United Healthcare of Illinois Copay Saver Plan Information
Copay Saver
Deductible $1,500 $2,500 $5,000 $7,500 $10,000
Maximum Family Deductible Maximum two deductibles per family per calendar year
Coinsurance 80/20
Coinsurance Out-of-Pocket Maximum After Deductible $3,000
Plan Enhancements
Lifetime Maximum $3 Million- $5 Million
Initial Rate Guarantee 12 Month- 24 Month
Prescription Drug $15 Copay
Office Visit 2 2 Additional
Physicians (Illness & Injury)
Office Visit - History & Exam (Primary Care, Specialist) $35 copay - 2 visits per person per year , including wellness office visits (2 addt’l office visits available)
Primary Care Physician / Specialist Referrals Required No
Prescription Drug
Prescription Drugs Generic $15 copay; Brand: Not covered
Annual Maximum Not Applicable
Wellness/Preventive Care
Doctor Office Visit (adult or child) $35 copay -subject to visit limit stated above (3 month waiting period)
X-ray & Lab Not covered
Child Immunizations Not covered
Preventive Mammogram & PSA Testing You pay: 20% after deductible (no waiting period)
Outpatient Expense Benefits
X-ray & Lab You pay: 20% after deductible (must be performed within 14 days of surgery or confinement)
Facility/Hospital for Outpatient Surgery You pay: 20% after deductible
Surgeon, Assistant Surgeon, & Facility Fees You pay: 20% after deductible
Hemodialysis, Radiation, Chemotherapy, Organ Transplant Drugs, & CAT Scans, MRIs You pay: 20% after deductible
Emergency Room Fees - Illness You pay: $500 copay if not admitted, then 20% after deductible
Emergency Room Fees - Injury You pay: $500 copay if not admitted, then 20% after deductible
Other Covered Outpatient Expenses You pay: 20% after deductible
Spine & Back Disorders Not covered
Mental & Nervous Disorders (including substance abuse) Not covered
Inpatient Expense Benefits
Room & Board, Intensive Care Unit, Operating Room, Recovery Room, Physician Visit, & Professional Fees of Doctors, Surgeons, Nurses You pay: 20% after deductible
Other Covered Inpatient Services You pay: 20% after deductible
Other United Healthcare of Illinois health insurance plans:
