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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.
2024 materials
GMA Comprehensive (PPO)
GMA Premium (PPO)
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 | GMA Comprehensive (PPO) | GMA Premium (PPO) |
|---|---|---|
| Annual medical deductible | None | None |
| Annual out-of-pocket maximum | $2,000 | $1,500 |
| Office and clinic visits | $5 copay | $5 copay |
| Hospital services (inpatient) | $0 copay | $0 copay |
| Hospital services (outpatient) | $0 copay | $0 copay |
| Prescription drug coverage | Retail Tier 1: $10 copay Mail Order Tier 1: $25 copay |
Retail Tier 1: $5 copay Mail Order Tier 1: $12 copay |
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 costsharing that applies to out-of-network services.