Medical Benefits
Insurance Provider:
AllSavers UHC Plan# 5400-018140
Waiting Period:
1st of Month Following 30 Days
Links:
Insurance Costs & Breakdown:
Employee Only Coverage
Total Annual Cost
$7,459.20
Employer Annual Cost
$6,340.32
Employee Annual Cost
$1,118.88
Employee Cost Per Paycheck
$43.03
Employee + Spouse Coverage
Total Annual Cost
$15,268.20
Employer Annual Cost
$10,244.82
Employee Annual Cost
$5,023.38
Employee Cost Per Paycheck
$193.21
Employee + Child(ren)Coverage
Total Annual Cost
$13,848.36
Employer Annual Cost
$9,534.90
Employee Annual Cost
$4,313.46
Employee Cost Per Paycheck
$165.90
Plan Type:
Deductible:
Coinsurance:
Max Out of Pocket:
Primary Care Visit:
Specialist Visit:
Urgent Care:
Virtual Visits:
ER Facility/ER Physician:
Hospitalization:
Out-Patient Procedures:
Routine Lab/X-Ray:
Complex Imaging/Diagnostics:
RX Deductible:
RX (Tier 1/2/3/4)
RX Specialty:
Non-Network Deductible:
Non-Network Coinsurance:
Non-Network Max Out of Pocket:
Teledoc:
PPO Self Funded
$5,000(Ind), $10,000 (Fam)
100% After Ded.
$6,350 (Ind), $12,700 (Fam)
$0<19 yrs old; All others $60
$60
$100
$0
$300 Copay 100% After Ded
100% After Ded
100% After Ded
100% After Ded
100% After Ded
No RX Ded
$15 / $35 / $75 / $250
N/A
$10,000 (Ind), $20,000 (Fam)
50% After Ded
$15,000 (Ind), $30,000 (Fam)
Healthiest You - See link above
Employee + Family
Total Annual Cost
$22,367.28
Employer Annual Cost
Employee Annual Cost
$13,794.36
$8,572.92
Employee Cost Per Paycheck
$329.73