NEED TO OFFER BENEFITS ?
UNICARE 3000 DEDUCTIBLE
Annual Deductible
(copays do not apply toward satisfying
any deductible)
$3,000 per member, per year with a two-member family maximum
Out-of-Network Deductible
Does not apply Additional $2,000 out-of-network deductible
per member, per year
Annual Out-of-Pocket Maximums
(includes copays, except pharmacy copays)
$3,000 plus deductible per member,
$6,000 plus deductible per family
$10,000 plus deductible per member,
$20,000 plus deductible per family
pating Provider Nonparticipating Provider
Lifetime Maximum
$5,000,000 per member
Office Visits
All medical office visits and exams for any covered
illness or injury. Office visits associated with
preventive care for babies and children (through
age 6). Office visits associated with a routine Pap
smear, annual mammogram, colorectal cancer
screening, or PSA screening.
$30 copay, deductible waived for unlimited visits 50%
Professional Services
Including surgery, anesthesia, radiation therapy,
and in-hospital doctor visits 75% 50%
Preventive Care for Babies and Children (through age 6)
Immunizations
100%, deductible waived
Adult Preventive Care
Routine Pap smears, annual mammograms
and PSA screenings
100%, deductible waived,
$300 maximum payment.
After maximum has been met,
75% and deductible applies 50%
Colorectal Cancer Screenings 75% 50%
Lab Work and X-rays
75% 50%
Inpatient Hospital Services
75% 50% less a $500 deductible
for nonemergency stays
Outpatient Medical Care
75% 50%
Physical/Occupational and Speech Therapy,
Acupuncture/Acupressure
$30 maximum per visit with a combined maximum of
12 visits per year for all of these services
Ambulatory Surgical Center
75% 50%
