Choice Plus HSA Silver 4500 HSA W/Motion - Plan BG8T What .
Benefit SummaryChoice Plus HSA Silver 4500Virgin Islands - Choice PlusHSA w/Motion - Plan BG8TWhat is a benefit summary?This is a summary of what the plan does and does not cover. This summary can also help you understand your shareof the costs. It’s always best to review your Certificate of Coverage (COC) and check your coverage before getting anyhealth care services, when possible.What are the benefits of the Choice Plus Plan with an HSA?Get network freedom and an HSA.A network is a group of health care providers and facilities that have a contract withUnitedHealthcare. You can receive care and services from anyone in or out of our network, but you save money when you use the network. You can save money when youuse the health savings account (HSA) and the network. There's coverage if you need to go out of the network. Out-of-network means that aprovider does not have a contract with us. Choose what's best for you. Just rememberout-of-network providers will likely charge you more. There's no need to choose a primary care provider (PCP) or get referrals to see aspecialist. Consider a PCP; they can be helpful in managing your care.Are you a member?Easily manage your benefitsonline at myuhc.com andon the go with theUnitedHealthcareHealth4Me mobile app.For questions, call themember phone number onyour health plan ID card. Preventive care is covered 100% in our network. You can open a health savings account (HSA). An HSA is a personal bank accountto help you save and pay for your health care, and help you save on taxes.Not enrolled yet? Learn more about this plan and search for network doctors or hospitals atwelcometouhc.com/choiceplushsa or call 1-866-873-3903, TTY 711, 8 a.m. to 8 p.m. localtime, Monday through Friday.Benefits At-A-GlanceWhat you may pay for network careThis chart is a simple summary of the costs you may have to pay when you receive care in the network. It doesn’t include allof the deductibles and co-payments you may have to pay. You can find more benefit details beginning on page 2.Co-payment(Your cost for an office visit)You have no co-payment.Individual DeductibleCo-insurance(Your cost before the plan starts to pay) (Your cost share after the deductible) 4,500You have no co-insurance.This Benefit Summary is to highlight your Benefits. Do not use this document to understand your exact coverage for certainconditions. If this Benefit Summary conflicts with the Certificate of Coverage (COC), Schedule of Benefits, Riders, and/orAmendments, those documents are correct. Review your COC for an exact description of the services and supplies that are andare not covered, those which are excluded or limited, and other terms and conditions of coverage.UnitedHealthcare Insurance CompanyPage 1 of 16
Your CostsIn addition to your premium (monthly) payments paid by you or your employer, you are responsible for paying thesecosts.Your cost if you useNetwork BenefitsYour cost if you useOut-of-Network BenefitsAnnual Deductible - Combined Medical and PharmacyWhat is an annual deductible?The annual deductible is the amount you pay for Covered Health Care Services per year before you are eligible toreceive Benefits. It does not include any amount that exceeds Allowed Amounts. The deductible may not apply to allCovered Health Care Services. You may have more than one type of deductible. All individual deductible amounts will count towards meeting the family deductible, but an individual will nothave to pay more than the individual deductible amount.Medical Deductible - Individual 4,500 per year 9,000 per yearMedical Deductible - Family 9,000 per year 18,000 per yearDental - Pediatric Services Deductible IndividualIncluded in your medical deductible.Included in your medicaldeductible.Dental - Pediatric Services Deductible FamilyIncluded in your medical deductible.Included in your medicaldeductible.Out-of-Pocket Limit - Combined Medical and PharmacyWhat is an out-of-pocket limit?The Out-of-Pocket Limit is the maximum you pay per year. Once you reach the Out-of-Pocket Limit, Benefits arepayable at 100% of Allowed Amounts during the rest of that year. Your co-pays, co-insurance and deductibles (including pharmacy) count towards meeting the out-of-pocketlimit. All individual out-of-pocket limit amounts will count towards meeting the family out-of-pocket limit, but anindividual will not have to pay more than the individual out-of-pocket limit amount.Out-of-Pocket Limit - Individual 4,500 per year 18,000 per yearOut-of-Pocket Limit - Family 9,000 per year 36,000 per yearPage 2 of 16
