Medical Benefits
We offer a high-deductible plan through UMR, a division of United Healthcare (UHC), with a Health Savings Account through Optum Bank. UMR gives you the freedom to see any physician or other health care professional from the network, including specialists. You may also choose outside of network with reduced benefits. You pay a small portion of the weekly premium. **You must acknowledge affirmatively on the Tobacco-Free affidavit to receive the Tobacco-Free premium discount.
United Healthcare PPO Network |
Out-of-Network |
|
---|---|---|
Calendar Year Deductible (includes Rx) |
$2,000/$4,000 |
$5,000/$10,000 |
Calendar Year Out of Pocket Maximum Includes deductible, coinsurance and copays if applicable. |
$3,000/$6,000 |
$10,000/$20,000 |
Services |
||
Emergency Room/Ambulance |
100% After Deductible |
100% After Deductible |
Urgent Care |
100% After Deductible |
70% After Deductible |
Hospital Services other than Mental Health and |
100% After Deductible |
70% After Deductible |
Inpatient and Outpatient Physician Charges |
100% After Deductible |
70% After Deductible |
Outpatient Services/Outpatient Physician |
100% After Deductible |
70% After Deductible |
Outpatient Lab and X-Ray Charges |
100% After Deductible |
70% After Deductible |
Outpatient Surgery/Surgeon Charges |
100% After Deductible |
70% After Deductible |
Physician and Specialist Office Visit |
100% After Deductible |
70% After Deductible |
Physician Office Services (Office Surgery) |
100% After Deductible |
70% After Deductible |
Therapy Services – Outpatient Hospital and Office |
100% After Deductible |
70% After Deductible |
Preventative Services Routine Care Benefits |
||
Routine Physical Exams at Appropriate Ages |
100%, Deductible Waived |
70% after deductible |
Immunization (Including Flu Vaccine) |
100%, Deductible Waived |
70% after deductible |
Routine Diagnostic Tests, Lab and X-Rays |
100%, Deductible Waived |
70% after deductible |
Routine Mammograms and Breast Exams: Limited |
100%, Deductible Waived |
70% after deductible |
Routine Pelvic Exams and Pap Test: Limited to 1 |
100%, Deductible Waived |
70% after deductible |
Routine PSA and Prostate Exams: Limited to 1 |
100%, Deductible Waived |
70% after deductible |
Routine Colonoscopy, Sigmoidoscopy and |
100%, Deductible Waived |
70% after deductible |
Limits Apply as Follows: |
||
Physical |
20 visits per year |
20 visits per year |
Occupational |
20 visits per year |
20 visits per year |
Speech |
20 visits per year |
20 visits per year |
Pulmonary |
20 visits per year |
20 visits per year |
Cardiac 36 visits per year |
36 visits per year |
36 visits per year |
Your pharmacy benefits will be administered by RxBenefits in partnership with OptumRx. The RxBenefits service model delivers enhanced safety, better cost savings, and top-notch customer service. With OptumRx, you’ll have access to a massive network of more than 64,000 pharmacies nationwide.
Start searching for savings through the OptumRx website or mobile app.
- Log in to optumrx.com and select Drug pricing and information from the member tools dropdown
- OR Download the OptumRx app, then select Search drug pricing
Pharmacy Search
- Search for an in-network pharmacy by visiting the OptumRx website.
If you need to fill a prescription before your card arrives, simply provide the following, along with your member number or Social Security number, to the pharmacy:
RXBIN: 610011 RXBPCN: IRX
RXGRP: RXBENHOSP
Pharmacy Member Services: 800.334.8134
Pharmacist Helpdesk: 800.880.1188
Download the OptumRx App now from the Apple App Store or Google Play.
Prescription Drugs |
Retail (30 Day Supply) |
Retail (90 Day Supply) |
Mail Services (90 Day Supply) |
---|---|---|---|
Maximum Day Supply Allowed |
31 |
90 |
90 |
Tier 1/Generic Copay |
$10 |
$25 |
$25 |
Tier 2/Brand Copay |
$35 |
$87.50 |
$87.50 |
Tier 3/Non-Preferred |
$60 |
$150 |
$150 |
Generic Specialty Medication Copay |
$10 with a maximum 30 day supply allowed per fill |
$10 with a maximum 30 day supply allowed per fill |
$10 with a maximum 30 day supply allowed per fill |
Formulary Specialty Medication Copay |
$100 with a 30 day supply allowed per fill |
$100 with a 30 day supply allowed per fill |
$100 with a 30 day supply allowed per fill |
Non-Formulary Specialty Medication Copay |
$300 with a 30 day supply allowed per fill |
$300 with a 30 day supply allowed per fill |
$300 with a 30 day supply allowed per fill |
Annual Medical / Rx Combined |
$2,000 per Individual, $4,000 per Family beginning every January 1st. |
Annual Medical / Rx Combined |
$3,000 per Individual, or $6,000 per Family beginning every January |
McCownGordon Construction now covers Regenexx under your health plan. Regenexx uses your body’s natural healing agents to replace the need for up to 70% of elective orthopedic surgeries. Your stem cells and blood platelets are concentrated in our on-site orthobiologics lab and injected under image guidance into the precise area of your injury where they repair and regrow damaged bone, cartilage, muscle, tendon, and ligament tissues. With Regenexx, you can get back to doing what you love without invasive surgery and lengthy recovery.
Contact Regenexx at
816.281.6648
regenexxbenefits.com/mccowngordon
Conditions Treated
Spine:
- bulging, collapsed, or herniated disc
- ruptured or torn disc
- degenerative disc disease
- disc extrusion
- disc protrusion
- back or neck nerve pain
Hip:
- arthritis
- osteonecrosis
- bursitis
- labral/labrum tear
- tendinopathy
- joint replacement alternative
Ankle/Foot:
- arthritis
- instability
- bunions
- ligament sprain or tear
- plantar fasciitis
- achilles tendinopathy
Hand/Wrist/Elbowarthritis:
- tennis elbow
- ulnar nerve entrapment
- CMC joint arthritis (thumb)
- carpal tunnel
- trigger finger
Shoulder:
- arthritis
- rotator cuff tears
- labral tear
- rotator cuff tendinosis
- joint replacement alternative
Knee:
- arthritis
- meniscus tear
- sprain or tear of ACL/PCL
- sprain or tear of the MCL/LCL
- tendinopathy
- joint replacement alternative
Talk to a U.S.-licensed doctor for non-emergency conditions 24/7 from anywhere you are. See download below for more information.
1-800-TELADOC (835-2362) | Teladoc.com
Group Number
76-412134
Provided By
UMR
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