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​​​​​​​​​Health Plan - UHC CDH Plan​

There are no changes to CDH plan design, deductibles, coinsurance, copays, or out-of-pocket. 

Highlights of CDH High Plan

  • When billed by the Provider as Preventive, preventive services are covered 100% in-network.
  • Some services received for a copay (Primary, Specialist, Urgent Care, Emergency Room).
  • Some services are subject to the annual deductible/co-insurance (Outpatient or inpatient services/ procedures). 
  • Behavioral Health/Substance Abuse outpatient services first 20 visits covered at no cost, then a $25 copay.
  • Diagnostic tests at a participating freestanding facility are capped at $100 per test.
  • An annual basic eye exam at no cost at a participating optometrist.
  • A discount dental plan is included at participating dental providers. 
NO OUT OF NETWORK COVERAGE (you are covered when traveling for a true medical emergency).
Open Access
All of the County’s health plans are Open Access, which means members do not select a Primary Care Physician (PCP), and NO referral is needed to see most network specialists. Members are encouraged (but not required) to see a primary care or family medicine physician for routine care. Physicians listed under the Primary Care and Family Medicine category on MyUhc.com have a lower copay/cost than physicians listed as a Specialist. Because you are not required to obtain a referral to see a specialist, keeping your primary/family physician updated on any specialty care received is recommended so that all your personal health care information resides in one location.

EXCLUSIONS AND LIMITATIONS
All health plans have specific Exclusions and Limitations. Please contact the on-site UnitedHealthcare Reps for more information.
The chart below is a summary of coverage; for more details, go to MyUHC.com:

 

​​BENEFIT UHC CDH National Network
Annual Deductible*​​$1,300 Single, $2,600 Dependents 
(Does not include Rx)
​Annual Coinsurance @ 20%*​$1,500 Single, $3,000 Dependents
​Annual Max Out of Pocket*​$2,800 Single, $5,600 Dependents
​Preventive Care​No Cost when billed as Preventive Care 
by Provider
​Primary Care Doctor​$25 copay
​Specialist​​$50 copay
​Lab Work​No cost at Lab Corp or Quest
​Virtual Visits (Telehealth)​$50 copay
​Urgent Care -National Network​$50 copay
​Emergency Room​$250 copay
​MRI/Nuclear Medicine​20% up to a $100 max, at 
Freestanding Facility​
​Behavioral Health/Substance 
Abuse Out Patient visits		​No cost for the first 20 visits, $25 copay 
per visit thereafter. Requires a referral prior to 1st visit
​All other medical services​Subject to Annual Deductible and 
20% Coinsurance
​Rx copays OptumRx​Generic:  $7.00-30-day / $14.00-90-day
Preferred: $25.00-30-day / $50.00-90-day
Non-Preferred: $45.00-30-day / $90.00-90-day
Specialty: $75.00 30-day Only
​The plan includes the following benefits:​​Basic annual eye exam
Discount Dental Plan​
​*Does not include pharmacy copays
Contact Info:​

UHC Member Services: 1-866-633-247​​4

On-Site Reps​​: 

​​Neerie Kolehma​ 954-357-7191 

Chris Sands 954-357- 7192

​Pharmacy - UnitedHealthcare - CDH

Your pharmacy benefits are provided under the County's self-insured pharmacy plan through UnitedHealthcare (UHC). Some of the plan features include: 
  • an open formulary with five tiers of coverage at affordable co-pays, 
  • a large network of participating pharmacies,
  • a 90-day mandatory maintenance medication program (excludes specialty).​ ​
Consumer-Driven Health (CDH) Rx Plans - Copay Rates

 
​​​Tiers
​  ​30-Day Supply
​ ​90-Day Supply Maintenance Medication
​Generic​​​$7​​$14
​Bra​nd-Preferred​$30​$60
​Non-Preferred​​$45​$90
​Specialty Pharmacy​$75​30-Day Supply Only
​Dispense-as-Written (DAW1)​ & Excluded Drug ("Tried & Failed")​​$75​$150​​

​New Plan for Those with Type 2 Diabetes​​​​ ​​​​Level ​​​2 

​Level2 works with people to help them as they work to improve their type 2 diabetes. Members eligible for the program will be notified by UHC. Plus, all this at a small additional cost of $5 per enrolled member per paycheck​.

​
​Plan​ Clinical Prior Authorization Program
Certain prescriptions require “clinical prior authorization” or approval from your plan before being covered. The categories/medications that require clinical prior authorization may include but are not limited to:
 Acne (topical after age 24), ADHD/Narcolepsy (after age 19), Botulinum Toxins, Lamisil/Sporanox, Obesity, and Peniac. Upon receipt of a prescription falling into a covered category, UHC will contact your doctor’s office and request the documentation needed for Prior Authorization. 
​Additional Programs:

Contact Info:​

​UHC Member Services: 1-866-633-2474
​Specialty Pharmacy
They will assist members with specialty medications to ensure safe and effective administration. UHC provides free home delivery to your home/work address. Please get in touch with UHC for more information regarding specialty pharmacy. 
​
Contact Info:​

​Member Services: 866-633-2474

On-Site Reps​​: 

​​Neerie Kolehma​ 954-357-7191 

Chris Sands 954-357- 7192