Welcome State of Maryland Employees and Retirees
UnitedHealthcare Choice Plus POS
This traditional health plan covers you when you use doctors and hospitals in or out of our nationwide network. You can get care outside of our network, but your costs may be higher.
In or out of the network, you’re covered.
| Benefit/Service | Network | Non Network |
|---|---|---|
| Deductible | ||
| Employee | None | $125 |
| Family | None | $250 |
| Out-of-pocket maximum | ||
| Employee | $500 | $1,500 |
| Family | $1,000 | $3,000 |
| Office / Doctor visit | $15 copay | 70% after deductible |
| Specialist visit | $30 copay | 70% after deductible |
| Urgent care visit | $30 copay | 70% after deductible |
| Emergency room | $75 for facility / $75 ER Physician ($75 Copay ER Facility, waived if admitted / $75 Copay for ER Physician, waived if admitted / For Non Emergency Diagnoses: 50% Coinsurance plus 2 $75 Copays) | |
| Ambulance | 100% for Medical Emergency / 90% for Non-Medical Emergency | 100% for Medical Emergency / 70% for Non-Medical Emergency |
| Outpatient surgery | 90% | 70% after deductible |
| Lab and X-ray | 90% | 70% after deductible |
| Hospital stay | 90% | 70% after deductible |
| Maternity Stay | 90% | 70% after deductible |
| Well-child visits | 100% | Not Covered |
| Mammogram | 100% for routine preventive / 90% for diagnostic mammogram | 70% after deductible |
| Annual adult physical | 100% | Not Covered |
| Acupuncture for Chronic Pain Mgmt | 90% | 70% after deductible |
| Chiropractic | 90% | 70% after deductible |
| Hearing Aid Exam | $15 / $30 | Children Under Age 19 Only - 70% after deductible |
|
Hearing Aids ($5,000 Max per ear every 36 months) |
100% for standard hearing aid | Adult hearing aids not covered 70% for children under 19 |
| DME | 90% | 70% after deductible |
| PT/OT/SP | $30 copay | 70% after deductible |
| Vision Plan | See Vision Plan | |