Health Insurance Help

[Bairagi From Bapatla]

Plan Details Deductible $1000 Individual Out-of-Pocket Max $3500 Individual

 

 

deeni ardham ento cheppagalara... idhi manchi plan or not?

[Bairagi From Bapatla]

LTT

[moviefan]

1000 Deductible ante.. nuvvu 2014 lo doctor deggariki vellina prati sari neeku bill vasthundhi kada so first 1000 nuvvu kadithey. from $1001 insurance company will pay their part like (80% or 90% or 70%). simple ga ayethey nuvvu first 1000 kadithey gaani insurnace vaadu picture loki raadu.

 

2015 jan lo malli nee deductible reset avthundhi.

[Bairagi From Bapatla]

1000 Deductible ante.. nuvvu 2014 lo doctor deggariki vellina prati sari neeku bill vasthundhi kada so first 1000 nuvvu kadithey. from $1001 insurance company will pay their part like (80% or 90% or 70%). simple ga ayethey nuvvu first 1000 kadithey gaani insurnace vaadu picture loki raadu.

 

2015 jan lo malli nee deductible reset avthundhi.

ohhh nenu ee plan ki 150 kaduthunna bhayya... nd maa employer 150 kaduthunadata so total ee plan ki 300 vesuko... is it good or bad?

[Bairagi From Bapatla]

ltt

[agora]

help

[moviefan]

ohhh nenu ee plan ki 150 kaduthunna bhayya... nd maa employer 150 kaduthunadata so total ee plan ki 300 vesuko... is it good or bad?

 

plan details okkada post cheyyi biaragi... i will try to tell if its good or not.

 

Restaurant lo dish cost yekkuva unte food baga untundha ?

[dkchinnari]

1000 Deductible ante.. nuvvu 2014 lo doctor deggariki vellina prati sari neeku bill vasthundhi kada so first 1000 nuvvu kadithey. from $1001 insurance company will pay their part like (80% or 90% or 70%). simple ga ayethey nuvvu first 1000 kadithey gaani insurnace vaadu picture loki raadu.

 

2015 jan lo malli nee deductible reset avthundhi.

doctor visit kelthe 300 ayindhi anuko... so 300 motham maname kattala.till we reach 1000?

[Journey]

ohhh nenu ee plan ki 150 kaduthunna bhayya... nd maa employer 150 kaduthunadata so total ee plan ki 300 vesuko... is it good or bad?

Ne coverage entha? Eye and dental included ante it is good.. Kani chinna vatiki doctor dagariki velina prathi sari $1000 lopala bill ithe neku insurance pedha use em ledu... Above $1000 ithe ne benifit..

[dkchinnari]

Ne coverage entha? Eye and dental included ante it is good.. Kani chinna vatiki doctor dagariki velina prathi sari $1000 lopala bill ithe neku insurance pedha use em ledu... Above $1000 ithe ne benifit..

deductible menaing adi kadhu..?

 

ee plan tisukunte thanu max year Out-of-Pocket Max $3500 anthe pettedhi...

[Yuva Nataratna]

Ne coverage entha? Eye and dental included ante it is good.. Kani chinna vatiki doctor dagariki velina prathi sari $1000 lopala bill ithe neku insurance pedha use em ledu... Above $1000 ithe ne benifit..

 

wrong perception..... deductible is the maximum amount per year that you pay for medical expenses, any extra expenses will be paid on the whole by the insurance provider....

[Bairagi From Bapatla]

plan details okkada post cheyyi biaragi... i will try to tell if its good or not.

 

Restaurant lo dish cost yekkuva unte food baga untundha ?

Coverage(plan)Type

CHOICE+/INS plan written on 2011 COC.

Calendar Year (CY) or Policy Year (PY)

Contact Customer Service if you need to determine if the Plan Deductible is based on a Calendar Year or Policy Year basis.

 

Additional information regarding the UnitedHealth Wellness program can be found on unitedhealthwellness.com

or 800-478-1057.

 

Topics include (but are not limited to):

UnitedHealth Wellness Card
UnitedHealth Wellness website (unitedhealthwellness.com)
myRenewell
Total Well-Being Program
UnitedHealth Allies discount program

 

Note: When we use the words 'we,' 'us,' and 'our' in this document, we are referring to UnitedHealthcare Insurance Company.

 

When we use the words 'you' and 'your' we are referring to people who are Covered Persons as the term is defined in Defined Terms.

 

COINSURANCE

The amount We pay based on Eligible Expenses

 

In Network

100% - Medical Services

100% - Lab, X-ray and Diagnostics - Outpatient

 

Out of  Network

70% - Medical Services

 

 

COPAYMENT

In Network

$25 - Primary Physician office visit

$50 - Specialist Physician office visit

Specialist Physician: A physician who has a majority of his or her practice in areas other than general pediatrics, internal medicine, obstetrics/gynecology, family practice or general medicine.

 

$200 - Emergency Room

$500 per day

$2,500 maximum amount per Hospital Inpatient Stay

$150 per test - Lab, X-Ray and Major Diagnostics

$50 per visit - Outpatient Mental Health, Neurobiological and Substance Use Disorder Services if MHPAEA does not apply.  See specific benefit categories for MHPHAEA Payment Amount Link.

$500 -  Surgery - Outpatient

$100 - Urgent Care Center

Copayments are not subject to Plan Deductible unless otherwise stated.

Copayments are not subject to Out of Pocket Maximum unless otherwise stated.

 

 

Out of  Network

$200 - Emergency Room

 

 

PLAN DEDUCTIBLE

Contact Customer Service if you need to determine if the Plan Deductible is based on a Calendar Year or Policy Year basis.

 

In Network

Individual: $1,000 per year

Family: $2,000 per year         

 

Out of  Network

Individual: $3,000 per year             

Family: $6,000 per year                                                             

 

Individual deductible applies to each covered person under the policy. The individual deductible and/or family deductible must be met before benefits are paid.

                               

Family deductible is an accumulation of the individual deductibles. Once the family deductible maximum amount has been reached all covered family members will be eligible to receive benefits.                                                                                                                                                                                                                                                                                                                                                

                                                                                                              

                                    

The Plan Deductible and Out-of-Pocket Maximum includes medical health services and does not include services covered under prescription drug services.

 

See specific benefit services categories to determine if the Plan Deductible applies.

 

3 month carryover does not apply.

 

                                                                                                      

                                                                                                            

OUT OF POCKET MAXIMUM

In Network

Individual: $3,500 per year                                

Family: $7,000 per year                          

 

Out of Network

Individual: $6,000 per year                          

Family: $12,000 per year       

 

Individual out of pocket maximum applies to each covered person under the policy. The individual out of pocket and/or family out of pocket must be met before eligible claims will be paid in full.                                              

                                                                                                                    

Family out of pocket maximum is an accumulation of the individual out of pocket maximums. Once the family out of pocket maximum amount has been reached we will consider that all covered family members have met their out of pocket maximums.                                                                                                                                                                                                                                                                         

                                                                         

                               

The Out of Pocket Maximum includes the Plan Deductible.

 

The Plan Deductible and Out-of-Pocket Maximum includes medical health services and does not include services covered under prescription drug services.

 

 

LIFETIME LIMITATIONS ESSENTIAL BENEFITS

HEALTH CARE REFORM

Click on the Limitations Link below for details.

Limitations Link

 

 

REIMBURSEMENT RATE

When Covered Health Services are received from a non-Network provider as a result of an Emergency or as otherwise arranged by us, Eligible Expenses are billed charges unless a lower amount is negotiated or authorized by state law.

 

For Non-Network Benefits, Eligible Expenses are based on either of the following:

 

When Covered Health Services are received from a non-Network provider, Eligible Expenses are determined, based on:

·                Negotiated rates agreed to by the non-Network provider and either us or one of our vendors, affiliates or subcontractors, at our discretion.

·                If rates have not been negotiated, then one of the following amounts:

§    Eligible Expenses are determined based on 110% of the published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar service within the geographic market.

§    When a rate is not published by CMS for the service, we use an available gap methodology to determine a rate for the service as follows:

♦       For services other than Pharmaceutical Products, we use a gap methodology that uses a relative value scale, which is usually based on the difficulty, time, work, risk and resources of the service. The relative value scale currently used is created by Ingenix, Inc. If the Ingenix, Inc. relative value scale becomes no longer available, a comparable scale will be used. We andIngenix, Inc. are related companies through common ownership by UnitedHealth Group.

♦       For Pharmaceutical Products, we use gap methodologies that are similar to the pricing methodology used by CMS, and produce fees based on published acquisition costs or average wholesale price for the pharmaceuticals. These methodologies are currently created by RJ Health Systems, Thomson Reuters (published in its Red Book), or UnitedHealthcare based on an internally developed pharmaceutical pricing resource.

§    When a rate is not published by CMS for the service and a gap methodology does not apply to the service, or the provider does not submit sufficient information on the claim to pay it under CMSpublished rates or a gap methodology, the Eligible Expense is based on 50% of the providers billed charge, except that certain Eligible Expenses for Mental Health Services and Substance Use Disorder Services are based on 80% of the billed charge.

§    For Mental Health Services and Substance Use Disorder Services the Eligible Expense will be reduced by 25% for Covered Health Services provided by a psychologist and by 35% for Covered Health Services provided by a masters level counselor.

We update the CMS published rate data on a regular basis when updated data from CMS becomes available. These updates are typically implemented within 30 to 90 days after CMS updates its data.

[Bairagi From Bapatla]

aa paina description naa plan bhayya... 2yrs nunchi undi kani yenadu vaadala... insurance gurinchi no knowledge... edho employer pay chei antunadu chesthunna... paina daniki in addition dental kooda undi naku... evaraina thelisthe konchem cheppi punyam katukondi....

 

thanks in advance...

[dkchinnari]

wrong perception..... deductible is the maximum amount per year that you pay for medical expenses, any extra expenses will be paid on the whole by the insurance provider....

nope..after duductible motham pay cheyadu..max out of pocket limit vache varaku it will be co-insurance like 20 r 30%..

then total insurance guys responsiblity.

[dkchinnari]

aa paina description naa plan bhayya... 2yrs nunchi undi kani yenadu vaadala... insurance gurinchi no knowledge... edho employer pay chei antunadu chesthunna... paina daniki in addition dental kooda undi naku... evaraina thelisthe konchem cheppi punyam katukondi....

 

thanks in advance...

http://www.ehealthinsurance.com/individual-health-insurance/resources/buyers-guide/page2/