Both the PPO Plan and the High Deductible Health Plan (HDP) with Health Savings Account (HSA) use the large, national UnitedHealthcare Choice Plus network. Prescription drug benefits are administered by CVS Caremark and Mental Health/Substance Abuse services are provided by UnitedHealthcare. All mental health services must be pre-certified through UnitedHealthcare.
If you cover your spouse on the PPO Plan (includes spouse covered on PMD or MPD) or the HDP, your monthly cost is subject to the Spouse Medical Plan Surcharge and an affidavit is required. If you do not provide the affidavit by the date due, you will pay $200 more per month in addition to the applicable monthly premium.
For coverage effective January 1, 2024, you can enroll in the PPO plan or HDP, or you can opt out of medical coverage as long as you are enrolled in other comparable coverage and provide the required signed Certification of Other Coverage form and proof of other comparable coverage. You may be eligible for an employer contribution to your flexible spending account based on your opt-out status.
Summary of Benefits and Coverage
Under the Affordable Care Act, group health plans provide a Summary of Benefits and Coverage (SBC). The SBC is an easy to understand summary to help you compare health plans and coverage, regardless if coverage is purchased privately or through your employer. The SBC includes an illustrated coverage example for three benefits scenarios: having a baby, managing type 2 diabetes, and a simple fracture. Each policy or plan uses the same illustration to help you compare plans. You should not use this information to estimate the cost of your own care. The information is comparative only. Also available to you is a Uniform Glossary of terms commonly used in health insurance coverage.