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Medical - Compare Options

This Medical Plan Comparison Chart includes the coverage levels for commonly used services. This comparison chart does not reflect all medical plan services, exclusions, limitations, or restrictions. It is not considered a contract or guarantee of coverage under the Plans. Refer to the Summary Plan Document located at www.oraclebenefits.com for more details on Plan provisions and limitations. Click here to find which medical plan(s) are available to you.
UHC - Medium PPO Choice Plus
UnitedHealthCare
UHC - Premium PPO Choice Plus
UnitedHealthCare
You may use any doctor or facility. You receive a higher level of benefits when you use Network providers. You are responsible for ensuring all providers are in the network.
You may use any doctor or facility. You receive a higher level of benefits when you use Network providers. You are responsible for ensuring all providers are in the network.
Network:
90%
Non-Network:
70% 5
Network:
100%
Non-Network:
80% 5
Network:
$400 individual/$1,200 family
Non-Network:
$800 individual/$2,400 family 5
Network:
$400 individual/$1,200 family
Non-Network:
$800 individual/$2,400 family 5
Embedded
Embedded
Network:
$2,000 individual/$4,000 family
Non-Network:
$5,000 individual/$10,000 family 10
Network:
$2,000 individual/$4,000 family
Non-Network:
$5,000 individual/$10,000 family 10
Not Applicable
Not Applicable
Preventive Care
Network:
100%
Non-Network:
100% of UCR 2
Network:
100%
Non-Network:
100%of UCR 2
Network:
100%
Non-Network:
100% of UCR 2
Network:
100%
Non-Network:
100% of UCR 2
Network:
100%
Non-Network:
100% of UCR 2
Network:
100%
Non-Network:
100% of UCR 2
Network:
100%
Non-Network:
100% of UCR 2
Network:
100%
Non-Network:
100% of UCR 2
Prescription Drugs - Retail Pharmacy, 34-Day Supply
Network:
Tier 1 - $5 copay; Limited to a 34-day supply; Deductible does not apply
Non-Network:
50% of billed charged per applicable prescription; Limited to a 34-day supply; Deductible does not apply 1 7
Network:
Tier 1 - $5 copay; Limited to a 34-day supply; Deductible does not apply
Non-Network:
50% of billed charged per applicable prescription; Limited to a 34-day supply; Deductible does not apply 1 7
Network:
Tier 2 - 75% ($40 minimum, $80 maximum); Limited to a 34-day supply; Deductible does not apply
Non-Network:
50% of billed charged per applicable prescription; Limited to a 34-day supply; Deductible does not apply 1 7
Network:
Tier 2 - 80% ($30 minimum, $60 maximum); Limited to a 34-day supply; Deductible does not apply
Non-Network:
50% of billed charged per applicable prescription; Limited to a 34-day supply; Deductible does not apply 1 7
Network:
Tier 3 - 75% ($60 minimum, $120 maximum); Limited to a 34-day supply; Deductible does not apply
Non-Network:
50% of billed charged per applicable prescription; Limited to a 34-day supply; Deductible does not apply 1 7
Network:
Tier 3 - 80% ($50 minimum, $100 maximum); Limited to a 34-day supply; Deductible does not apply
Non-Network:
50% of billed charged per applicable prescription; Limited to a 34-day supply; Deductible does not apply 1 7
See section below for Mail Order Pharmacy.
Prescription Drugs - Mail Order Pharmacy, 90-Day Supply
Network:
Tier 1 - $10 copay; Limited to a 90-day supply; Deductible does not apply
Non-Network:
Not covered1 7
Network:
Tier 1 - $10 copay; Limited to a 90-day supply; Deductible does not apply
Non-Network:
Not covered1 7
Network:
Tier 2 - 75% ($80 minimum, $160 maximum); Limited to a 90-day supply; Deductible does not apply
Non-Network:
Not covered1 7
Network:
Tier 2 - 80% ($60 minimum, $120 maximum); Limited to a 90-day supply; Deductible does not apply
Non-Network:
Not covered1 7
Network:
Tier 3 - 75% ($120 minimum, $240 maximum); Limited to a 90-day supply; Deductible does not apply
Non-Network:
Not covered1 7
Network:
Tier 3 - 80% ($100 minimum, $200 maximum); Limited to a 90-day supply; Deductible does not apply
Non-Network:
Not covered1 7
See section above for Retail Pharmacy.
