United HealthCare (Health Maintenance Organization or HMO)
Customer Service, call toll free at 1-877-366-0011, 8:00 am - 5:00 pm EST, Monday through Friday.
This plan will close December 31, 2010.
- Member Home Page
- 2010 Member Handbook
- 2010 Plan Highlights
Primary Care Physician (PCP) coordinates health care services; each family member may choose a different physician. To change your PCP contact the customer service office.
Physician Office Visit: $20 copay PCP; $25 copay specialist
Lab & X-Ray: 100% benefit
Maternity: $20 copay PCP; $25 copay specialist
Chiropractic Care: $20 copay per visit
Emergency Room Use: $75 copay per visit (This applies only if not admitted to the hospital.)
Annual Medical Deductible: None
Annual Medical Out-of-Pocket Maximum: None
Annual Pharmacy Copay Maximum: None
Routine vision care limited to one visit/year. Eye exams must be obtained from a Spectera Vision provider. Phone 1-800-638-3120 for a participating provider or view the provider directory, using your Social Security number as the subscriber's identification number. You must use an approved provider to receive benefits for an eye exam and ID card must be presented. Exams performed by an optometrist will be covered for $15 copay.
Chiropractic Care will be covered for $15 copay; maintenance visits not covered when no additional progress is apparent or expected to occur. Phone 1-800-873-4575 for more information about chiropractic care.
- Pharmacy benefits administered by CVS
Caremark. Phone toll-free at 1-877-522-TNRX (8679).
30-day supply at Retail Pharmacies
Tier 1 (generic drugs): $5 copayment
Tier 2 (preferred brand-name drugs): $25 copayment
Tier 3 (non-preferred brand-name drugs): $75 copayment
Use a network pharmacy when filling prescriptions with up to a 30-day supply. The network includes more than 1,600 pharmacies across the state and includes chain pharmacies such as CVS, Kroger, Publix, RiteAid, Sam's, Target, Walgreens, and Walmart. Many local, independent pharmacies are also in the network.
90-day supply by Mail Order
Tier 1 (generic drugs): $10 copayment
Tier 2 (preferred brand-name drugs): $50 copayment
Tier 3 (non-preferred brand-name drugs): $100 copayment
Use the CVS Caremark Mail Service Pharmacy to fill your long-term prescriptions. Mail service is a cost-effective choice for some medicines. With mail service you can get up to a three-month supply for less than what you would pay by filling your prescriptions every 30 days.
90-day supply by Mail at Retail
You can also get your three-month supply (84-90 days’ supply) from a participating retail pharmacy store. With this option, you still pay the lower mail service prices. The mail at retail network will be different from the 30-day retail network.
Diabetic Supplies (strips, lancets, syringes): Coinsurance waived when using In-Network Provider
Diabetic Prescription Drug (oral and insulin): Copay waived for generic and preferred brand when using In-Network Provider; $75 for 30-day supply for non-preferred brand; $100 for 90-day supply for non-preferred brand.