Annual Deductible
Out-of-Pocket Max
Family Deductible
Family Out-of-Pocket
🎯 Your Network Strategy - This Saves You Money!
This plan has THREE tiers of providers. Using the right tier can save you hundreds per visit.
🥇 Designated Network
BEST CHOICE
Lowest costs
🥈 Network
GOOD CHOICE
Moderate costs
🚫 Out-of-Network
AVOID IF POSSIBLE
Highest costs + balance billing
👩⚕️ Doctor Visits
🔬 Testing & Imaging
🚨 Emergency & Urgent Care
🏥 Hospital & Surgery
💊 Prescription Drugs
Prescription Deductible: $400 individual (Tier 1 drugs are exempt)
Tier 1
$20 retail
$40 mail (90-day)
No deductible
Tier 2
$45 retail
$90 mail (90-day)
After $400 deductible
Tier 3
$75 retail
$150 mail (90-day)
After $400 deductible
Tier 4
$125 retail
$250 mail (90-day)
After $400 deductible
💡 Annual Cost Scenarios
Based on actual examples from your plan document:
🤱 Having a Baby
Total Medical Costs: $12,700
You Pay: $5,720
Includes prenatal care, delivery, hospital stay
🩺 Managing Diabetes
Total Medical Costs: $5,600
You Pay: $1,000
Annual routine care for controlled condition
🦴 Simple Fracture
Total Medical Costs: $2,800
You Pay: $2,700
ER visit, X-ray, follow-up care
🚫 What's NOT Covered
🎯 Your Action Plan
- Find Designated Network providers - Use uhc.com/shopdc to locate the cheapest tier of providers in your area
- Schedule annual physical - It's FREE and includes all age-appropriate screenings
- Get all preventive care early - Colonoscopy, mammogram, vaccines - all covered at no cost
- Use mail-order prescriptions - Get 90-day supplies to save money on ongoing medications
- Plan major procedures carefully - If you need surgery, you'll hit your $3,750 deductible, so bunch procedures together
- Emergency fund planning - Budget for worst-case scenario of $9,100 out-of-pocket maximum
- Track your spending - Once you hit $3,750 deductible, your costs drop significantly
✨ Special Benefits Included
🧠 Mental Health
Outpatient: 30% after deductible
Some intensive treatments: FREE
👶 Pediatric Vision
Eye exam: $30 copay (1x/year)
Glasses: 50% coinsurance (1x/year)
🦷 Pediatric Dental
Cleanings: FREE (2x/year)
Deductible: $50 individual / $100 family
🦻 Hearing Aids
Coverage: Up to $2,500/year
Need Help?
Visit: uhc.com/shopdc | Call: 1-800-782-3740
This plan meets Minimum Essential Coverage and Minimum Value Standards