MEDICAL & PRESCRIPTION DRUG
MEDICAL & PRESCRIPTION
Coverage to Build a Foundation of Good Health
At Olympic Steel, we understand the importance of good health as the foundation for a productive life at home and at work. That is why we offer medical and prescription coverage, administered by UnitedHealthcare (UHC), to fit your needs and budget.
Keep in mind that you may use any provider or facility. However, if you choose a network provider, your UHC benefits will be paid at the highest level. In addition, if you use a Tier 1 Designated provider your office visit out of pocket amount will be reduced. Remember that you will pay more for care if you choose an out-of-network provider.
Use Your Coverage Wisely – Urgent Care vs Emergency Room
Everyone wants to save time and money and sometimes it takes a little legwork to do both. One way is to be aware of the appropriate usage of the Emergency Room versus using an Urgent Care center.
Urgent Care is for minor illness and injuries such as sprains and cuts, colds and the flu. The Emergency Room is for true emergencies such as broken bones, chest pains, and excessive bleeding…any condition that may be life-threatening or that will cause permanent damage without immediate and a higher level of care.
On average, the cost of the Emergency Room is five to eight times higher than the cost of Urgent Care and the average wait time is several hours instead of minutes. Why pay more and wait more for the same outcome?
How it Works
UnitedHealthcare PPO Plan
The UHC medical plan is a Preferred Provider Organization (PPO) which means UHC has contracted with a network of healthcare providers, including facilities, to provide better pricing for those who seek care within the network. UHC has further enhanced their PPO network by identifying certain providers as Designated Tier 1 providers. Tier 1 providers have demonstrated that they provide both quality and cost-effective care for their patients. Since managing healthcare dollars is everyone’s responsibility, there is a lower copay for you when you seek care from a Tier 1 provider. See the plan summary for more details.
In-Network Medical Plan FAQs:
- When you use network and Tier 1 providers you will pay less for your care;
- Office visits, ER, Urgent Care and Generic prescription drug all have flat copays and are not subject to the Plan deductible;
- Copays do not count toward your deductible
- Copays do accumulate toward your annual out-of-pocket maximum
- The annual deductible will apply to services such as Inpatient hospital stays, Outpatient services and some diagnostic testing
- Once the deductible is met, the Plan’s will begin to pay benefits at 80% (network)
- Your coinsurance amount after the deductible is 20%; once your annual out of pocket maximum is met the Plan will pay covered services at 100% for the rest of the plan year (network).
Prescription Coverage through UHC/OptumRx
If you enroll in the medical plan, you are automatically enrolled in prescription drug coverage. The pharmacy benefits manager is OptumRx, UHC’s pharmacy partner. To find out which drugs are covered, refer to the National Drug List found to the right side of this window or contact a customer service representative at 1-833-760-7890.
Some medications may require prior authorization from OptumRx before your prescription will be filled. Your doctor should contact OptumRx to initiate a prior authorization request.
Visit MyUHC.com if you have questions regarding your medical or prescription coverage.
|Calendar Year Deductible||$750 /individual
|Calendar Year Out-of-Pocket Maximum||$4,000/individual
|Coinsurance (amount you pay)||20% after deductible||40% after deductible|
|Preventive Care||No charge||40% after deductible|
|PCP Office Visit||$25 copay||40% after deductible|
|Tier 1 PCP Visit – New!||$10 copay||40% after deductible|
|Specialist Office Visit||$45 copay||40% after deductible|
|Tier 1 Specialist Visit – New!||$25 copay||40% after deductible|
|Urgent Care||$50 copay||40% after deductible|
|Emergency Services||$200 copay||$200 copay (Must contact Customer Service within 48 hours)|
|Hospital Services||20% after deductible||40% after deductible|
|Diagnostic X-ray and Lab||20% after deductible||40% after deductible|
|Prescription Drug Type||You Pay|
|Generic – Retail Prescription Drug (30-day supply)||$10 copay|
|Generic – Mail Order Prescription Drug (90-day supply)||$10 copay|
|Brand Preferred||25% coinsurance|
|Brand Non-Preferred||50% coinsurance|
Physician office visit copays, ER and urgent care copays, and prescriptions do not count toward your deductible, but do accumulate toward your out-of-pocket maximum. The annual deductible is included in the out-of-pocket maximum.