March 21, 2010

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UnitedHealthcare Administered by Golden Rule – Saver 80 – LOUISIANA

A comparison of the Saver 80 offered by UnitedHealthcare Administered by Golden Rule is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application Saver 80 Application Saver 80 Application
Brochure Saver 80 Brochure Saver 80 Brochure
Copay N/A N/A
Office Visit Not covered Not covered
Deductible $500 (maximum 2 per family, per calendar year) $500 (maximum 2 per family, per calendar year)
Coinsurance 80% 80%
Coinsurance Limit Saver 80 Saver 80
Out-of-Pocket Maximum $3,000 per covered person after deductible $3,000 per covered person after deductible
Lifetime Maximum $3 million per covered person $3 million per covered person
Prescription Drugs
  • Not covered - Discount card included
  • Annual Maximum: Not applicable
    		•
  • Not covered - Discount card included
  • Annual Maximum: Not applicable
    		•
    Emergency Room You pay: $500 copay if not admitted, then 20% after deductible You pay: $500 copay if not admitted, then 20% after deductible
    Adult Preventative Care
  • Doctor Office Visit: Not covered
  • X-ray and lab: Not covered
  • Preventive Mammogram, Pap Smear, PSA screening: You pay: 20% after deductible (no waiting period)
    		•  Not covered
    Child Preventative Care Not covered Not covered
    Lab / X-Ray Outpatient X-ray and lab: You pay: 20% after deductible (performed in the doctor's office or a network facility, Must be performed within 14 days of surgery or confinement) Outpatient X-ray and lab: You pay: 20% after deductible (performed in the doctor's office or a network facility, Must be performed within 14 days of surgery or confinement)
    Maternity Optional Benefit Optional Benefit
    Physical Therapy Saver 80 Saver 80
    Skilled Nursing Saver 80 Saver 80
    Home Health Care Saver 80 Saver 80
    Mental Health Mental & Nervous Disorders (including Substance Abuse): You pay: 20% after deductible (Limited benefit) Mental & Nervous Disorders (including Substance Abuse): You pay: 20% after deductible (Limited benefit)
    Hospital Care You pay: 20% after deductible You pay: 20% after deductible
    Optional Benefits Saver 80 Saver 80