United Healthcare of Texas HSA 100 Plan Information
Calendar-Year Deductible Choices
Single- $1,500, $2,500, $3,000 or $5,000
Family- $2,500, $5,000, $7,000 or $10,000
Coinsurance choices You pay: 0%
Coinsurance Out-Of-Pocket Maximum $0
Lifetime Maximum Benefit $3Million ($5Million plan enhancment available)
Initial Rate Guarantee 12 Months (24 Months plan enhancment available)
Physicians (Illness & Injury)
Office Visit-History and Exam No charge after deductible
Primary Care Physician/Specialist Referrals Required No
Prescription Drugs
Preferred price card No charge afterdeductible
Annual Maximum $3,000
Wellness/Preventive Care Benefits (3 month waiting period, not subject to deductible
X-ray and Lab You pay: $0
Child Immunizations (0-18) You pay: $0
Preventive Mammograms, Pap Smear, PSA screening You pay: $0
Outpatient Expense Benefits
X-ray and Lab No charge after deductible
Facility/Hospital for Outpatient Surgery No charge after deductible
Surgeon, Assistant Surgeon, and Facility Fees No charge after deductible
Hemodialysis, Radiation, Chemotherapy, Organ Transplant Drugs, and CAT Scans, MRIs No charge after deductible
Emergency Room Fees No charge after deductible
Other Covered Outpatient Expenses No charge after deductible
Spine and Bank Disorders No charge after deductible
Mental and Nervous Disorders (including substance abuse) No charge after deductible
Inpatient Expense Benefits
Room and Board, Intensize Care Unit, Operating Room, Refcovery Room, Prescription Drugs, Physician Visit, and Professional Fees of Doctors, Surgeons, Nurses No Charge after deductible
Other Covered Inpatient Services No charge after deductible
Other United Healthcare of Texas health insurance plans:
