2010 How to Choose a Medical Plan Tool

Step 1: Compare the medical plans available to you – BlueCross BlueShield (BCBS), United Healthcare Choice Plus (UHC) and High Deductible. Estimate what your out-of-pocket costs may be with each plan.

All three plans cover the same kinds of services, but how you access care and the way each plan pays benefits is different.

Health Plan	Plan Highlights
BCBS/UHC	In-network benefits are available when using the national BCBS BlueCard or UHC Choice Plus provider networks. Out-of-network benefits are available, but are more expensive since there are no negotiated provider discounts and the out-of-network deductible and out-of-pocket maximum are higher.
High Deductible	There is no difference in benefits if you use an in-network or out-of-network provider. However, when you receive care from in-network providers, your plan costs are typically lower because UHC has negotiated discounts with in-network providers.

	Blue Cross Blue Shield Plan and United Healthcare Choice Plus Plan		High Deductible Plan
	In-Network	Out-of-Network	High Deductible
General
Deductible	$400 per person/$800 per family maximum	$800 per person/$1,600 per family maximum	$1,200 per person/$2,400 per family maximum
Out-of-Pocket Maximum	$2,500 per person/$5,000 per family	$5,000 per person/$10,000 per family	$3,500 per person/$7,000 per family
Lifetime Maximum	Unlimited	Unlimited	Unlimited
Copayments
Retail Medical Clinic	$10 copay per visit	30% coinsurance after the deductible	20% coinsurance after the deductible
Primary Care Office Visit (including allergy shots)	$20 copay per visit	30% coinsurance after the deductible	20% coinsurance after the deductible
Specialist Office Visit	$30 copay per visit	30% coinsurance after the deductible	20% coinsurance after the deductible
Urgent Care Facility	$30 copay per visit	30% coinsurance after the deductible	20% coinsurance after the deductible
Emergency Room	$100 per visit; waived if admitted to a hospital	$100 per visit; waived if admitted to a hospital	20% coinsurance after the deductible
Hospital
Inpatient Hospital and Physician Services	10% coinsurance after the deductible	30% coinsurance after the deductible	20% coinsurance after the deductible
Outpatient Surgical Services	10% coinsurance after the deductible	30% coinsurance after the deductible	20% coinsurance after the deductible
Preventive Care
Well Baby	No copay	No coverage	20% coinsurance, no deductible
Maternity Office Visits (prenatal and postnatal)	$30 copay for initial visit	30% coinsurance after the deductible	20% coinsurance after the deductible
Physical Examinations and Immunizations	No copay	No coverage	20% coinsurance, no deductible
Mammography	$20 copay	30% coinsurance after the deductible	20% coinsurance, no deductible
Colonoscopy	10% coinsurance	30% coinsurance after the deductible	20% coinsurance, no deductible
Vision Care (routine exam)	No copay	No coverage	20% coinsurance, no deductible
Hearing Care (routine exam)	No copay	No coverage	20% coinsurance, no deductible

When you enroll in any of the medical plans offered by the company, you will automatically receive prescription drug coverage through Express Scripts. Review the out-of-pocket costs associated with the prescription drug coverage using the chart below.

Prescription Drug Overview
	Network Pharmacy	Non-network Pharmacy
Prescriptions (excluding fertility drugs)*
Generic - Retail to 30 days - Mail to 90 days	You pay: $5 copay $10 copay	If you fill a prescription at a non-participating pharmacy but had access to a participating pharmacy, you will be reimbursed for the negotiated pharmacy cost minus the applicable in-network coinsurance. If you did not have access to a participating pharmacy, the in-network coinsurance will apply.
Formulary Brand - Retail to 30 days - Mail to 90 days	You pay 20% coinsurance: $25 minimum, $100 maximum $50 minimum, $200 maximum
Non-Formulary Brand - Retail to 30 days - Mail to 90 days	You pay 40% coinsurance: $25 minimum, $100 maximum $50 minimum, $200 maximum
Prescription Out-of-Pocket Maximum	$2,000 per member, per calendar year.

*Specialty medicine sourced by CuraScript mail order pharmacy is subject to retail prescription plan design. The prescription drugs annual out-of-pocket maximum per person includes both retail and mail order drug expenses (excluding infertility medications, which are covered at 50% in all plans except the High Deductible Plan) and is separate from the medical plan's annual out-of-pocket expenses. Once you pay $2,000 in prescription drug copays and coinsurance, all retail and mail order prescription drugs filled during the remainder of the calendar year will be covered at 100% of eligible expenses.

Note: The Out of Area Plan is available only to employees outside of the UHC and BCBS Plan service areas. Access the Out of Area Plan Overview page for additional details and eligibility information.

Step 2: Check to see which doctors, hospitals and specialists are available in each plan.

Health Plan	Instructions	Referrals Required
BCBS	Use the BCBS provider directory. Click “Find a doctor” in the right navigation.	Enrollees do not have to select a primary care physician and referrals are not required to see a specialist.
UHC	Use the the UHC provider directory, select “Physicians & Facilities” and then select “UnitedHealthCare Choice Plus” from the drop down menu. Plan members located in greater Minnesota and Western Wisconsin should use the Medica Choice provider directory to find a provider. Click on the "Member Through Work" link and then select “Medica Choice with United Healthcare Choice Plus.”
High Deductible	High Deductible Plan enrollees use the UHC physician network. Visit the UHC provider directory, select “Physicians & Facilities” and then select “UnitedHealthCare Choice Plus” from the drop down menu. Plan members located in greater Minnesota and Western Wisconsin should use the Medica Choice provider directory to find a provider. Click on the "Member Through Work" link and then select “Medica Choice with United Healthcare Choice Plus.”