UHC Medical Plan – POS Gold Choice – Summary of Benefits

1. Overview

The UnitedHealthcare POS Gold Choice plan offers flexible medical coverage with both in‑network and out‑of‑network access. Employees are free to see specialists without referrals, and costs are lowest when using UnitedHealthcare Choice Plus providers.

This article summarizes how the plan works and what employees can expect to pay for common medical services.

2. Key Plan Features

Plan Type

• Point‑of‑Service (POS)
• In‑network and out‑of‑network coverage
• No referrals required

Provider Network

• Uses the UHC Choice Plus network
• Out‑of‑network providers may result in much higher out‑of‑pocket costs

3. Deductibles & Out‑of‑Pocket Costs

Annual Deductible

Prescription Drug Deductible

• $350 Individual / $700 Family
• Applies only to Tiers 3 & 4 specialty/higher‑tier prescriptions

Out‑of‑Pocket Maximum

Not Included in the Out‑of‑Pocket Max

• Premiums
• Balance billing
• Non‑covered services
• Preauthorization penalties

4. Office Visits & Preventive Care

Primary Care

• $35 copay (in‑network)
• 50% coinsurance out‑of‑network

Specialist Visits

• $70 copay in‑network
• 50% coinsurance out‑of‑network

Preventive Care

• No charge in‑network
• Some preventive services covered at out‑of‑network rates
• Must follow UHC preventive care guidelines

Virtual Visits

• No charge through designated virtual network providers
• No coverage out‑of‑network

5. Diagnostic Testing & Imaging

Lab / X‑Ray

• 20% coinsurance in‑network
• 50% coinsurance out‑of‑network
• Out‑of‑network labs may not be covered

CT / MRI / PET

• 20% coinsurance in‑network
• 50% coinsurance out‑of‑network
• Out‑of‑network imaging requires preauthorization

6. Prescription Drugs

Retail (31‑day) & Mail‑Order (90‑day)

Additional Details

• Tier 1 & Tier 2 not subject to the RX deductible
• Some drugs require preauthorization
• Certain preventive medications available at no cost
• Out‑of‑network pharmacy use may not be covered

7. Emergency & Urgent Care

Emergency Room

• 20% coinsurance (in‑ and out‑of‑network)

Emergency Transportation

• 20% coinsurance

Urgent Care

• $50 copay in‑network
• 50% coinsurance out‑of‑network
• Additional testing during visit may add cost

8. Hospitalization & Surgery

Outpatient Surgery

• 20% coinsurance in‑network
• 50% coinsurance out‑of‑network

Inpatient Hospital Stay

• 20% coinsurance in‑network
• 50% coinsurance out‑of‑network
• Out‑of‑network requires preauthorization

9. Mental Health & Substance Abuse

Outpatient Visits

• $35 copay in‑network
• 50% coinsurance out‑of‑network
• Intensive programs may require preauthorization

Inpatient Care

• 20% coinsurance in‑network
• 50% coinsurance out‑of‑network

10. Maternity Care

Office Visits

• No charge for prenatal preventive care

Delivery Services

• Professional fees: 20% coinsurance
• Facility services: 20% coinsurance
• Length‑of‑stay rules apply for out‑of‑network care

11. Therapy, Rehab & Skilled Care

Home Health Care

• 20% coinsurance
• Up to 364 visits per year

Rehabilitation Therapy

• $35 copay per visit in‑network
• PT/OT/ST: 20 visits each per year
• Cardiac & pulmonary rehab: unlimited

Skilled Nursing Facility

• 20% coinsurance
• Up to 100 days per year

Durable Medical Equipment

• 20% coinsurance in‑network
• Not covered out‑of‑network

12. Pediatric Vision & Dental (Medical‑Based)

Eye Exam

• $10 copay
• Once every 12 months

Glasses

• $25 copay per frame
• One pair per 12 months

Dental Cleanings

• 0% coinsurance
• Two per 12‑month period

13. Excluded Services

Examples include:

• Cosmetic surgery
• Adult dental
• Routine foot care
• Long‑term care
• Weight loss programs
• Non‑emergency international care

14. Other Covered Services (with limits)

• Acupuncture (6 visits/year)
• Bariatric surgery
• Hearing aids
• Infertility treatment
• Private‑duty nursing
• Adult routine eye exam (1 per year)
• Chiropractic/spinal manipulation (20 visits per year)

15. Continuation of Coverage

If you lose coverage, options may include:

• COBRA
• Marketplace health plans

Assistance is available via state and federal agencies.