United Healthcare of Illinois Plan 100 Plan Information
Plan 100®
Deductible $1,500 $2,500 $5,000 $7,500 $10,000
Maximum Family Deductible Maximum two deductibles per family per calendar year
Coinsurance 100/0
Coinsurance Out-of-Pocket Maximum After Deductible $0
Plan Enhancements
Lifetime Maximum $3 Million- $5 Million
Initial Rate Guarantee 12 Month -24 Month
Prescription Drug $3,000 Annual Maximum -No Annual Maximum Copay
Office Visit No charge after Ded
Physicians (Illness & Injury)
Office Visit - History & Exam (Primary Care, Specialist) No charge after deductible
Primary Care Physician / Specialist Referrals Required No
Prescription Drug
Prescription Drugs Preferred price card - No charge after deductible
Annual Maximum $3000 (No annual maximum available)
Wellness/Preventive Care
Doctor Office Visit (adult or child) No charge after deductible (No waiting period)
X-ray & Lab No charge after deductible (in conjunction with the preventive office visit performed in the doctor’s office or a network facility; No waiting period)
Child Immunizations No charge after deductible (age 0-18, no waiting period)
Preventive Mammogram & PSA Testing No charge after deductible (no waiting period)
Outpatient Expense Benefits
X-ray & Lab No charge after deductible (performed in the doctor’s office or a network facility)
Facility/Hospital for Outpatient Surgery No charge after deductible
Surgeon, Assistant Surgeon, & Facility Fees No charge after deductible
Hemodialysis, Radiation, Chemotherapy, Organ Transplant Drugs, & CAT Scans, MRIs No charge after deductible
Emergency Room Fees - Illness You pay: $100 copay if not admitted, then no charge after deductible
Emergency Room Fees - Injury No charge after deductible
Other Covered Outpatient Expenses No charge after deductible
Spine & Back Disorders No charge after deductible (Limited benefit; CAT scan and MRI tests are not subject to this limitation)
Mental & Nervous Disorders (including substance abuse) No charge after deductible (Limited benefit)
Inpatient Expense Benefits
Room & Board, Intensive Care Unit, Operating Room, Recovery Room, Physician Visit, & Professional Fees of Doctors, Surgeons, Nurses No charge after deductible
Other Covered Inpatient Services No charge after deductible
Other United Healthcare of Illinois health insurance plans:
