Unicare of Texas Health Savings Account Compatible Variable Deductible Plan TXIMHDHPC0706 Plan Information

Plan Name: Health Savings Account Compatible Variable Deductible Plan TXIMHDHPC0706

Plan Type: High Deductible Health Savings Account-Qualified

Health Savings Account: Compatibility with tax deferred savings accounts

Physician Choice: Yes

Annual Out-of-Pocket Maximum: Single party: $5000 or Family: $10,000 (includes annual deductible)

Annual Deductible: Subject to change annually to meet minimum IRS requirements. The 2007 amounts are: $1100 for single party or $2200 for family coverage.

Office Visits: UniCare pays 80%

Professional Services: UniCare pays 80%

Hospital Inpatient: UniCare pays 80%

Hospital Outpatient: UniCare pays 80%

Inpatient Medical Emergency: UniCare pays 80%

Preventive Care for Babies and Children (through age 6): UniCare pays 80%

Preventive Care for Adults: UniCare pays 80%

Drug Benefits: After the annual deductible is met, UniCare pays 100% except for the following member copay: Generic: $10 copay. Brand Formulary: $30 copay. Brand Non-Formulary: $50 copay.

Other Unicare of Texas health insurance plans:

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