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.

 

For management retirees - UnitedHealthcare® Group Medicare Advantage (PPO) with prescription drug coverage

2024 materials

For formerly represented retirees - UnitedHealthcare® Group Medicare Advantage (PPO)

2024 materials

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

Plan options and costs
Benefits and costs

For management retirees - UnitedHealthcare® Group Medicare Advantage (PPO) with prescription drug coverage

For formerly represented retirees - UnitedHealthcare® Group Medicare Advantage (PPO)

For management retirees - UnitedHealthcare® Group Medicare Advantage (PPO) with prescription drug coverage

For formerly represented retirees - UnitedHealthcare® Group Medicare Advantage (PPO)
Annual medical deductible

$190

$300
Annual medical deductible

$190

$300
Annual out-of-pocket maximum

$3,090

$1,700
Annual out-of-pocket maximum

$3,090

$1,700
Office and clinic visits

$15 after deductible copay for primary care
20% after deductible coinsurance for specialist visit

20% after deductible coinsurance for primary care
20% after deductible coinsurance for specialist visit
Office and clinic visits

$15 after deductible copay for primary care
20% after deductible coinsurance for specialist visit

20% after deductible coinsurance for primary care
20% after deductible coinsurance for specialist visit
Hospital services (inpatient)

$200/day

10% per admission afteer deductible coinsurance
Hospital services (inpatient)

$200/day

10% per admission afteer deductible coinsurance
Hospital emergency services (outpatient)

20% after deductible coinsurance for surgery and observation

20% after deductible coinsurance for all other procedures

10% after deductible coinsurance for surgery and observation

20% after deductible coinsurance for all other procedures
Hospital emergency services (outpatient)

20% after deductible coinsurance for surgery and observation

20% after deductible coinsurance for all other procedures

10% after deductible coinsurance for surgery and observation

20% after deductible coinsurance for all other procedures
Urgent care

$30 copay inside and outside the U.S.

$30 copay inside and outside U.S.
Urgent care

$30 copay inside and outside the U.S.

$30 copay inside and outside U.S.
Prescription drug coverage

Rx deductible: $400

Retail
Tier 1: $15 copay
Tier 2: $30 copay
Tier 3: $50 copay
Tier 4: $65 copay

Mail Order
Tier 1: $30 copay
Tier 2: $60 copay
Tier 3: $100 copay
Tier 4: $130 copay
Prescription drug coverage

Rx deductible: $400

Retail
Tier 1: $15 copay
Tier 2: $30 copay
Tier 3: $50 copay
Tier 4: $65 copay

Mail Order
Tier 1: $30 copay
Tier 2: $60 copay
Tier 3: $100 copay
Tier 4: $130 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.