United Health One Health Plans

Plan Name:

STM Value

STM Plus

STM Plus Elite

STM Copay Value

STM Copay

  Plan Brochure Plan Brochure Plan Brochure Plan Brochure Plan Brochure
Deductible Options: $1,000-$10,000 $1,000-$10,000 $1,000-$10,000 $1,000-$10,000 $1,000-$10,000
Co-Insurance Options: 70% 70% or 80% 70% or 80% 70% 70%
Out of Pocket Max Options: $5,000 or $10,000 $2,000 or $5,000 $2,000 or $5,000 $10,000 $10,000
Lifetime Maximum Options: $1 Million $1 Million $1.5 Million $1 Million $1 Million
Doctor Office Visits: See Below* See Below* See Below* $50 Copay** $50 Copay**
Specialists Visits: See Below* See Below* See Below* $50 Copay** $50 Copay**
Urgent Care Visits: See Below* See Below* See Below* $50 Copay** $50 Copay**
Prescriptions: Discount Card Only Deductible then Co-Insurance w/Option to Add On Deductible then Co-Insurance w/Option to Add On Discount Card w/Options to Add On Deductible then Co-Insurance w/Options to Add On
X-Ray, Labs, Imaging: Deductible then Co-Insurance Deductible then Co-Insurance Deductible then Co-Insurance Deductible then Co-Insurance Deductible then Co-Insurance
E.R. and Hospitalization: Deductible then Co-Insurance Deductible then Co-Insurance Deductible then Co-Insurance Deductible then Co-Insurance Deductible then Co-Insurance
Application Fee: $20.00 $20.00 $20.00 $20.00 $20.00
Additional Comments:

*

**

*View Pages 2 and 3 of Brochure – With network providers, you will not be balance billed for eligible expenses. Health care professionals in the network agree to provide you quality care at lower fees… “  

**View Page 6 of Brochure

-2 Visit Limit for a term 180 Days or Less. Or

-4 Visit Limit for a term 181 days and over.

-Per covered person, per term. Additional visits subject to Deductible and Co-Insurance.