Medical

Jim Ellis offers three UnitedHealthcare medical plans.  An HMO with in-network coverage only, a POS plan with both in and out-of-network coverage, and a HSA plan with in-network coverage only and a Health Savings Account (HSA).

Employees enrolled with an annual earnings below $50,000 receive an additional employer contribution towards medical coverage in compliance with the Affordable Care Act (or ACA).  Jim Ellis funds an additional employer contribution towards your medical coverage and to meet the definition of affordable coverage.  The full funding amount will apply towards the United Healthcare Navigate HSA (Health Savings Account) plan. 

 
Navigate HMO HSA Plan

The Navigate HMO HSA plan is an HMO, and provides coverage for in-network services only, with preventive services being covered at 100%.  All other services are subject to the deductible, including prescription drug.  A Primary Care Physician (PCP) must be selected, and a referral is required to see network specialists for coverage to apply.  This plan comes with a Health Savings Account (HSA), which allows you to set aside money on a pre-tax basis to pay for qualified medical expenses.

The HSA is administered by Optum Bank, a UnitedHealthcare company.  Any balance remaining in your HSA rolls over to next year and is never taxable if it is used for qualified medical expenses at any time in the future.  To be eligible for an HSA, you must not have other medical coverage in addition to the Jim Ellis Navigate HMO HSA plan, you must not be enrolled in Medicare, and you cannot be claimed as a dependent on someone else's tax return.

We encourage you to evaluate this option at this time, especially if you don’t have serious ongoing medical issues.  Employee deductions are lowest for this plan, and you are able to put aside pre-tax money in the HSA to use when you have out-of-pocket medical expenses.  This account belongs to you, and you own the account regardless whether you remain in the Jim
Ellis HSA or other medical plan.

 
Navigate HMO Plan

The Navigate HMO plan has lower premiums, a higher deductible, and higher out-of-pocket costs than the Choice Plus POS plan, and the premiums are higher than the Navigate HMO HSA plan.  The plans has copays for office visits, and provides coverage for in-network services only.  You must select a Navigate HMO Primary Care Physician (PCP) and obtain referrals to network specialists for coverage to apply.

 

Choice Plus POS Plan

The Choice Plus POS plan has higher premiums but a lower deductible and out-of-pocket cost than the other plans.  You do not need to select a Primary Care Physician (PCP), and you may go directly to network specialists without a referral for in-network coverage to apply.  The Choice Plus POS plan includes in and out-of-network coverage with a separate out-of-network deductible and out-of-pocket maximums.  We encourage you to utilize participating Choice Plus POS providers to maximize your benefits. 

 

Additional Benefits for Navigate HMO HSA and HMO Participants

Jim Ellis provides the following additional benefits to Navigate HMO HSA and Navigate HMO plan members to supplement your medical plan in the event of an unexpected illness or accident.

  • $2,000 Critical Illness benefit for diagnosis of heart attack, stroke, internal cancer, kidney failure, major organ transplant, carcinoma in situ (25%), coronary artery bypass surgery (25%), coma, paralysis, deafness, blindness, benign brain tumor, and occupational HIV.
  • Accident coverage according to the certificate schedule.

Benefits are provided for employees, spouses, and children covered on the HMO HSA and HMO plans.

 

Important Documents

Navigate HMO HSA Plan
In-Network Only
Navigate HMO Plan
In-Network Only
Choice Plus POS Plan
In | Out
Premium Information Lowest cost option Lowest cost than Choice Plus POS Highest cost option
In and Out-of-Network Coverage? No - In-network coverage only No - In-network coverage only Yes - In and out-of-network coverage
Includes a Health Savings Account (HSA) Yes No No
Calendar Year Deductible
     
Individual
$3,000 $4,000 $2,000 | $6,000
Family
$6,000 $8,000 $2,000 | $6,000
Coinsurance
Plan Pays 80% Plan Pays 80% Plan Pays 80% | Plan Pays 60%
Calendar Year Out-of-Pocket Max
Includes Deductible and Copays
You
$5,000 $6,600 $5,000 | $5,000
Family
$10,000 $13,200 $10,000 | $15,000
Office Visits
Primary Care Physician (PCP)
Deductible, then 20% $40 $30* | Deductible + Coinsurance
* waived for under age 19
Specialist
Deductible, then 20% $80 $60 | Deductible + Coinsurance
Outpatient Diagnostic Lab & X-Ray
In Office / Center
Deductible, then 20% You pay $0 You pay $0 | Deductible + Coinsurance
In Hospital
Deductible, then 40% You pay $0 You pay $0 | Deductible + Coinsurance
Major Diagnostics & Imaging
Hospital
$500 hospital deductible, then medical deductible + 20% $500 hospital deductible, then medical deductible + 20% $500 hospital deductible, then medical deductible + 20%
Outpatient Surgery
$500 hospital deductible, then medical deductible + 20% $500 hospital deductible, then member pays deductible + 20% $500 hospital deductible, then member pays deductible + 20%
In Office / Center
Deductible, then 20% Deductible, then 20% Deductible, then 20%
In Hospital
$500 hospital deductible, then medical deductible + 20% $500 hospital deductible, then medical deductible + 20% $500 hospital deductible, then medical deductible + 20%
Inpatient Hospitalization
$500 hospital deductible, then medical deductible + 20% $500 hospital deductible, then medical deductible + 20% Deductible, then 20%
Emergency Care
Deductible, then 20% $250 copay $250 copay
Urgent Care
Deductible, then 20% $100 copay $100 copay | Deductible + Coinsurance
Preventive Care
Covered 100% in-network Covered 100% in-network Covered 100% in-network

Prescription Drug Benefits


For the Navigate HMO and Choice Plus POS Plans, covered prescription drugs are subject to a copay, then covered at 100% when purchased at a participating pharmacy.  The medical deductible is required to be met on the Navigate HMO HSA plan before copays apply.

 

Review the prescription drug list carefully to ensure your medications are covered and to confirm your cost.  The drug list is a document of commonly prescribed medications sorted by cost levels, or tiers.  The medications are noted if step therapy, supply limits, specialty, and / or prior authorization is required.  For more information, visit www.myuhc.com and select Benefits / Prescription Benefits.

Navigate HMO HSA Plan Navigate HMO Plan Choice Plus POS Plan
Retail
Up to 31 day supply
Tier 1
Medical Deductible, then $10 $15 $15
Tier 2
Medical Deductible, then $35 $45 $45
Tier 3
Medical Deductible, then $60 $85 $85
Tier 4
N/A $125 $125
Mail Order
Up to 90 day supply
Tier 1
Medical Deductible, then $25 $37.50 $37.50
Tier 2
Medical Deductible, then $85 $112.50 $112.50
Tier 3
Medical Deductible, then $150 $212.50 $212.50
Tier 4
N/A $312.50 $312.50

Finding a Participating Provider


Access www.myuhc.com and click "Find Medical and Mental Health Providers and Facilities."

  • For Navigate HMO and Navigate HMO HSA participants, choose Navigate HMO for the plan name.
  • For Choice Plus POS participants, choose Choice Plus for the plan name.

 

Frequently Asked Questions (FAQs)

  1. Why do I need to select a PCP? With the Navigate HMO and HMO HSA plans, you are required to select a participating PCP.  Your PCP will be your first point of contact when you need care, and you must obtain a referral from your PCP before you see another PCP or specialist for the plan to pay benefits.
  2. Can I select any type of physician to be my PCP?  Your PCP must be a general practice, family practice, pediatrician, or internal medicine physician.  The PCP's name and telephone number will be listed on each member's health plan ID cards.
  3. What if I am new the plan?  A UnitedHealthcare PCP will be assigned to you, or once enrolled, you can contact UHC Customer Service to pick your own. Changes to your selected PCP will be effective on the first day of the following month.
  4. If I am covering a family member under my plan, but they live out of state, can they select a PCP where they live?  Unfortunately, no.  They must choose a PCP in a city near where you live or work, not where the family member lives or works.

Referrals are not required for:

  • Obstetricians / Gynecologists
  • Behavioral health or substance abuse disorder claimants
  • Convenience care clinics
  • Urgent care centers
  • Emergency room care

Wellness


Employee health and wellness continues to be a priority for Jim Ellis.  The Jim Ellis Wellness Program is designed to help you improve your health with incentives when you complete simple tasks.  When you comply with the requirements by the due date, you avoid potential surcharges.

  • Biometric screening: In order to avoid the $25 per month surcharge, you must complete the screening within 60 days of your benefits effective date.
  • Non-tobacco affidavit or active participation in tobacco cessation program for tobacco users: To avoid the separate $25 per month surcharge, you must complete the non-tobacco affidavit or be an active participant in tobacco cessation by the deadline.

More information is available on the Wellness page of this website.  Additionally, biometric screening instructions and the non-tobacco affidavit are available in the Resources section.

Telemedicine


The medical plans include a telemedicine benefit which allows you to speak to a participating doctor from home or work through your smartphone, tablet or computer 24 hours a day / 7 days a week, at no cost to you

Consider this convenient benefit for non-complex medical conditions. such as:

  • Allergies
  • Colds / influenza
  • Headaches / migraines
  • Sprains / strains
  • Infections: ear, sinus, respiratory, urinary tract, etc.
  • Minor burns
  • And more

As a telemedicine member, all family members are required to complete a Personal Health History Disclosure (which can be found on the Resources page) prior to your first consultation.  This Disclosure is forwarded to an on-call physician when you call 1800MD.  The physician reviews and returns your call to complete the consultation, make a diagnosis, issue prescriptions (if necessary) and refer you to a primary or specialist physician or hospital (if necessary).  We encourage you to call 1800MD or go online to complete your medical history prior to needing services: 800-530-8666 or www.1800md.com

Real Appeal Weight Loss Program


UnitedHealthcare offers a program at no additional cost to all medical plan participants.  Real Appeal is a simple step-by-step program that can help you lose weight without turning your life upside down.  The program includes personalized weight loss coaching, 24/7 online support, a mobile app, and a success kit.  The kit includes a success guide, workout DVDs, simple recipes, a blender, food scale, and more! 

Earning Rewards through UnitedHealthcare


The UHC reward program can be accessed through "Rally" when you login to myuhc.com.

  1. Biometric Screening ($75): Participate in a biometric screening event and earn a $75 reward.  Learn more about your total cholesterol, blood pressure, and Body Mass Index (BMI).  This is available for employees only.
  2. Online Health Survey ($25): Complete an Online Health Survey through Rally by logging into myuhc.com within 90 days of your insurance effective date.  Answer all of the survey questions to personalize your overall experience with the site.
  3. Fitness Reimbursement ($20/month): Visit a participating Fitness Center at least 12 times per month.  You must register through the Health & Wellness "Rally" tab on myuhc.com.
  4. Telephonic Coaching ($75): Qualification is based on the answers to the Online Health Survey.  Topics include weight management, tobacco cessation, nutrition, etc.  A telephone-based health coaching session takes 3-5 months to complete.
  5. Missions ($50): Complete the Online Health Survey to receive suggested Missions, which are interactive and include choices such as move, eat, or feel.  Missions take at least 4 weeks to complete.
  6. Estimate Healthcare Costs ($25): Perform a cost estimate on an upcoming procedure through myuhc.com and earn a reward.

You can earn up to $200 in rewards for employee and $200 for enrolled spouse.  Rewards may be used to purchase gift cards through myuhc.com.