Smokey Bones Online Benefits Information

MEDICAL

The medical program provides the framework for your good health and well-being. Below is a brief summary of the High Deductible Plan (HDHP) being offered through UnitedHealthcare Choice Plus Network. A Choice Plus network is a network of providers contracted with UnitedHealthcare to provide healthcare services at negotiated rates for our firestarters and their covered family members. Although you may use the services of an out-of-network provider; you will receive the highest level of benefits and pay at a lower cost when you choose an in-network provider. 

Medical Plan Summary

Benefit Highlights

In-Network

Out-of-Network

Annual Deductible

Individual / Family

 

$5,000/$10,000

 

$15,000/$30,000

Out-of-Pocket Maximum

Individual / Family

Coinsurance (plan will pay)

 

$6,450/$12,900

60%

 

$20,000/$40,000

50%

Physician Office Visits

Primary Care Physician

 

CYD + Coins. *

 

CYD + Coins. *

Specialist CYD + Coins. * CYD + Coins. *
Virtual Visits CYD + Coins. * CYD + Coins. *
Preventive Care 100%, no CYD CYD + Coins. *
Inpatient Care

CYD + Coins. * +$250

per occurrence copay

CYD + Coins. * +$250

per occurrence copay

Outpatient Care

CYD + Coins. * +$500

per occurrence copay

CYD + Coins. * +$500

per occurrence copay

Routine X-Ray & Lab CYD + Coins. * CYD + Coins. *
Emergency Room CYD + Coins. * CYD + In-network Coins.
Urgent Care CYD + Coins. * CYD + Coins. *

 

Prescription Drugs

Retail (After CYD)

Tier 1 $10
Tier 2 $35
Tier 3 $60

Additional Information-Click on link below: 

UHC Bronze Plan Summary of Benefits 

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