United Healthcare of Illinois Plan 80 Plan Information
Plan 80
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 $3,000 Annual Maximum No Annual Maximum Copay
Office Visit You pay 20% after Ded
Physicians (Illness & Injury)
Office Visit - History & Exam (Primary Care, Specialist) You pay: 20% after deductible
Primary Care Physician / Specialist Referrals Required No
Prescription Drug
Prescription Drugs You pay: 20% after deductible
Annual Maximum $3000 (No annual maximum available)
Wellness/Preventive Care
Doctor Office Visit (adult or child) You pay: 20% after deductible (No waiting period)
X-ray & Lab You pay: 20% after deductible (in conjunction with the preventive office visit performed in the doctor’s office or a network facility; No waiting period)
Child Immunizations You pay: 20% after deductible (age 0-18, no waiting period)
Preventive Mammogram & PSA Testing You pay: 20% after deductible (no waiting period)
Outpatient Expense Benefits
X-ray & Lab You pay: 20% after deductible (performed in the doctor’s office or a network facility)
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: $100 copay if not admitted, then 20% after deductible
Emergency Room Fees - Injury You pay: 20% after deductible
Other Covered Outpatient Expenses You pay: 20% after deductible
Spine & Back Disorders You pay: 20% after deductible (Limited benefit; CAT scan and MRI tests are not subject to this limitation)
Mental & Nervous Disorders (including substance abuse) You pay: 20% 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: 20% after deductible
Other Covered Inpatient Services You pay: 20% after deductible
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