UnitedHealthcare Life Insurance Company

UnitedHealthcare Life Insurance Company | Platinum Copay Select

  • Platinum Copay Select is an Obamacare health insurance plan offered by UnitedHealthcare Life Insurance Company that is available for individuals and families.

  • This plan is a PPO, meaning you will have the flexibility to visit a preferred healthcare provider network that have preferred rates for in-network physicians. (Read more about PPOs.)

  • This plan is a Platinum metal level plan, which has the highest monthly cost, and for that cost provides the highest coverage (in terms of lowest deductibles and co-pays). Platinum plans are best for those who expect to use their health care benefits a lot throughout the year.

  • Deductible amount of $500. A deductible is the amount of healthcare costs you will pay on your own each year before the insurance company.

  • Max out-of-pocket of $1,500, which is the most you will pay in a plan year outside of premiums, out-of-network providers and non-essential health benefits.


Ways to Enroll or Learn More

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Plan Summary

Monthly Cost

Plan Name:
Platinum Copay Select

Plan ID:
45002MI0170001

Plan Type:
PPO

Deductible:
$500

Maximum Out-of-Pocket:
$1,500

Summary of Benefits:

Provider Information:

Who is this plan for?

This plan with a higher monthly cost is great for individuals and families who have multiple, serious, or chronic health needs, regularly visit the doctor, and regularly use multiple prescription drugs. The low deductible on this plan means you won't have to pay as much money out of pocket for medical care and prescriptions before your insurance kicks in. The low out-of-pocket maximum on this plan protects you from having to pay a large medical bill if an emergency happens. Plans with this type of provider network tend to have a more broad provider network.

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Highlights


Dental Coverage:
Child

Emergency Room:
10% Coinsurance after deductible Individual: $250 Family:

Retail Drugs:
$35

Generic Drugs:
$5

Overview


Plan Type:
PPO

Metal Level:
Platinum

Health Spending Account:
No

Primary Care Office Visit:
$15

Specialist Office Visit:
$30

Out of Network Coverage:
Yes

Out of Country Coverage:
Yes

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
33% Coinsurance after deductible
Well Baby Care
In Network:
No Charge

Out of Network:
33% Coinsurance after deductible

Inpatient

Hospital Services
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Physician Fee
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Skilled Nursing Facility
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Mental Health
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Substance Abuse
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Home Healthcare
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible

Outpatient

Surgery
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
X-ray and Diagnostics
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Labs
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Facility Fee
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Mental Health
In Network:
$15

Out of Network:
33% Coinsurance after deductible
Substance Abuse
In Network:
$15

Out of Network:
33% Coinsurance after deductible
Rehabilitation Services
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
No Charge

Out of Network:
33% Coinsurance after deductible
Infertility Treatment
In Network:
Not Covered

Out of Network:
Not Covered
Labor and Delivery Inpatient Services
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible

Dental

Accidental Care
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Basic Dental Care (Child)
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Dental Checkup (Child)
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Major Dental Care (Child)
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Orthodontia (Child)
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible

Vision

Eye Exam (Child)
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Glasses (Child)
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible

Additional Coverage

Chiropractic Care
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Habilitation Services
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Rehabilitation Services (Speech)
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Rehabilitation Services (Occupational Therapy)
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Hospice Service
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Diabetes Care Management
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Durable Medical Equipment
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Nutritional Consuleling
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Reconstructive Surgery
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible

Doctor Visits

Primary Care Visit
In Network:
$15

Out of Network:
33% Coinsurance after deductible
Specialist Visit
In Network:
$30

Out of Network:
33% Coinsurance after deductible
Other Practitioner Office Visit
In Network:
$30

Out of Network:
33% Coinsurance after deductible
Preventative Care / Screening / Immunization
In Network:
No Charge

Out of Network:
33% Coinsurance after deductible

Emergency Room and Urgent Care

Emergency Room Services
In Network:
10% Coinsurance after deductible Individual: $250 Family:

Out of Network:
10% Coinsurance after deductible Individual: $250 Family:
Urgent Care Services
In Network:
10% Coinsurance after deductible

Out of Network:
33% Coinsurance after deductible
Ambulance/Transportation Services
In Network:
10% Coinsurance after deductible

Out of Network:
10% Coinsurance after deductible

Drugs

Generic Prescription
In Network:
$5

Out of Network:
$5
Retail Brand Drugs
In Network:
$35

Out of Network:
$35
Non Retail Brand Drugs
In Network:
20% Coinsurance after deductible

Out of Network:
20% Coinsurance after deductible
Specialty Drugs
In Network:
30% Coinsurance after deductible

Out of Network:
30% Coinsurance after deductible
Drug Deductible
In Network:
Individual: No Charge Family: Not Applicable

Out of Network:
Individual: Not Applicable Family: Not Applicable

Additional Plan Information

Summary Of Benefits:

Provider Information:

HealthCare.com is a privately owned website, and monthly costs shown above are estimates only. Your monthly premium may change based on the data provided, outside fees, optional benefits or if other factors take effect before your coverage start date. Note that insurance companies reserve the right to change your premium rate and the policy terms at any time. Effective date, benefit amounts and other conditions may apply at the discretion of the insurance carrier you select. Depending on your state of residence, this website may not display all plans available by state. The Obamacare Tax Subsidy Calculator amounts are estimates only and the actual amount of subsidy eligibility may differ. Access to your physician depends on network selected, and networks can change without notice. Contact your health insurance company to confirm your healthcare provider is still available in the network you select.

UnitedHealthcare Life Insurance Company, a UnitedHealthcare company, is the underwriter and administrator of these plans. This screen is intended only as general information. It presents only a brief overview of some of the standard benefits of the plan(s) shown. Before you apply, please use the link(s) provided to download and review the product information for a more complete explanation of benefits, exclusions, limitations, terms under which the plan(s) may not be renewed or benefits may be reduced, and any state variations applicable to any of these items. This insurance coverage is not designed or marketed as employer-provided insurance. It does not comply with your state’s small-employer group health insurance laws. These plans cannot be used, now or in the future, by you or an employer to provide insurance for employees. Estimated Premium shown is based on the information you provided, and is subject to change based on the plan you select, and other factors. We shall exclusively determine the premium actually required, and the effective date of any coverage issued. To be considered for reimbursement, expenses must qualify as covered expenses and are subject to eligible expense limits unless you use a network provider. Navigate Plus PPO plans (AL, AR, AZ, FL, GA, IL, LA, MO, MS, NC, OH, PA, UT) Compass Plus Plans (IL, MO, NC, PA) You must select a Primary Care Physician (PCP) within our network and your state of residence. Your PCP refers you to specialists when additional care is needed (no referral needed for a network obstetrician or gynecologist). Important note: If you use a specialist without a referral from a PCP, your network benefits will be reduced. If you do not select a valid PCP, you will be assigned one to manage your care. Out of network non-emergency covered expenses, you pay all charges above the eligible expense, plus an additional 25% and are subject to the out-of-network calendar year deductible and coinsurance with no out-of-pocket limit. Navigate EPO plans (CO, MI, SC, TN, WI) and Compass Balanced (TX) You must select a Primary Care Physician (PCP) within our network and your state of residence. Your PCP refers you to specialists when additional care is needed (no referral needed for a network obstetrician or gynecologist). Important note: If you use a specialist without a referral from your PCP, there are no benefits. If you do not select a valid PCP, you will be assigned one to manage your care. These plans only pay benefits for eligible expenses from a network provider. No benefits are payable for non-emergency care from a non-network provider. Choice PPO Plans (TX) These plans only pay benefits for eligible expenses from a network provider. No benefits are payable for non-emergency care from a non-network provider. Choice Plus PPO plans (CT, IA, IN, KS, KY, NE, OK, VA) For out of network non-emergency covered expenses, you pay all charges above the eligible expense, plus an additional 25% and are subject to the out-of-network calendar year deductible and coinsurance with no out-of-pocket limit. Choice Plus PPO Plans (KS) For out-of-network non-emergency covered expenses, you pay all charges above the eligible expense, plus the following: Gold Copay Select + 25%; Select Saver, Bronze HSA 100 and Silver Copay Select plans + 20%; Silver HSA 100 and Bronze Copay Select 2 + 15%; Bronze Copay Select 1 + 5%, then the out-of-network calendar year deductible with no out-of-pocket limit.

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