United Healthcare of Texas Copay Saver Plan Information
Calendar-Year Deductible Choices You pay: $1,500, $2,500, $5,000, $7,500 or $10,000
Coinsurance Choices You pay: 20%
Coinsurance Out-Of-Pocket Maximum $3,000
Lifetime Maximum Benefit $3Million ($5Million plan enhancment availble)
Initial Rate Guarantee 12 Months (24 Months plan enhancment available)
Physicians (Illness & Injury)
Office Visit-History and Exam $35 copay- no deductible, 2 visits per person per year, including wellness office visits (2 Additional Visits plan available)
Primary Care Physician/Specialist Referrals Required No
Prescription Drugs
If you choose name-brand when generic is available, you pay your generic copay plus the additional cost above the generic price Generic copay-$15, no deducible Brand-not covered
Annual Maximum Not Applicable
Wellness/Preventive Care Benefits
(3 month waiting period, not subject to deductible unless otherwise indicated)
Doctor Office Visit $35 copay-subject to visit limit stated above
X-ray and Lab Not Covered
Child Immunizations (0-18) Not Covered
Preventive Mammogram, Pap Smear, PSA screening You pay: 20% after deductible
Outpatient Expense Benefits
X-ray and Lab You pay: 20% after deductible (must be performed within 14 days of surgery of confinement)
Facility/Hospital for Outpatient Surgery You pay: 20% after deductible
Surgeon, Assistant Surgeon, and Facility Fees You pay: 20% after deductible
Hemodialysis, Radiation, Chemotherapy, Organ Transplant Drugs, and 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- Injury You pay: $500 copay if not afmitted, then 20% after deductible
Other Covered Outpatient Expenses You pay: 20% after deductible
Spine and Back Disorders (CAT scan and MRI tests are not subject to this limitation) Not Covered
Mental and Nervous Disorders (including substance abuse) Not Covered
Inpatient Expense Benefits
Room and Board, Intensive Care Unit, Operating Room, Recovery Room, Prescription Drugs, Physician Visit, and Professional Fees of Doctors , Surgeons, Nurses You pay: 20% after deductible
Other Covered Inpatient Services You pay: 20% after deductible
Other United Healthcare of Texas health insurance plans:
