UnitedHealthcare HMO Plans

CS VEBA Performance and CS VEBA Alliance

UnitedHealthcare HMO Plans CS VEBA Performance and CS VEBA Alliance are Health Maintenance Organization’s (HMOs) with a closed network of providers. HMOs allow you to receive comprehensive coverage at set prices, called copays.

How the plan works

You choose a primary care physician (PCP) from the associated UHC network.
The PCP coordinates your care and refers you to specialists.
The plan covers the cost of services only when your primary care physician authorizes it.

Doctors/Other Medical Care Providers: You can only use doctors, hospitals, and pharmacies that participate in the HMO network. Doctors who participate in the HMO network are called in-network providers. There is no coverage if you go to out-of-network providers, except for emergency services.

Annual Deductible: You don’t need to pay an annual deductible before the plan begins to pay for a portion of covered medical services.

Copays: When you receive medical care, you pay a set dollar amount called a copay.

Annual Out-of-Pocket Maximum: The HMO plans include an annual out-of-pocket maximum. Once you reach the out-of-pocket maximum, the plan pays 100% of covered charges for the remainder of the plan year.

Prescription Coverage: Prescriptions will be managed by Evernorth/Express Scripts. UHC HMO members will receive an ID card from UHC for medical and an ID card from Evernorth/Express Scripts for prescription drug benefits.

Note: Review the comparison charts below for copays, annual out-of-pocket maximums, and a list of medical groups.

Per Pay Period Cost

	Employee Only	Employee Plus 1	Employee Plus 2 or more
UnitedHealthcare Performance HMO	$460.83	$921.30	$1,303.45
UnitedHealthcare SignatureValue CS VEBA Alliance HMO	$422.13	$883.90	$1,250.53