Sign in
Coverage and benefits
Get a quick overview of your plan benefits and costs and find more detailed information about additional benefits and programs.
Important Information about your Part D Vaccine and Insulin Coverage
What You Pay for Vaccines – Our plan covers most adult Part D vaccines at no cost to you.
What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan. Refer to your plan materials.
ConocoPhillips Core (PPO)
2025 materials
Plan
ConocoPhillips Plus (PPO)
2025 materials
Plan
Preventive services
The following preventive services are covered under your plan for a $0 copay when you visit your primary care provider:
- Annual Wellness Exam
- Annual Routine Physical
- Screenings for certain Cancers (Prostate, colorectal, breast cancer)
- Screening for diabetes
- Smoking and Tobacco Use Cessation
For more information about these preventive services, please call the Customer Service number on your member ID card.
Benefits and costs
| Benefits and costs |
ConocoPhillips Core (PPO) |
ConocoPhillips Plus (PPO) |
|---|---|---|
|
ConocoPhillips Core (PPO) |
ConocoPhillips Plus (PPO) |
|
| Annual medical deductible |
$0 |
$0 |
| Annual medical deductible | ||
|
$0 |
$0 |
|
| Annual out-of-pocket maximum |
$2800 |
$500 |
| Annual out-of-pocket maximum | ||
|
$2800 |
$500 |
|
| Office and clinic visits |
$15 copay for primary care office (includes non-MD office visits) $30 copay for specialist office visit $15 copay for Virtual Visit $15 copay for telemedicine |
$5 copay for primary care office (includes non-MD office visits) $10 copay for specialist office visit $5 copay for Virtual Visit
$5 copay for telemedicine |
| Office and clinic visits | ||
|
$15 copay for primary care office (includes non-MD office visits) $30 copay for specialist office visit $15 copay for Virtual Visit $15 copay for telemedicine |
$5 copay for primary care office (includes non-MD office visits) $10 copay for specialist office visit $5 copay for Virtual Visit
$5 copay for telemedicine |
|
| Hospital services (inpatient) |
$250 copay for day 1 |
$50 copay for day 1 |
| Hospital services (inpatient) | ||
|
$250 copay for day 1 |
$50 copay for day 1 |
|
| Hospital services (outpatient) |
$100 copay for outpatient surgery $100 copay for outpatient hospital services $30 copay for outpatient mental health/substance abuse (individual visit) $15 copay for outpatient mental health/substance abuse (group visit) $55 copay for partial hospitalization (mental health day treatment) per day |
$25 copay for outpatient surgery $25 copay for outpatient hospital services $20 copay for outpatient mental health/substance abuse (individual visit) $10 copay for outpatient mental health/substance abuse (group visit) $5 copay for partial hospitalization (mental health day treatment) per day |
| Hospital services (outpatient) | ||
|
$100 copay for outpatient surgery $100 copay for outpatient hospital services $30 copay for outpatient mental health/substance abuse (individual visit) $15 copay for outpatient mental health/substance abuse (group visit) $55 copay for partial hospitalization (mental health day treatment) per day |
$25 copay for outpatient surgery $25 copay for outpatient hospital services $20 copay for outpatient mental health/substance abuse (individual visit) $10 copay for outpatient mental health/substance abuse (group visit) $5 copay for partial hospitalization (mental health day treatment) per day |
|
| Prescription drug coverage |
Retail
Tier 1: $5 copay Tier 2: $45 copay Tier 3: 40% coinsurance Tier 4: 30% coinsurance |
Retail
Tier 1: $5 copay Tier 2: $45 copay Tier 3: 40% coinsurance Tier 4: 30% coinsurance |
| Prescription drug coverage | ||
|
Retail
Tier 1: $5 copay Tier 2: $45 copay Tier 3: 40% coinsurance Tier 4: 30% coinsurance |
Retail
Tier 1: $5 copay Tier 2: $45 copay Tier 3: 40% coinsurance Tier 4: 30% coinsurance |
|
| Rx Deductible |
$250 |
$250 |
| Rx Deductible | ||
|
$250 |
$250 |
|
Important 2025 changes explained
For 2025, all stand-alone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage will be impacted by changes made by the federal government. This video provides an overview of those changes.
Disclaimer
Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.