This Plan is an individual practice plan offering you a high deductible health plan (HDHP) with a Health Savings Account (HSA) or Health Reimbursement Account (HRA) for those who do not qualify for an HSA. HDHP's have higher annual deductibles and annual out-of-pocket maximum limits than other types of FEHB plans. OPM requires that FEHB plans be accredited to validate that plan operations and/or care management meet nationally recognized standards. UnitedHealthCare Insurance Company, Inc. holds the following accreditations: National Committee for Quality Assurance. To learn more about this plan's accreditation(s), please visit the following websites:
- National Committee for Quality Assurance (www.ncqa.org)
General Features of our High Deductible Health Plan
We have Point of Service (POS) benefits
Our High Deductible Health Plan (HDHP) plan offers Point-of-Service (POS) benefits. This means you can receive many covered services from a non-participating provider. However, out-of-network benefits may have higher out-of-pocket-costs than our in-network benefits.
When you receive services from Plan providers, you will not have to submit claim forms or pay bills. You pay only the copayments, coinsurance, and deductibles described in this brochure. When you receive emergency services from non-Plan providers, you may have to submit claim forms.
How we pay providers
Network providers - We contract with individual physicians, medical groups, and hospitals to provide the benefits in this brochure. These Plan providers accept a negotiated payment from us, and you will only be responsible for your cost-sharing (copayments, coinsurance, deductibles and non-covered services and supplies).
Out-of-Network providers - Because these providers are not contracted with us and do not participate in our networks, these providers are paid based on an out of network plan allowance. Members will be responsible for the difference between our allowance and the amount billed.
Preventive care services
Preventive care services received in network are generally covered with no cost sharing and are not subject to copayments, coinsurance, or deductibles when received from a network provider.
The annual deductible in-network of $2,000 for Self Only enrollment or $4,000 for Self Plus One or Self and Family enrollment, must be met before benefits are paid for care other than preventive care services. The annual deductible out-of-network of $4,000 for Self Only enrollment or $8,000 for Self Plus One or $8,000 Self and Family enrollment must be met before out-of-network benefits are paid.
Health Savings Account
You are eligible for an HSA if you are enrolled in an HDHP, not covered by any other health plan that is not an HDHP (including a spouse's health plan, excluding specific injury insurance and accident, disability, dental care, vision care, or long-term coverage), not enrolled in Medicare, have not received VA (except for veterans with a service-connected disability) or Indian Health Service (IHS) benefits within the last three months, are not covered by your own or your spouse's flexible spending account (FSA), and are not claimed as a dependent on someone else's tax return.
- You may use the money in your HSA to pay all or a portion of the annual deductible, copayments, coinsurance, or other out-of-pocket costs that meet the IRS definition of a qualified medical expense.
- Distributions from your HSA are tax-free for qualified medical expenses for you, your spouse, and your dependents, even if they are not covered by a High Deductible Health Plan.
- You may withdraw money from your HSA for items other than qualified medical expenses, but it will be subject to income tax and, if you are under 65 years old, an additional 20% penalty tax on the amount withdrawn.
- For each month that you are enrolled in an HDHP and eligible for an HSA, UnitedHealthcare will pass through (contribute) a portion of the health plan premium into your HSA. In addition, you (the account holder) may contribute your own money to your HSA up to an allowable amount determined by IRS rules. Your HSA dollars earn tax-free interest.
- You may allow the contributions in your HSA to grow over time, like a savings account. The HSA is portable - you may take the HSA with you if you leave the Federal government or switch to another plan.
- Your HSA account fiduciary is Optum Financial Bank.
- Please refer to section 5 Savings - HSAs and HRAs for more complete information
Health Reimbursement Arrangement (HRA)
If you are not eligible for an HSA, or become ineligible to continue an HSA, you are eligible for a Health Reimbursement Arrangement (HRA). Although an HRA is similar to an HSA, there are major differences.
- An HRA does not earn interest.
- An HRA is not portable if you leave the Federal government or switch to another plan.
- You will need to advise UnitedHealthcare if you are ineligible to allow us to move you into the HRA.
