UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)

Health Insurance Plan Details (2026 Plan)

Monthly Premium

EPO
$ubsidy
Gold
Deductible
N/A /yr
Max Out-of-Pocket
N/A /yr

Details

Deductible (per individual)$0 /yr
Deductible (per family)$0 /yr
Max Out-of-Pocket (per individual)$7,700 /yr
Max Out-of-Pocket (per family)$15,400 /yr
Drug Deductible (per individual)$500
Drug Deductible (per family)$1000
Drug Max Out-of-Pocket (per individual)Included in Medical
Drug Max Out-of-Pocket (per family)Included in Medical
Plan TypeEPO
Includes Child Dental?Yes
Includes Adult Dental?Yes
Medical Services
Preventive CareNo Charge
Primary Care Visit$20 Copay
Specialist Visit$55 Copay
Emergency Room$750 Copay
Inpatient Facility$1,750 Copay per Day
Inpatient PhysicianNo Charge
Drug Costs
Generic Drugs$3 Copay
Preferred Brand Drugs$30 Copay
Non-preferred Brand Drugs40% Coinsurance after deductible
Specialty Drugs50% Coinsurance after deductible

Plan Documents

Summary of Benefits and CoverageSBC doc
Provider DirectoryDoctor lookup
Drug Formulary List drug list

* Figures shown are only for in-network medical costs

** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible


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