Copay Choice with UHC PPO Plan

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Copay Choice with UHC PPO Plan

National network

The Copay Choice with UHC PPO Plan is an easy-to-use plan with a large network. You can visit any doctor, clinic or facility in the network without a referral.

What are the features?

  • One of the largest networks in the nation
  • Nationwide network coverage when you travel
  • No referrals needed when you see network providers 

How does it work?

Choose from any doctor, clinic or facility in the large Medica Choice with UnitedHealthcare Options PPO network. While you don’t need a referral to see a specialist in the network, it’s a good idea to work closely with your primary care doctor to coordinate your health care needs.

» View the Summary of Benefits and Coverage for the Copay Choice with UHC PPO Plan.

» Find a physician or facility in the Medica Choice with UnitedHealthcare Options PPO network.

Benefit Summary for Copay Choice with UHC PPO Plan

Friendly reminder: coinsurance is your share of the costs of a covered health care service, calculated as a percentage. Coinsurance applies after you've met your deductible.
Network Benefits
Overall deductible No deductible in-network. $300 per person/ $900 per family for out-of-network services.
Out-of-pocket limit $3,000 per person/ $5,000 per family in-network. $4,000 per person/ $6,000 per family for out-of-network services.
If you visit a health care provider's office or clinic
Primary care visit $35 copay/ visit. Deductible does not apply.
Chiropractic visit $35 copay/ visit. Deductible does not apply.
Convenience care visit $15 copay/ visit. Deductible does not apply.
Specialist visit $35 copay/ visit. Deductible does not apply.
Preventive care/screening/immunization No charge. Deductible does not apply.
If you have a test
Diagnostic test - lab No charge. Deductible does not apply.
Diagnostic test - x-ray No charge. Deductible does not apply.
Imaging (CT/PET scans, MRI) 20% coinsurance. Deductible does not apply.
If you need drugs to treat your illness or condition
Generic drugs Retail: $10/ prescription Deductible does not apply. Mail order: $20/ prescription Deductible does not apply.
Preferred brand drugs Retail: $20/ prescription Deductible does not apply. Mail order: $40/ prescription Deductible does not apply.
Non-preferred brand drugs Retail: $35/ prescription Deductible does not apply. Mail order: $70/ prescription Deductible does not apply.
Specialty drugs Preferred: 20% coinsurance No more than $200 copay/ prescription. Deductible does not apply. Non-Preferred: 30% coinsurance. Deductible does not apply.
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center) No charge. Deductible does not apply.
Physician/surgeon fees No charge. Deductible does not apply.
If you need immediate medical attention
Emergency room care $55 copay/ visit. Deductible does not apply.
Emergency medical transportation No charge. Deductible does not apply.
Urgent care $35 copay/ visit. Deductible does not apply.
If you have a hospital stay
Facility fee (e.g., hospital room) No charge. Deductible does not apply.
Physician/surgeon fees No charge. Deductible does not apply.
Network information
Network type National network
Network area Nationwide
Special features Largest network of providers.
Referrals needed No referrals needed if you see a Medica Choice Passport network provider.

Compare Plans

You can compare this plan side-by-side with up to two other plans to see the differences between their benefits.

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Enrollment Instructions

To enroll, log in to Employee Self Service (using a computer inside the City network) to enroll.

You'll need your City network (Active Directory, username and password.

mymedica.com

Once your plan starts, register on mymedica.com to manage your health plan. Order ID cards, find out what's covered, track your claims and more!

Visit mymedica.com

Additional Benefits from the City of Saint Paul

The City of Saint Paul offers a variety of non-medical employee benefits.

» Learn more about non-medical employee benefits.