UnitedHealthcare HMO Plans

Network 1 and CS VEBA Alliance

HMOs allow you to receive comprehensive coverage at set prices, called copays.

Doctors/Other Medical Care Providers: You can only use doctors, hospitals, and pharmacies that participate in the HMO network. Doctors who participate in the HMO network are called in-network providers. There is no coverage if you go to out-of-network providers, except for emergency services.

Annual Deductible: You don’t need to pay an annual deductible before the plan begins to pay for a portion of covered medical services.

Copays: When you receive medical care, you pay a set dollar amount called a copay.

Annual Out-of-Pocket Maximum: The HMO plans include an annual out-of-pocket maximum. This is the maximum amount you could pay out of your own pocket.

Prescription Coverage: Prescriptions will be managed by Express Scripts. UHC HMO members will receive an ID card from UHC for medical and an ID card from Express Scripts for prescription drug benefits.

Note: Review the comparison charts below for copays, annual out-of-pocket maximums, and a list of medical groups.

Per Pay Period Cost

	Employee Only	Employee Plus 1	Employee Plus 2 or more
UnitedHealthcare Performance HMO Network 1	$416.85	$833.38	$1,179.06
UnitedHealthcare SignatureValue CS VEBA Alliance HMO	$399.94	$799.55	$1,131.19