Outpatient Medical Services
Network:
Available through American Well: General Physician $5 copay, Nutritionist $5 copay, Mental Health Counseling $10 copay
Non-Network:
Not covered14
Network:
Available through American Well: General Physician $5 copay, Nutritionist $5 copay, Mental Health Counseling $10 copay
Non-Network:
Not covered14
Network:
$25 copay
Non-Network:
70% of UCR after deductible2
Network:
$20 copay
Non-Network:
80% of UCR after deductible2
Network:
$35 copay
Non-Network:
70% of UCR after deductible2
Network:
$30 copay
Non-Network:
80% of UCR after deductible2
Network:
90% after deductible
Non-Network:
70% of UCR after deductible.
A $200 penalty is imposed if there is no prior authorization for non-network services. Penalty does not apply towards plan deductible or out of pocket maximum.2
Network:
100% after deductible
Non-Network:
80% of UCR after deductible.
A $200 penalty is imposed if there is no prior authorization for non-network services. Penalty does not apply towards plan deductible or out of pocket maximum.2
Network:
Applicable Doctor/Specialist copay applies
Non-Network:
70% of UCR after deductible2
Network:
Applicable Doctor/Specialist copay applies
Non-Network:
80% of UCR after deductible2
Network:
90% after deductible and $100 copay
Non-Network:
70% of UCR after deductible and $100 copay2
Network:
100% after deductible and $100 copay
Non-Network:
80% of UCR after deductible and $100 copay2
Network:
100% for first 6 EAP visits through United Behavioral Health ; Additional sessions $25/visit
Non-Network:
90% of UCR after deductible2 6
Network:
100% for first 6 EAP visits through United Behavioral Health ; Additional sessions $20/visit
Non-Network:
90% of UCR after deductible2 6
Network:
$35 copay. Combined Network & Non-Network limit of 60 visits for each therapy type, per year. Medical review is needed for further visits
Non-Network:
70% of UCR after deductible. Combined Network & Non-Network limit of 60 visits per year for each therapy type, per year. Medical review is needed for further visits2
Network:
$30 copay. Combined Network & Non-Network limit of 60 visits for each therapy type, per year. Medical review is needed for further visits
Non-Network:
80% of UCR after deductible. Combined Network & Non-Network limit of 60 visits per year for each therapy type, per year. Medical review is needed for further visits2
Inpatient Hospital Services
Network:
Provider responsibility
Non-Network:
Patient responsibility.  A $200 penalty applies to non-certified hospitalizations/inpatient stays. Penalty does not apply towards plan deductible or out of pocket maximum.
Network:
Provider responsibility
Non-Network:
Patient responsibility.  A $200 penalty applies to non-certified hospitalizations/inpatient stays. Penalty does not apply towards plan deductible or out of pocket maximum.
Network:
90% after deductible and $250 copay
Non-Network:
70% of UCR after deductible and $250 copay2
Network:
100% after deductible and $250 copay
Non-Network:
80% of UCR after deductible and $250 copay2
Network:
90% after deductible and $250 copay
Non-Network:
70% of UCR after deductible and $250 copay2
Network:
100% after deductible and $250 copay
Non-Network:
80% of UCR after deductible and $250 copay2
Network:
90% after deductible
Non-Network:
90% of UCR after deductible2
Network:
100% after deductible
Non-Network:
90% of UCR after deductible2
Network:
90% after deductible
Non-Network:
90% of UCR after deductible2
Network:
100% after deductible
Non-Network:
90% of UCR after deductible2
Family Planning / Maternity Care
Network:
90% after deductible
Non-Network:
70% of UCR after deductible 2 3
Network:
100% after deductible
Non-Network:
80% of UCR after deductible 2 3
Network:
90% after deductible and $250 copay
Non-Network:
70% of UCR after deductible and $250 copay 2 3
Network:
100% after deductible and $250 copay
Non-Network:
80% of UCR , after deductible and $250 copay 2 3
Network:
90% after deductible
Non-Network:
70% of UCR after deductible
A $200 penalty is imposed if there is no prior authorization for non-network services. Penalty does not apply towards plan deductible or out of pocket maximum.2 3
Network:
100% after deductible
Non-Network:
70% of UCR after deductible
A $200 penalty is imposed if there is no prior authorization for non-network services. Penalty does not apply towards plan deductible or out of pocket maximum.2 3
Network:
90% after deductible and $250 copay
Non-Network:
70% of UCR after deductible and $250 copay 2 11 3
Network:
100% after deductible and $250 copay
Non-Network:
80% of UCR after deductible and $250 copay 2 11 3
Network:
90% after deductible and $100 copay
Non-Network:
70% of UCR after deductible and $100 copay 2 3
Network:
100% after deductible and $100 copay
Non-Network:
80% of UCR after deductible and $100 copay 2 3
Network:
90% after deductible
Non-Network:
70% of UCR after deductible 2 3
Network:
100% after deductible
Non-Network:
80% of UCR after deductible 2 3
Coverage varies by plan guidelines/procedure setting (e.g., hospital, office visit, outpatient surgical center)
Coverage varies by plan guidelines/procedure setting (e.g., hospital, office visit, outpatient surgical center)
Covers FDA-approved devices that cannot be purchased over the counter. Coverage varies by plan - contact UHC to verify
Covers FDA-approved devices that cannot be purchased over the counter. Coverage varies by plan - contact UHC to verify
Refer to Prescription Drug Benefits
Refer to Prescription Drug Benefits
Network:
100%
Non-Network:
70% of UCR after deductible and applicable facility copay 1 2 9
Network:
100%
Non-Network:
80% of UCR after deductible and applicable facility copay 1 9
Network:
Applicable copay if performed in doctors office, otherwise 90% after deductible and applicable facility copay
Non-Network:
70% of UCR after deductible and applicable facility copay 2 9
Network:
Applicable copay if performed in doctors office, otherwise 100% after applicable facility copay
Non-Network:
80% of UCR after deductible and applicable facility copay 2 9
RRS Network: Provider responsibility. Services must be performed by Reproductive Resource Services. Non-RRS services are not covered. 4
RRS Network: Provider responsibility. Services must be performed by Reproductive Resource Services. Non-RRS services are not covered. 4
Network:
70%; Infertility medical services must be received by Reproductive Resource Services
Non-Network:
Not covered4
Network:
70%; Infertility medical services must be received by Reproductive Resource Services
Non-Network:
Not covered4
Medical - $25,000 / Prescription Drugs - $12,000 (Infertility charges do not apply to out of pocket maximum)
Medical - $25,000 / Prescription Drugs - $12,000 (Infertility charges do not apply to out of pocket maximum)
Emergency Medical Services
Network:
$150 copay if true emergency (waived if admitted to hospital)
Non-Network:
$150 copay if true emergency (waived if admitted to hospital)
Network:
$150 copay if true emergency (waived if admitted to hospital)
Non-Network:
$150 copay if true emergency (waived if admitted to hospital)
Network:
70% after deductible
Non-Network:
70% of UCR after deductible2
Network:
80% after deductible
Non-Network:
80% of UCR after deductible2
100% of billed charges
100% of billed charges
Network:
$25 copay
Non-Network:
70% of UCR after deductible2
Network:
$20 copay
Non-Network:
80% of UCR after deductible2
Miscellaneous Services
Network:
$35 copay. Combined Network & Non-Network limit of 20 visits per year. Medical review is needed for further visits
Non-Network:
70% of UCR after deductible. Combined Network & Non-Network limit of 20 visits per year. Medical review is needed for further visits2
Network:
$30 copay. Combined Network and Non-Network limit of 20 visits per year. Medical review is needed for further visits
Non-Network:
80% of UCR after deductible. Combined Network and Non-Network limit of 20 visits per year. Medical review is needed for further visits2
Network:
80%
Non-Network:
80% of billed charges
Network:
80%
Non-Network:
80% of billed charges
Network:
90% after deductible
Non-Network:
70% of UCR after deductible.
A $200 penalty is imposed if there is no prior authorization for non-network services. Penalty does not apply towards plan deductible or out of pocket maximum.2
Network:
100% after deductible
Non-Network:
80% of UCR after deductible.
A $200 penalty is imposed if there is no prior authorization for non-network services. Penalty does not apply towards plan deductible or out of pocket maximum.2
Network:
80% Limited to a single purchase per affected ear every three years.
Non-Network:
80% of UCR 2
Network:
80%
Non-Network:
80% of UCR 2
Network:
Treatment w/office visit: Applicable Doctor/Specialist copay applies; Injections only (no office visit): 90%
Non-Network:
70% of UCR after deductible2
Network:
Treatment w/office visit: Applicable Doctor/Specialist copay applies; Injections only (no office visit): 100%
Non-Network:
80% of UCR after deductible2
Network:
$35 copay
Non-Network:
70% of UCR after deductible; If performed at lab - refer to non-preventive lab benefit2
Network:
$30 copay; If performed at lab - refer to non-preventive lab
Non-Network:
80% of UCR after deductible; If performed at lab - refer to non-preventive lab benefit2
Network:
80% after deductible
Non-Network:
80% of billed charges after deductible 12 13 15
Network:
80% after deductible
Non-Network:
80% of billed charges after deductible 12 13 15

This Medical Plan Comparison includes the coverage levels for commonly used services. This comparison chart does not reflect all medical plan services, exclusions, limitations, or restrictions. It is not considered a contract or guarantee of coverage under the Plans. Refer to the Summary Plan Document located at www.oraclebenefits.com for more details on Plan provisions and limitations.


1 In accordance with Healthcare Reform‘s Expanded Women‘s Preventive Care Services, certain contraceptives are available at no charge. Contact your medical plan to verify coverage.
2 UCR refers to Usual, Customary and Reasonable charges in your geographic area.
3 If you are enrolled in one of the United Healthcare plans, you may access the Healthy Pregnancy program at the number on your id card, 1-800-411-7984 or visit www.healthy-pregnancy.com. If you are enrolled in one of the HMO plans, consult your specific HMO about any pregnancy programs they may offer.
4 United HealthCare Plan Members: Contact Reproductive Resource Services (RRS) at 1-866-774-4626 or www.myoptumhealthcomplexmedical.com.
5 Deductible and copayment applies only when noted "after deductible" and "copay".
6 Contact United Behavioral Health (EAP) at 1-866-728-8413 or www.liveandworkwell.com.
7 United HealthCare Plan Members Prescription drugs are categorized into three tiers each with an assigned cost (e.g. copayment). Tier 1 is the lowest cost option, tier 2 is mid-range, and tier 3 is the highest cost option. Generally generic medications are classified as tier 1 however that may not always be the case. Obtain the most current tier information on www.myuhc.com or by calling UHC using the number on your ID card. Certain medications for rare and/or complex conditions are classified as Specialty Medications. These medications are subject to different dispensing processes and costs. If you are taking one more of these medications contact United Healthcare at 1-866-672-2511 for more information.
8 If you request a brand name drug with a generic alternative, you may be required to pay for the difference between generic and brand (unless the brand name was requested by your doctor).
9 If you receive these services as part of an inpatient hospital stay or as part of an outpatient hospital procedure, the applicable hospital copayment apply.
10 Out of Pocket Maximum includes copays for items such as office visits, hospital network pharmacy and emergency room. Please refer to the Plan Documents for details.
11 Separate hospitalization co-pay for the newborn may apply if the newborn is admitted for their own medical condition separate from labor and delivery. See hospital co-pays for details.
12 Coverage for physical, speech or occupational, please see those sections.
13 Progress notes required - please refer to Plan for details.
14 Telehealth benefits are available through American Well. Telehealth enables UHC eligible employees and dependents to obtain services from licensed physicians virtually. Seek care using your computer, tablet, mobile device, and telephone. Go to http://oracle.amwell.com/ for more information and/or to access services.
15 Autism services offered through Oracle‘s United Healthcare (UHC) medical plans include assessments by eligible board certified behavioral analysts, licensed mental health clinicians and therapists and comprehensive services and treatments including Applied Behavior Analysis (ABA). For more information about UHC’s autism coverage, please contact UHC at 1-866-672-2511.