Welcome State of Maryland Employees and Retirees
UnitedHealthcare Options PPO Plan
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.
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
| 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% | 70% after deductible |
| Mammogram | 100% for routine preventive / 90% for diagnostic mammogram | 70% after deductible |
| Annual adult physical | 100% | 70% after deductible |
| Acupuncture for Chronic Pain Mgmt | $20 copay | 70% after deductible |
| Chiropractic | $20 copay | 70% after deductible |
| Hearing Aid Exam | $15 / $30 | 70% after deductible |
|
Hearing Aids ($5,000 Max per ear every 36 months) |
100% for standard hearing aid | 70% after deductible |
| DME | 90% | 70% after deductible |
| PT/OT/SP | $30 copay | 70% after deductible |
| Vision Plan | See Vision Plan | |