We protect you against catastrophic out-of-pocket expenses for covered services. The IRS limits annual out-of-pocket expenses for covered services, including deductibles and copayments, to no more than $7,000 for Self Only enrollment, and $14,000 for a Self Plus One or Self and Family. The out-of-pocket limit for this Plan may differ from the IRS limit, but cannot exceed that amount.
Health education resources and accounts management tools
myuhc.com provides you the ability to:
- Review eligibility and look up benefits
- Check current and past claim status
- Find a doctor or hospital, including UnitedHealth Premium designated physicians
- Print a temporary ID card or request a replacement card
- Compare hospitals in quality, efficiency and cost - all at the procedure level
- Take a health assessment and participate in Health Coaching
- Use the Personal Health Record to organize health data and receive condition specific information to better manage their health
- Learn about health conditions, symptoms and the latest treatment options
myHealth Cost Estimator: Changes the way you access health care information for the better. myHealthcare Cost Estimator (myUCE) allows you to research your treatment options based on your specific situation. Lean about the recommended care, estimated cost and time to treat your condition. The care path allows you to see the appointments, tests and follow up care involved, from the first consult to the last follow up visit. You can also learn about estimated costs ahead of time to help you plan. Create a custom estimate based on your own plan details and selected providers.
UnitedHealthcare Mobile App - allows you to obtain secure, on-the-go access to your personalized health information to help you better understand and use your health plan effectively. You can download this app from Apples ITunes Store or Google Play for Android. With the app you can:
- Find care and costs, including virtual care
- Review your plan information, including deductibles and copays/coinsurance
- Access your Optum Bank financial accounts
- Check on the status of claims
- Pay bills
- Access and View your Medical ID card
- Conduct a provider search (medical and behavioral)
- Find urgent care locations and hospital
Your rights and responsibilities
OPM requires that all FEHB plans provide certain information to their FEHB members. You may get information about us, our networks, and our providers. OPM's FEHB website (www.opm.gov/insure) lists the specific types of information that we must make available to you. Some of the required information is listed below.
- UnitedHealthcare Insurance Company Inc. has been in existence since 1972
- UnitedHealthcare Insurance Company Inc. is a for profit corporation
- If you want more information about us, call 877-835-9861. You may also visit our website at www.uhcfeds.com.
You are also entitled to a wide range of consumer protections and have specific responsibilities as a member of this Plan. You can view the complete list of these rights and responsibilities by visiting our website at www.myuhc.com. You can also contact us to request that we mail a copy to you.
By law, you have the right to access your protected health information (PHI). For more information regarding access to PHI, visit our website at www.myuhc.com to obtain our Notice of Privacy Practices. You can also request that we mail a copy to you.
Your medical and claims records are confidential
We will keep your medical and claims records confidential. Please note that we may disclose your medical and claims information (including your prescription drug utilization) to any of your treating physicians or dispensing pharmacies.
To enroll in this Plan, you must live in or work in our service area. Our service area is:
South East - Plan code LS: Alabama, Arkansas, Florida, Louisiana, Mississippi, North Carolina and Tennessee.
West - Plan code LU: Colorado, Nevada, Oregon and Washington and:
Tucson, Arizona (Including the counties of: Santa Cruz, and portion of Pima county including the following zip codes : 85321, 85341, 85601, 85602, 85611, 85614, 85619, 85622, 85629, 85633, 85634, 85637, 85639, 85641, 85646, 85652, 85653, 85654, 85658, 85701, 85702, 85703, 85704, 85705, 85706, 85707, 85708, 85709, 85710, 85711, 85712, 85713, 85714, 85715, 85716, 85717, 85718, 85719, 85720, 85721, 85722, 85723, 85724, 85725, 85726, 85728, 85730, 85731, 85732, 85733, 85734, 85735. 85736, 85737, 85738, 85739, 85740, 85741, 85742, 85743, 85744, 85745, 85746, 85747, 85748, 85749, 85750, 85751, 85752, 85754, 85755, 85756, 85757, 85775
Phoenix, Arizona - Including the counties of: Maricopa and Pinal
Central - Plan code N7: Iowa and Kentucky
Northeast: Plan code V4: District of Columbia, Maryland, Pennsylvania, and Virginia