2012 Plan Options
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. All options use the same nationwide 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.
Working Spouse/Domestic Partner Surcharge
You can choose to cover your spouse/domestic partner and dependents under the Children's medical plan options, too. But, if your spouse or domestic partner’s employer offers medical coverage and you elect coverage for your spouse or domestic partner through a Children’s medical plan option, you will pay a Working Spouse/Domestic Partner Surcharge of $50 per month (pre-tax) for your spouse or domestic partner’s coverage. This surcharge does not apply if your covered spouse or domestic
partner does not work, does not have subsidized group medical coverage available through an employer, or is employed by Children's Medical Center. See the Benefit Eligibility section, FAQs at the left or the 2012 Surcharge Flow Chart under Resources at the left for more details.
Here are your medical plan options at a glance. For specific details, see 2012 Medical Plan Options Comparison Chart under Resources at the left.
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Choice Saver
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.
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Choice Plus
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.
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Choice Basic
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.
A Discount for You
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.
- If the child is insured, the discount is taken off the balance due after insurance has been paid.
- If the child is not insured, the same discount off total charges will be applied.
How Choice Saver Works
Here is how you pay for care in the Choice Saver medical plan option.
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1
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Use your Healthcare Reimbursement Account (HRA) funds.
When you present your medical ID card, the cost for the service will be deducted from your HRA. You will not pay out-of-pocket medical expenses until these funds are depleted.
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2
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Pay the rest of your deductible.
If you use all of your HRA funds, you will pay the full cost of care until you meet your total annual deductible. You must present your medical ID card to have the charges applied to your deductible.
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3
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Pay a percentage of the cost.
After you meet the deductible, you will pay a percentage of the cost of care (coinsurance) — generally 20% in-network and 50% out-of-network.
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4
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Children’s pays.
If you meet the out-of-pocket maximum, Children’s pays 100% of your remaining covered medical expenses for the rest of the year.
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