Your deductible
A deductible is money you must spend out-of-pocket for covered expenses or the recognized amount when applicable before the Plan pays benefits. Your deductible is determined by the Plan you choose, the number of people you cover and whether you use in-network or out-of-network providers. See the chart under "Your medical benefits" for specific deductible amounts.
With the UnitedHealthcare Choice and Value Plans, the family deductible may be satisfied by any combination of covered expenses incurred by any covered family member. However, no one family member may contribute more than the individual deductible amount.
With the UnitedHealthcare HSA plans, the total family deductible must be met before the Plan covers any expenses. No one family member's expenses are capped at an individual deductible amount.
The deductible applies to all expenses except:
- Expenses that are subject to a flat dollar copayment, such as office visits and emergency room services under the Choice and Value PPO plans (See "Your share in the cost of covered services" for more information about copayments.)
- Covered preventive healthcare expenses
- Approved travel and lodging expenses
- Expenses that exceed the eligible expenses guidelines or the recognized amount, where applicable
- Your contributions toward the cost of medical coverage (your premium)
- The amounts of any penalty you incur by not obtaining prior authorization as required
- Except when required by law, only expenses incurred for in-network services apply toward the in-network deductible. Likewise, only expenses incurred for out-of-network services apply toward the out-of-network deductible.
Assume that you enroll in the Choice PPO plan and have a family of four. When you use in-network doctors and facilities, the annual family deductible is $1,050 under the Choice PPO plan. Here is an example of how the family deductible might be satisfied:
|
Participant
|
Covered expenses
|
|
Employee:
|
$250
|
|
Spouse:
|
$350
|
|
Child #1:
|
$250
|
|
Child #2:
|
$200
|
|
Total:
|
$1,050
|
Assume that you enroll in the Basic HSA plan and have a family of four. When you use in-network doctors and facilities, the annual family deductible is $5,000 under the Basic HSA plan. With the HSA plans, the total family deductible must be met before the Plan covers any expenses. No one family member's expenses are capped at an individual deductible amount.
Here is an example of how the family deductible might be satisfied:
|
Participant
|
Covered expenses
|
|
Employee:
|
$1,000
|
|
Spouse:
|
$2,750
|
|
Child #1:
|
$750
|
|
Child #2:
|
$500
|
|
Total:
|
$5,000
|