United Healthcare Enrollment:

January 1, 2021 - December 31, 2021.

Please read the following policy descriptions carefully:

HSA Base Plan

HSA $5000 (100%)

Individual/Family

Deductible $5,000/$10,000

Individual/Family

Out of pocket max $6,250/$12,500

Office visit copay

Primary Care/Specialist

Deductible $35/$70

Pharmacy Copay

Deductible $10/$35/$60

 

$  33.91 | Employee Only

$107.11 | Employee + Spouse

$  97.12 | Employee + Child

$170.32 | Employee + Family

*A $30 monthly contribution will be made to your HSA account.

Balanced Enriched Plan 

Balanced $3,000 (80%)

 

Individual/Family

Deductible $3,000/$6,000

Individual/Family

Out of pocket max $6,250/$12,500

Office visit copay

Primary Care/Specialist

Deductible $35/$70

Pharmacy Copay

Deductible $10/$35/$60

 

$  47.72 | Employee Only

$136.81 | Employee + Spouse

$124.66 | Employee + Child

$213.75 | Employee + Family

 

Dental Plan

$1,000 Annual Benefit Maximum

Deductible: $50/$150 (Individual/Family)

Diagnostic/Preventative: 100%

Basic Services: 80%

Major Services: 50%

$ 3.06  | Employee Only

$ 8.75  | Employee + Spouse

$11.16 | Employee + Child

$18.17 | Employee + Family

*Please note, if you select the HSA Base Plan and do not have an Health Savings Account, please complete the HSA Application and return to Robyn Jones.

United Healthcare Enrollment

Please complete the form to enroll in or continue your health insurance in 2021. The last day to enroll is December 14, 2020.