United Healthcare of Illinois HSA Plan 70 Plan Information
HSA 70®
Deductible $5,000
Maximum Family Deductible One deductible per family per calendar year
Coinsurance 70/30
Coinsurance Out-of-Pocket Maximum After Deductible $600
Note In-network per family per year
Plan Enhancements
Lifetime Maximum $3 Million -$5 Million
Initial Rate Guarantee 12 Month -24 Month
Prescription Drug $3,000 Annual Maximum -No Annual Maximum
Office Visit You pay 30% after Ded
Physicians (Illness & Injury)
Office Visit - History & Exam (Primary Care, Specialist) You pay 30% after deductible
Primary Care Physician / Specialist Referrals Required No
Prescription Drug
Prescription Drugs Preferred price card - You pay: 30% after deductible
Annual Maximum $3000 Covered (not paid) per person per calendar year (No annual maximum available)
Wellness/Preventive Care
Doctor Office Visit (adult or child) $35 Copay (3 month waiting period)
X-ray & Lab You pay: 30% (in conjunction with the preventive office visit performed in the doctor’s office or a network facility; 3 month waiting period, not subject to deductible)
Child Immunizations You pay: 30% (ages 0-18, 3 month waiting period, not subject to deductible)
Preventive Mammogram & PSA Testing You pay: 30% (no waiting period)
Outpatient Expense Benefits
X-ray & Lab You pay: 30% after deductible (performed in the doctor’s office or a network facility)
Facility/Hospital for Outpatient Surgery You pay: 30% after deductible
Surgeon, Assistant Surgeon, & Facility Fees You pay: 30% after deductible
Hemodialysis, Radiation, Chemotherapy, Organ Transplant Drugs, & CAT Scans, MRIs You pay: 30% after deductible
Emergency Room Fees - Illness You pay: 30% after deductible
Emergency Room Fees - Injury You pay: 30% after deductible
Other Covered Outpatient Expenses You pay: 30% after deductible
Spine & Back Disorders You pay: 30% after deductible (Limited benefit)
Mental & Nervous Disorders (including substance abuse) You pay: 30% after deductible (Limited benefit)
Inpatient Expense Benefits
Room & Board, Intensive Care Unit, Operating Room, Recovery Room, Physician Visit, & Professional Fees of Doctors, Surgeons, Nurses You pay: 30% after deductible
Other Covered Inpatient Services You pay: 30% after deductible
Other United Healthcare of Illinois health insurance plans:
