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UnitedHealthOne - Saver 80 Plan Benefits

Saver 80 Benefit Summary

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Plan Feature In-Network
Maximum 2 per family, per calendar year
$1,000 single / $2,000 family
$1,500 single / $3,000 family
$2,500 single / $5,000 family
$5,000 single / $10,000 family
$7,500 single / $15,000 family
$10,000 single / $20,000 family
$12,500 single / $25,000 family
Coinsurance Choices
The level of coverage provided by the plan after the calendar year Deductible has been satisfied.
You pay 20%
Coinsurance Out-of-Pocket Maximum
In-network, per person, per calendar year, after deductible.
Lifetime Maximum Benefit Unlimited
Physicians (illness and injury)
Office Visits
Primary Care or Specialist
Not covered
Wellness Care
From age 16. Covers services associated with both an annual physical exam and an annual gynecological exam. Includes immunizations and routine diagnostic tests received or ordered on the same day as part of the exam when covered services are received in provider's office.
100% (deductible waived)
Well-Child Care
To age 16. Includes immunizations, physical exams and routine diagnostic tests.
100% (deductible waived)
Doctor Office Visit
Adult or child, in-network only.
Not covered
Preventive Mammorgram, Pap Smear, PSA screening
No waiting period.
100% (deductible waived)
Outpatient Expense Benefits
X-Ray and Lab
Must be performed within 14 days of surgery or confinement
You pay 20% after deductible
Facility/Hospital for Outpatient Surgery
Surgery in doctor's office not covered
You pay 20% after deductible
Surgeon, Assistant Surgeon, and Facility Fees You pay 20% after deductible
Hemodialysis, Radiation, Chemotherapy, Organ Transplant Drugs, and CAT Scans, MRIs You pay 20% after deductible
Emergency Room Fees - Illness You pay $500 copay if not admitted, then 20% after deductible
Emergency Room Fees - Injury You pay $500 copay if not admitted, then 20% after deductible
Spine and Back Disorders
CAT scan and MRI tests not subject to this limitation.
Not covered
Mental and Nervous Disorders
Including substance abuse.
Not covered
Other Outpatient Expenses Not covered
Inpatient Expense Benefits
Room and Board, Intensive Care Unit, Operating Room, Recovery Room, Prescription Drugs, Physician Visit, and Professional Fees of Doctors, Surgeons, and Nurses You pay 20% after deductible
Other Inpatient Services You pay 20% after deductible

Prescription Drug Benefit You Pay
Discount Card
You may obtain Rx drugs at an average savings of 20-25%. Discounts vary by pharmacy, geographic area, and drug.
Discount card included, but prescriptions not covered under plan
Annual Maximum
Covered expense, per person per calendar year.
Not applicable
READ YOUR POLICY CAREFULLY; This outline of coverage provides a brief description of the important features of the Policy. This is not the insurance contract, and only the actual Policy provisions will control. The Policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR POLICY CAREFULLY!

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