Residency Information-Health Insurance
(Revised 7/2003)
United HealthCare CHOICE+
Residents of the UT Graduate Medical Education System are enrolled in the United HealthCare CHOICE+ plan. Eligibility for the employee and for dependents may be verified by calling United HealthCare Customer Service.
Insurance Agent
The insurance agent that handles the UT resident group policy is Jerry Holland of Gerald Holland Insurance Company. You can contact Jerry or his secretary Peggy toll free at (888) 393-9500 with questions or when you need assistance. Your health insurance plan covers dental services only in the case of accident and only 10%. Separate dental insurance is available as a separate policy at the cost of the resident.
Plan Information
Identification Number: (Resident's Social Security #)
Employer Name: University of Tennessee Graduate Medical Education
Group Policy Number: 702275
Co-pays
Office Visit Copay: $ 15
Emergency Room Copay: $100
Urgent Care CoPay: $ 50
Pharmacy CoPay
$7 (31 days) Generic
$25 (31 days) Brand Name on Preferred Drug List
$50 (31 days) Brand Name not on Preferred Drug List
Deductibles
In Network Annual Deductibles (Calendar Year, Jan - Dec):
$250 per covered person
$500 for all covered persons in a family
Out of Network Annual Deductibles (Calendar Year, Jan - Dec):
$500 per covered person
$1000 for all covered persons in a family
Out of Pocket Maximums
In Network Annual Out of Pocket Maximums (Calendar Year, Jan - Dec):
$1000 per covered person
$2000 for all covered persons in a family
(Out of Pocket Maximum does not include deductible.)
Out of Network Annual Out of Pocket Maximums (Calendar Year, Jan - Dec):
$4000 per covered person
$8000 for all covered persons in a family
(Out of Pocket Maximum does not include deductible.)
Maximum Benefits
In Network Maximum Plan Benefit: No Maximum Plan Benefit
Out of Network Maximum Plan Benefit: $1,000,000 per covered person
Insurance Company Information
For authorization, eligibility, claims address and coverage information, please call the United Customer Service office at: 1-866-844-4864.
Address for submission of medical claims:
United Health Care
P. O. Box 30555
Salt Lake City, UT 84130-0555
Address for submission of pharmacy claims:
PAID Prescriptions, L.L.C.
P.O. Box 2096
Lee’s Summit, MO 64063-7096
(800) 842-2042
Employee Portion of Premiums:
Individual $35
Employee/Spouse $74
Employee/Child $65
Family $102
All benefits are subject to the member’s eligibility and the plan provisions. If you have any questions, please call the customer service number shown above for assistance or contact the Gerald Holland Insurance Company.
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