Welcome to the Medical section of My Life at Children’s. Here you will find all the information you need about your medical plan options. Select an option from the menu at the left for more details.
You have three medical plan options. All cover the same services — such as doctor visits, hospital stays and lab work — and pay 100% for in-network preventive care based on age, gender and medical history (in accordance with healthcare reform guidelines). All options use the same network of providers — UnitedHealthcare Choice network. All the plans are self-funded by Children’s Medical Center and administered by UnitedHealthcare. The options differ based on cost and flexibility. Choose the one that is best for you.
Here are your medical plan options at a glance.
The Choice Saver medical plan option is a low-cost, quality option with a Healthcare Reimbursement Account (HRA) funded by Children’s. Compared to the other medical plan options, Choice Saver has the lowest premiums and highest deductibles. The HRA is 100% funded by Children’s to help you meet your annual deductible. If you enroll in Choice Saver after Jan. 1, the HRA amount will be prorated based on the month your benefits are effective. The HRA pays for eligible medical expenses before you pay for anything yourself. Expenses paid by the HRA are applied to your deductible. If you remain enrolled in Choice Saver, any remaining balance in the HRA will roll over to the following year. There are no copays with the Choice Saver option. All covered medical expenses apply toward the deductible except prescription drugs and covered preventive care. You can use in- or out-of-network providers, but this option pays more when you use an in-network provider.
You can go to any doctor you want, but this option pays more when you use an in-network provider. When you need care, you pay either a set copay or a percentage of the cost, depending on the type of service you receive. Compared to the other medical plan options, Choice Plus has the highest premiums and lowest deductibles.
This option only pays benefits if you receive care through an in-network provider. When you need care, you pay either a set copay or a percentage of the cost, depending on the type of service you receive.
Children of employees receive a 50% discount on outpatient services and 25% on inpatient services received at Children’s. You are considered a Children's employee if you are paid by Children's Medical Center.
Here is a closer look at how the Choice Saver option works:
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First, Children's funds your HRA.
Children’s puts $400 per individual or $800 per family in a Healthcare Reimbursement Account (HRA). If you enroll in Choice Saver after Jan. 1, the HRA amount will be prorated based on the month your benefits are effective. When you have a covered healthcare expense processed through your Choice Saver plan option, it is automatically paid from your available HRA dollars and applied to your deductible. See How To Get the Most out of Your Medical Benefits at the left for more details. If you have remaining funds in your HRA at the end of the year, these funds will roll over and be added to your HRA for the following year(s) as long as you remain in the Choice Saver plan.
2
Then, you pay the rest of your deductible.
When (or if) you use all of your HRA money, you pay 100% of healthcare expenses until you meet the deductible of $1,500 per individual or $4,500 per family in-network ($2,500 per individual or $7,500 per family out-of-network).* By using the HRA funds first, the deductible you pay is reduced.
3
Next, Children’s pays some, and you pay some.
After you meet the deductible, you and Children’s share the cost of care. Generally, you will pay 20% of in-network costs (50% out-of-network).
4
Finally, Children’s pays all costs.
Once you meet the out-of-pocket maximum ($5,000 per individual or $15,000 per family in-network), Children’s pays 100% of your remaining covered medical expenses for the rest of the year.**
Welcome to the Medical section of My Life at Children’s. Here you will find all the information you need about your medical plan options. Select an option from the menu at the left for more details.