Your CostsWhat is co-insurance?Co-insurance is the amount you pay each time you receive certain Covered Health Care Services calculated as apercentage of the Allowed Amount (for example, 20%). You pay co-insurance plus any deductibles you owe. Coinsurance is not the same as a co-payment (or co-pay).What is a co-payment?A Co-payment is the amount you pay each time you receive certain Covered Health Care Services calculated as a setdollar amount (for example, 50). You are responsible for paying the lesser of the applicable Co-payment or theAllowed Amount. Please see the specific Covered Health Care Service to see if a co-payment applies and how muchyou have to pay.What is Prior Authorization?Prior Authorization is getting approval before you receive certain Covered Health Care Services. Physicians and otherhealth care professionals who participate in a Network are responsible for obtaining prior authorization. However thereare some Benefits that you are responsible for obtaining authorization before you receive the services. Please see thespecific Covered Health Care Service to find services that require you to obtain prior authorization. Service site reviewmay be a component of the prior authorization process.Want more information?Find additional definitions in the glossary at justplainclear.com.Page 3 of 16
Your CostsFollowing is a list of services that your plan covers in alphabetical order. In addition to your premium (monthly) paymentspaid by you or your employer, you are responsible for paying these costs.Covered Health Care ServicesAcupuncture ServicesLimited to 24 treatments per year.Ambulance ServicesEmergency Ambulance:Non-Emergency Ambulance:Cellular and Gene TherapyFor Network Benefits, Cellular or GeneTherapy services must be receivedfrom a Designated Provider.Your cost if you useNetwork BenefitsYour cost if you useOut-of-Network BenefitsYou pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.You pay nothing, after the medicaldeductible has been met.You pay nothing, after the networkmedical deductible has been met.You pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.Prior Authorization is required forNon-Emergency Ambulance.Prior Authorization is required forNon-Emergency Ambulance.The amount you pay is based onwhere the covered health care serviceis provided.Out-of-Network Benefits are notavailable.Prior Authorization is required.Clinical TrialsThe amount you pay is based on where the covered health care service isprovided.Prior Authorization is required.Prior Authorization is required.Congenital Heart Disease (CHD) SurgeriesBenefits will be the same as stated under Hospital - Inpatient Stay.Prior Authorization is required.Dental - Pediatric Services (Benefits covered up to age 19)Benefits provided by the National Options PPO 30 Network (PPO-UCR 50th).Dental - Pediatric Preventive ServicesDental Prophylaxis (Cleanings)You pay nothing, after the medicalLimited to two times every 12 months. deductible has been met.20% co-insurance, after the medicaldeductible has been met.Fluoride TreatmentsLimited to two times every 12 months.You pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.Sealants (Protective Coating)Limited to once per first or secondpermanent molar every 36 months.You pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.Space Maintainers (Spacers)You pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.Page 4 of 16
Your CostsCovered Health Care ServicesYour cost if you useNetwork BenefitsDental - Pediatric Diagnostic ServicesEvaluations (Check-up Exams)You pay nothing, after the medicaldeductible has been met.Limited to 2 times per 12 months.Covered as a separate Benefit only if noother service was done during the visitother than X-rays.Intraoral Radiographs (X-ray)Limited to 2 series of films per 12months for Bitewings and 1 time per 36months for Panoramic radiographimage.You pay nothing, after the medicaldeductible has been met.Dental - Pediatric Basic Dental ServicesEndodontics (Root Canal Therapy)20% co-insurance, after the medicaldeductible has been met.Your cost if you useOut-of-Network Benefits20% co-insurance, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.40% co-insurance, after the medicaldeductible has been met.Adjunctive ServicesPalliative (Emergency) Treatment:Covered as a separate Benefit only if noother services (other than the exam andradiographs) were done on the toothduring the visit.General Anesthesia: Covered onlywhen clinically Necessary.Occlusal Guard: Limited to one guardevery 12 months.20% co-insurance, after the medicaldeductible has been met.40% co-insurance, after the medicaldeductible has been met.Oral Surgery20% co-insurance, after the medicaldeductible has been met.40% co-insurance, after the medicaldeductible has been met.Periodontics20% co-insurance, after the medicaldeductible has been met.Periodontal Surgery: Limited to oneevery 36 months per surgical area.Scaling and Root Planing: Limited toone time per quadrant every 24 months.Periodontal Maintenance: Limited tofour times every 12 months incombination with prophylaxis.40% co-insurance, after the medicaldeductible has been met.Minor Restorative Services(Amalgam or Anterior Composite)20% co-insurance, after the medicaldeductible has been met.40% co-insurance, after the medicaldeductible has been met.Simple Extractions (Simple toothremoval)Limited to one time per tooth perlifetime.20% co-insurance, after the medicaldeductible has been met.40% co-insurance, after the medicaldeductible has been met.Page 5 of 16
Your CostsCovered Health Care ServicesYour cost if you useNetwork BenefitsDental - Pediatric Major Restorative ServicesCrowns/Inlays/Onlays40% co-insurance, after the medicalLimited to one time per tooth every 60 deductible has been met.months.Your cost if you useOut-of-Network Benefits50% co-insurance, after the medicaldeductible has been met.Removable Dentures(Full denture/partial denture)Limited to a frequency of one every 60months.40% co-insurance, after the medicaldeductible has been met.50% co-insurance, after the medicaldeductible has been met.Bridges (Fixed partial dentures)Limited to one time every 60 months.40% co-insurance, after the medicaldeductible has been met.50% co-insurance, after the medicaldeductible has been met.Implant ProceduresLimited to one time every 60 months.40% co-insurance, after the medicaldeductible has been met.50% co-insurance, after the medicaldeductible has been met.Dental - Pediatric Medically Necessary OrthodonticsBenefits are not available for40% co-insurance, after the medicalcomprehensive orthodontic treatmentdeductible has been met.for crowded dentitions (crooked teeth),excessive spacing between teeth,temporomandibular joint (TMJ)conditions and/or having horizontal/vertical (overjet/overbite)discrepancies.50% co-insurance, after the medicaldeductible has been met.Prior Authorization is required fororthodontic treatment.Prior Authorization is required fororthodontic treatment.You pay nothing, after the medicaldeductible has been met.You pay nothing, after the networkmedical deductible has been met.Dental Services - Accident OnlyDiabetes ServicesDiabetes Self-Management andTraining/Diabetic Eye Exams/FootCare:Diabetes Self-Management Items:The amount you pay is based on where the covered health care service isprovided.The amount you pay is based on where the covered health care service isprovided under Durable Medical Equipment (DME), Orthotics and Suppliesand in the Outpatient Prescription Drug Rider.Prior Authorization is required forDME that costs more than 1,000.Durable Medical Equipment (DME), Orthotics and SuppliesYou pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.Prior Authorization is required forDME or orthotics that costs morethan 1,000.Page 6 of 16
Your CostsCovered Health Care ServicesYour cost if you useNetwork BenefitsEmergency Health Care Services - OutpatientYou pay nothing, after the medicaldeductible has been met.Your cost if you useOut-of-Network BenefitsYou pay nothing, after the networkmedical deductible has been met.Notification is required if confinedin an Out-of-Network Hospital.Gender DysphoriaThe amount you pay is based on where the covered health care service isprovided and in the Outpatient Prescription Drug Rider.Prior Authorization is required forcertain services.Habilitative ServicesInpatient:Habilitative services received during anInpatient Stay in an InpatientRehabilitative Facility are limited to 60days per year.Outpatient:Outpatient therapies are limited peryear as follows:75 visits for any combination ofphysical therapy, occupational therapyand speech therapy.30 visits of post-cochlear implant auraltherapy.20 visits of cognitive therapy.20 Manipulative Treatments.Prior Authorization is required forcertain services.The amount you pay is based on where the covered health care service isprovided.You pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.Prior Authorization is required forcertain Inpatient services.Hearing AidsHome Health CareLimited to 60 visits per year. One visitequals up to four hours of skilled careservices. This visit limit does notinclude any service which is billed onlyfor the administration of intravenousinfusion.To receive Network Benefits for theadministration of intravenous infusion,you must receive services from aprovider we identify.You pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.You pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.Prior Authorization is required.Page 7 of 16
Your CostsCovered Health Care ServicesYour cost if you useNetwork BenefitsYour cost if you useOut-of-Network BenefitsHospice CareYou pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.Prior Authorization is required forInpatient Stay.Hospital - Inpatient StayYou pay nothing, after the medicaldeductible has been met.20% co-insurance, after the medicaldeductible has been met.Prior Authorization is required.Lab, X-Ray and Diagnostic - OutpatientLab Testing - Outpatient:Limited to 18 Presumptive DrugYou pay nothing, after the medicaldeductible has been met.Tests per year.Limited to 18 Definitive DrugTests per year.20% co-insurance, after the medicaldeductible has been met.X-Ray and Other Diagnostic Testing Outpatient:20% co-insurance, after the medicaldeductible has been met.You pay nothing, after the medicaldeductible has been met.Prior Authorization is required forGenetic Testing, sleep studies,stress echocardiography andtransthoracic echocardiogramservices.Major Diagnostic and Imaging - OutpatientYou pay nothing, after the medicaldeductible has been met.20% co-insur
of the costs. It’s always best to review your Certificate of Coverage (COC) and check your coverage before getting any health care services, when possible. What are the benefits of the Choice Plus Plan with an HSA? Get network freedom and an HSA. A network is a group of health care providers and facilities that have a contract with .
HSA-TD2 HSA-TD27 HSA-TD25 HSA-TD26 SD SDLMNR SDLMKR-ES SDLMKR-EN HSA-TD2 HSA-TD30 HSA-TD28 HSA-TD29 SD SDLHNR-G SDLHKR-ESG SDLHKR-ENG 0.2 – 20 cm3 150 – 200 mm approx. 200 Nl/min max. 40 Nl/min max. 200 bar max. 120 bar HSA-TD25, 26, 27 HSA-TD2, 28, 29, 30 50 mm (2.0 in) 87 mm (3.4 in) 20
New York State Ambulatory Surgery Centers by Facility Type and Region HSA Region Hospital Based Hospital Extension Clinics Diagnostic & Treatment Center Total Western (HSA 1) 23 3 13 39 Finger Lakes (HSA 2) 17 3 6 26 Central NY (HSA 3) 22 7 18 47 NYPENN (HSA 4) 4 1 0 5 Northeastern (HSA 5) 25 5 14 44 Hudson Valley (HSA 6) 26 2 20 48 NYC .
Horizon Blue Cross Blue Shield of New Jersey has partnered with ACS/BNY Mellon to bring you competitive interest rates and investment options for your HSA. An HSA allows you not only to save money, but gives you the potential to earn money, too! Managing your HSA Keeping track of your HSA is easy.
between serum and plasma (Kroh EM et al., 2010; McDonald JS et al., 2011; Wang K et al., 2012). We have found that both serum and plasma samples work well for miRNA and RNA detection but that recovery is slightly higher from plasma samples (Figure 1). hsa-let-7c-5p hsa-miR-16-5p hsa-miR-221-3p hsa-miR-21-5p hsa-miR-26a-5p
Nano? Silver containing substance (SCAS) CAS No. Elemental silver a) Particulate silver 7440-22-4 b) Silver ionisation systems 7440-22-4 Silver adsorbed to silica dioxide Not yet allocated Silver chloride adsorbed to titan dioxide Not yet allocated Silver nitrate 7761-88-8 Silver sodium hydrogen zirconium phosphate 265647-11-8 Silver zinc .
CA/LG/Producers' Health Benefits Plan: Custom Anthem PPO HSA-H/48EB/01-22 Page 1 of 11 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2022 - 12/31/2022 Anthem BlueCross Coverage for: Individual Family Plan Type: PPO Producers' Health Benefits Plan: Custom Anthem PPO HSA-H 2700/2800/5400/20 (with Rx Choice) HSA
Health savings account (HSA) user guide. Welcome. Welcome to your Optum Bank health savings account (HSA). Explore all the ways we’re making it easy for you to get the most out of your HSA. Here, you’ll find out how to use your account. Plus, you can get information about our helpful online tools and resources. Looking for more details .
Andreas Wagner Head of Building Science Group Karlsruhe Institute of Technology Department of Architecture. Background Occupant behaviour has a strong influence on building energy performance Reasons for occupants’ interventions: dissatisfaction with building automation interfaces are not designed/equipped for intended purpose designers / building managers do not fully consider –or .
