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All rights reserved.
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Last updated: 04.20.2021 at 12:01 AM CT H2001_031821EMR