United Healthcare of Texas HSA 70 Plan Information
Calendar-Year Deductible
Single- $1,250, $2,500, $3,500 or $5,000
Family-$2,500, $5,000, $7,000 or $10,000
Coinsurance Choices You pay:30%
Coinsurance Out-Of-Pocket Maximum
Single- $3,000($1,250), $3,000($2,500), $2,100($3,500), $600($5,000)
Family- $6,000($2,500), $6,000($5,000), $4,200($7,000), $1,200($10,000)
Lifetime Maximum Benefit $3Million ($5Million plan enhancment available)
Initial Rate Guarantee 12 Months (24 Month plan enhancment available)
Physicians (Illness & Injury)
Office Visit- History and Exam You pay: 30% after deductible
Primary Care Physician/Specialist Referrals Required No
Prescription Drugs
Preferred price card You pay: 30% after deductible
Annual Maximum $3,000
Wellness/Preventive Care Benefits (3 month waiting period, not subject to deductible)
Doctor Office visit $35 copay
X-ray and Lab You pay: 30%
Child immunizations (0-18) You pay: 30%
Preventive Mammograms, Pap Smear, PSA screening You pay: 30%
Outpatient Expense Benefits
X-ray and Lab You pay: 30% after deductible
Facility/Hospital for Outpatient Surgery You pay: 30% after deductible
Surgeon, Assistant Surgeon, and Facility Fees You pay: 30% after deductible
Hemodialysis, Radiation, Chemotherapy, Organ Transplant Drugs, and CAT Scans, MRIs You pay: 30% after deductible
Emergency Room Fees You pay: 30% after deductible
Other Covered Outpatient Expenses You pay: 30% after deductible
Spine and Back Disorders You pay: 30% after deductible(limited benefit)
Mental and Nervous Disorders (including substance abuse) You pay: 30% after deductible (limited benefit)
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: 30% after deductible
Other Covered Inpatient Services You pay: 30% after deductible
Other United Healthcare of Texas health insurance plans:
