UHC Medical Plan

2024 Plan Information

Medical Plan

The Firm offers a choice of three Medical Plan options:

  • Options A and B are PPOs.
  • Option C is a Consumer-Driven Health Plan (also known as a High-Deductible Plan).

Employees who live in California or Hawaii, or who are US-based expats, have other medical plan options.

Regardless of which option you choose, you may elect one of two Medical Plan administrators – Cigna or UnitedHealthcare (UHC). Both:

  • Provide preventive care — including annual exams, immunizations and routine age-appropriate screenings — at no cost to you when you use in-network providers.
  • Cover the same services, like doctor visits, hospital care, lab work and X-rays.
  • Give you access to Cigna or UnitedHealthcare doctors, hospitals and other providers. Note: Although your paycheck contributions will be the same if you choose either administrator, you may pay less, on average, for medical services if you elect the preferred provider in your state.
  • Include prescription drug coverage, administered by Express Scripts.

Your Health Care Coverage When the COVID-19 Public Health Emergency Ends

The Firm’s Medical Plan will continue to provide comprehensive coverage for COVID-19 testing and treatment. The following services will be covered, subject to your applicable deductible and coinsurance:

  • Diagnostic COVID-19 PCR lab-based testing
  • COVID-19 treatment, including antivirals and therapeutics
  • Outpatient office visits and virtual care visits related to COVID-19

COVID-19 vaccines will be covered at 100% when obtained with an in-network provider. At-home COVID-19 tests will no longer be covered under the Medical Plan; however, you can purchase these tests using funds from your Health Care Flexible Spending Account or Health Savings Account.

Paycheck Contributions, Deductibles and Out-of-Pocket Maximums

When choosing a Medical Plan option, it’s important to consider your total costs because each option’s paycheck contributions (view 2023 and 2024 contributions), deductibles and out-of-pocket maximums differ. Making the right choice for you and dependents means understanding how the annual deductibles and out-of-pocket maximums work.

  • Your annual deductible is the fixed dollar amount you pay each year toward your medical expenses before the Medical Plan begins to cover a portion of the cost of your health care services. You pay the full cost of services (with some exceptions) until you meet the total deductible amount.
  • After meeting the annual deductible, you and the Plan share in the cost of services through coinsurance – you pay 20% of costs and the Plan pays the remaining 80%.
  • If the sum of your deductible and out-of-pocket costs reaches the annual out-of-pocket maximum, the Plan begins to pay 100% of the cost of in-network services and 100% of reasonable and customary cost for out-of-network services for the remainder of the year.

When comparing the three Medical Plan options, the higher the deductible and out-of-pocket maximum, the lower your paycheck contributions will be, and vice versa.

Preexisting Conditions

The Medical Plan has no preexisting condition exclusions.

National Medical Plans: Cigna and UnitedHealthcare

Here’s a look at the benefits provided under the Options A, B and C of the Medical Plan. Please note that your deductible and out-of-pocket maximum reset each Plan year.

Option AOption BOption C
Note

The figures in the chart below reflect what the Plan pays, with the exception of deductibles and out-of-pocket maximums, which employees pay. CSP applies to cancer-related medical claim expenses only (does not include pharmacy-related expenses). A diagnosis of cancer and engagement with a CSP nurse is required.

Individual Annual Deductible

In-Network:
$600

Out-of-Network:
$1,200

In-Network:
$1,200

Out-of-Network:
$2,400

In-Network:
$2,300 (deductible includes prescription drugs, however CSP program does not apply to pharmacy-related expenses)

Out-of-Network:
$4,600 (deductible includes prescription drugs, however CSP program does not apply to pharmacy-related expenses)

Family Deductible

In-Network:
$1,250

Out-of-Network:
$2,500

In-Network:
$2,500

Out-of-Network:
$5,000

In-Network:
$4,600 (deductible includes prescription drugs, however CSP program does not apply to pharmacy-related expenses)

Out-of-Network:
$9,200 (deductible includes prescription drugs, however CSP program does not apply to pharmacy-related expenses)

Individual Out-of-Pocket Maximum

In-Network:
$2,000

Out-of-Network:
$4,000

In-Network:
$3,000

Out-of-Network:
$7,500

In-Network:
$5,500 (includes prescription drugs)

Out-of-Network:
$11,000 (includes prescription drugs)

Family Out-of-Pocket Maximum

In-Network:
$5,000

Out-of-Network:
$10,000

In-Network:
$7,500

Out-of-Network:
$15,000

In-Network:
$11,000 (includes prescription drugs)

Out-of-Network:
$20,000 (includes prescription drugs)

Diagnostic and Preventive Care

In-Network:
100% (no annual deductible)

Out-of-Network:
100% up to a maximum of $250 (no annual deductible) then 60% of eligible expenses (no annual deductible)

In-Network:
100% (no annual deductible)

Out-of-Network:
100% up to a maximum of $250 (no annual deductible) then 60% of eligible expenses (no annual deductible)

In-Network:
100% (no annual deductible)

Out-of-Network:
100% up to a maximum of $250 (no annual deductible) then 60% of eligible expenses (no annual deductible)

Most other services, including inpatient and outpatient hospital and specialist visits

In-Network:
80% after annual deductible

Prior proof of medical necessity may apply for certain services. Check with your health plan administrator to verify coverage and if preauthorization is required.

Out-of-Network:
60% of eligible expenses after annual deductible

Prior proof of medical necessity may apply for certain services. Check with your health plan administrator to verify coverage and if preauthorization is required.

In-Network:
80% after annual deductible

Prior proof of medical necessity may apply for certain services. Check with your health plan administrator to verify coverage and if preauthorization is required.

Out-of-Network:
60% of eligible expenses after annual deductible

Prior proof of medical necessity may apply for certain services. Check with your health plan administrator to verify coverage and if preauthorization is required.

In-Network:
80% after annual deductible

Prior proof of medical necessity may apply for certain services. Check with your health plan administrator to verify coverage and if preauthorization is required.

Out-of-Network:
60% of eligible expenses after annual deductible

Prior proof of medical necessity may apply for certain services. Check with your health plan administrator to verify coverage and if preauthorization is required.

Cancer Support Program

In-Network:
100% covered after annual deductible if enrolled in program within 60 days of diagnosis. 80% after annual deductible if not enrolled in program.

Out-of-Network:
60% after annual deductible

In-Network:
100% covered after annual deductible if enrolled in program within 60 days of diagnosis. 80% after annual deductible if not enrolled in program.

Out-of-Network:
60% after annual deductible

In-Network:
100% covered after annual deductible if enrolled in program within 60 days of diagnosis. 80% after annual deductible if not enrolled in program.

Out-of-Network:
60% after annual deductible

Bariatric Surgery

In-Network:
Cigna: 100% at Cigna Certified Hospitals for bariatric surgery; 80% after annual deductible at other in-network facilities.

UHC: Surgery must be received at a UHC designated Center of Excellence (COE) and will be covered at 100% no annual deductible; all other services related to the surgery covered at 80% after annual deductible.

Out-of-Network:
Cigna: 60% of eligible expenses after annual deductible

UHC: No coverage

In-Network:
Cigna: 100% at Cigna Certified Hospitals for bariatric surgery; 80% after annual deductible at other in-network facilities.

UHC: Surgery must be received at a UHC designated Center of Excellence (COE) and will be covered at 100% no annual deductible; all other services related to the surgery covered at 80% after annual deductible.

Out-of-Network:
Cigna: 60% of eligible expenses after annual deductible

UHC: No coverage

In-Network:
Cigna: 100% after annual deductible at Cigna Certified Hospitals for bariatric surgery; 80% after annual deductible at other in-network facilities.

UHC: Surgery must be received at a UHC designated Center of Excellence (COE) and will be covered at 100% no annual deductible; all other services related to the surgery covered at 80% after annual deductible.

Out-of-Network:
Cigna: 60% of eligible expenses after annual deductible

UHC: No coverage

Maternity

In-Network:
80% after annual deductible

Out-of-Network:
60% of eligible expenses after annual deductible

In-Network:
80% after annual deductible

Out-of-Network:
60% of eligible expenses after annual deductible

In-Network:
80% after annual deductible

Out-of-Network:
60% of eligible expenses after annual deductible

Fertility Coverage (includes cryopreservation, artificial insemination, IVF, GIFT and ZIFT)

In-Network:
Administered by Maven: 80% after annual deductible

Out-of-Network:
No coverage

In-Network:
Administered by Maven: 80% after annual deductible

Out-of-Network:
No coverage

In-Network:
Administered by Maven: 80% after annual deductible

Out-of-Network:
No coverage