2020 Health Plan Options
SAWS will continue to offer the choice of two self-funded medical plans in 2020. Self-funded plans use your premiums and SAWS contributions to pay for the increasing cost of health care (claims). UnitedHealthcare will continue as our third party administrator and Express Scripts, Inc. will continue as our pharmacy benefit manager.
Stay In-Network
There are several things you can do to help keep costs down. The most important of these is choosing a UnitedHealthcare network provider. A network is a group of doctors, hospitals and other providers and facilities that have a contract with UnitedHealthcare. As part of their contract they have agreed to follow UHC's guidelines and provide health care services at lower prices. It pays to stay in the network — using network providers can reduce outof- pocket costs, in addition to the overall health plan costs. If you will be having labs done, ask your health care professional where it will be and be sure it is an in-network lab, such as Quest Diagnostics, Clinical Pathology Laboratories, or LabCorp. All of these savings contribute to keeping premium increases to a minimum.
Out-of-network providers do not have a contract with UnitedHealthcare and can bill you above the reasonable and customary rates. Depending on the plan, insurance may cover only a fraction of the cost or none at all. The EPO Plus Plan has NO out-of-network coverage.
UnitedHealth Premium Program (Tier 1 Premium Providers)
To help you make more informed choices about your health care, UHC created the UnitedHealth Premium Program. The Premium Program recognizes doctors who meet standards for quality and cost efficiency. Look for the Tier 1 icon or two hearts and find out more on page 10 of the Benefit Guide.
- Tier 1 Premium Provider – The physician meets the criteria for providing quality and cost-efficient care.
- Office visits with Tier 1 Premium Providers have lower copays than visits with Non-Tier 1 Premium Providers.
PPO Economy: The in-network benefit plan design has a $1,500 deductible and out-of-pocket maximum of $4,500 per individual.
| 2020 PPO Economy Medical Premiums | ||||
|---|---|---|---|---|
| Hired Before Jan. 1, 2011 | Hired After Jan. 1, 2011 | |||
| Tier Selection | SAWS | Employee | SAWS | Employee |
| Employee Only | $447 | $36 | $447 | $36 |
| Employee + Spouse | $897 | $115 | $752 | $260 |
| Employee + Child(ren) | $785 | $83 | $670 | $198 |
| Employee + Family | $1,328 | $167 | $1,058 | $437 |
EPO Plus: This in-network benefit plan has a deductible of $750 per individual and out-of-pocket maximum of $4,500 per individual.
| 2020 EPO Plus Medical Premiums | ||||
|---|---|---|---|---|
| Hired Before Jan. 1, 2011 | Hired After Jan. 1, 2011 | |||
| Tier Selection | SAWS | Employee | SAWS | Employee |
| Employee Only | $490 | $117 | $490 | $117 |
| Employee + Spouse | $983 | $290 | $840 | $433 |
| Employee + Child(ren) | $863 | $229 | $756 | $336 |
| Employee + Family | $1,467 | $413 | $1,187 | $693 |
PPO Networks: Both plans will offer the same PPO network through UnitedHealthcare. Go online to list of participating providers, and select the "UnitedHealthcare Choice Plus" network, or call 1-888-651-7277 to get personal assistance from a UnitedHealthcare representative. If you register on myuhc.com, your will access your personal account, along with direct access to the provider network.
| Summary of Coverage | ||||
|---|---|---|---|---|
| PPO Economy | EPO Plus | |||
| Plan Benefit | In-Network | Out of Network | In-Network | Out of Network |
| Deductible 1 | $1,500 individual | $2,500 individual | $750 individual | Not Covered |
| $4,500 family | $7,500 family | $2,250 family | Not Covered | |
| Coinsurance | 80% after deductible | 60% after deductible | 80% after deductible | Not Covered |
| Out of Pocket 1, 2 | $4,500 individual | $7,500 individual | $4,500 individual | Not Covered |
| $11,250 family | $18,750 family | $9,000 family | Not Covered | |
| PCP Office Visit | 60% after deductible | Not Covered | ||
| Tier 1 Premium Provider | $40 | $25 | ||
| Non-Tier 1 | $50 | $40 | ||
| Specialist | ||||
| Tier 1 | $60 | $40 | ||
| Non-Tier 1 | $70 | $60 | ||
| Preventive Care | 100% | 60% after deductible | 100% | Not Covered |
| Virtual Visits | $30 | N/A | $15 | N/A |
| Urgent Care | $60 | 60% after deductible | $60 | Not Covered |
| Emergency Room | $200 per visit co-pay, plus deductible and coinsurance |
$200 per visit co-pay, plus deductible and coinsurance EMERGENCY ONLY |
||
| Hospital Inpatient | 80% after deductible | 60% after deductible | 80% after deductible | Not Covered |
2 Note: Out-of-pocket maximums for both the PPO Economy and EPO Plus include medical and prescription copay, deductible, and coinsurance amounts. For all of the coverage details, call 210-233-2025 for a copy of the official plan documents
For all of the coverage details, see the official plan documents below.
In this section:
Medical Downloads
2020 Summary of Benefits and Coverage - PPO Economy Plan |
|
|
2020 Summary of Benefits and Coverage - EPO Plus Plan |
|
|
Active Medicare Part D Notice for UHC COBRA |
|