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Medical Plan Out-of- Pocket Expenses

Both Fordham options allow you to see any provider you choose, with higher benefits (and lower out-of-pocket costs for you) when you choose providers in the UnitedHealthcare (UHC) Choice Plus network. You may choose from more than 140,000 providers in the Greater New York area alone. If you see an out-of-network provider, note that UHC will base benefits on the 90th percentile of usual, customary, and reasonable charges. You will be responsible for paying the remaining balance between what the doctor billed and what UHC pays.

Terms to Know

  • Deductible. The amount you pay toward the cost of health care expenses each year before your plan begins to pay benefits. The deductible does not apply to in-network preventive care under either option.
  • Coinsurance. The percentage of the cost of covered services you pay after you’ve paid your deductible. For example, if your coinsurance is 20%, you pay 20% of the cost, and the plan pays 80%.
  • Copayment. The flat dollar amount you pay for certain services.
  • Out-of-pocket maximum. This feature provides important protection from very high medical expenses by limiting your out-of-pocket costs for the year. If you reach this limit, the plan pays 100% of all remaining costs for the year.

Deductibles

Health Investment Option
In Network: $1,500 Employee/$3,000 Family
Out of Network: $3,000 Employee/$6,000 Family

Enhanced Standard Option
In Network: $250 Employee/$500 Family
Out of Network: $300 Employee/$600 Family

If you enroll in family coverage, note that the family deductible works differently for the two options:

  • In the Health Investment Option, you must meet the family deductible before the plan begins paying benefits for anyone in the family; the individual deductible does not apply.
  • In the Enhanced Standard Option, the plan begins paying benefits for any individual once the individual deductible is met, and pays benefits for all covered family members once the family deductible is met.

Out-of-Pocket Maximum

Health Investment Option
In Network: $3,000 Employee/$6,000 Family
Out of Network: $6,000 /$12,000

Enhanced Standard Option
In Network: $2,500 /$5,000
Out of Network: $2,500 /$5,000

Preventive Care

Health Investment Option
In Network: No cost to you
Out of Network: You pay 40% after deductible

Enhanced Standard Option
In Network: No cost to you
Out of Network: You pay 20% after deductible

Office Visit/PCP

Health Investment Option
In Network: You pay 20% after deductible
Out of Network: You pay 40% after deductible

Enhanced Standard Option
In Network: $25 copay
Out of Network: You pay 20% after deductible

 

Specialist

Health Investment Option
In Network: You pay 20% after deductible
Out of Network: You pay 40% after deductible

Enhanced Standard Option
In Network: $50 copay
Out of Network: You pay 20% after deductible

Emergency Room

Health Investment Option
In Network: You pay 20% after deductible
Out of Network: You pay 20% after deductible

Enhanced Standard Option
In Network: $100 copay
Out of Network: $100 copay

Outpatient Diagnostic Testing

Health Investment Option
In Network: You pay 20% after deductible
Out of Network: You pay 40% after deductible

Enhanced Standard Option
In Network: You pay 5% after deductible
Out of Network: You pay 20% after deductible

Hospital Inpatient Care

Health Investment Option
In Network: You pay 20% after deductible
Out of Network: You pay 40% after deductible

Enhanced Standard Option
In Network: $250 copay
Out of Network: You pay 20% after deductible