SAWS: Benefits - Medican Plans
Aquifer Beaker

Edwards Aquifer

Aquifer Level 684.5'
2/22/19 - Official

The Edwards aquifer and its catchment area in the San Antonio region is about 8,000 square miles and includes all or part of 13 counties in south-central Texas.

Learn More »


image

Year-Round Watering Hours

Watering with an irrigation system or sprinkler is allowed any day of the week before 11 a.m. or after 7 p.m.

Learn More »


Close

Aquifer Level 684.5 | Year-Round Watering Hours

Log In

Pay Your Bill Online

Already registered? Log in now.

Forgot your password?

New User

My Account Page

No user account? No problem.

Sign Up Now


Close
Benefits

Health Plan Options

SAWS offers the choice of two self-funded medical plans. Self-funded plans use your premiums and SAWS contributions to pay for the increasing cost of health care (claims). UnitedHealthcare will continue as our third party administrator and Express Scripts, Inc. will continue as our pharmacy benefit manager.

Stay In-Network

There are several things you can do to help keep costs down. The most important of these is choosing a UnitedHealthcare network provider. A network is a group of doctors, hospitals and other providers and facilities that have a contract with UnitedHealthcare. As part of their contract they have agreed to follow UHC's guidelines and provide health care services at lower prices. It pays to stay in the network — using network providers can reduce outof- pocket costs, in addition to the overall health plan costs. All of these savings contribute to keeping premium increases to a minimum. Out-of-network providers do not have a contract with UnitedHealthcare and can bill you above the reasonable and customary rates. Depending on the plan, insurance may cover only a fraction of the cost or none at all.

UnitedHealth Premium Program (Tier 1 Premium Providers)

To help you make more informed choices about your health care, UHC created the UnitedHealth Premium Program. The Premium Program recognizes doctors who meet standards for quality and cost efficiency. Look for the two hearts and find out more on page 10 of the Benefit Guide.

  • Tier 1 Premium Provider – The physician meets the criteria for providing quality and cost-efficient care.
  • In 2019, office visits with Tier 1 Premium Providers will have lower copays than visits with Non-Tier 1 Premium Providers.

PPO Economy: The in-network benefit plan design has a $1,500 deductible and out-of-pocket maximum of $4,500 per individual.

2019 PPO Economy Medical Premiums
Hired Before Jan. 1, 2011 Hired After Jan. 1, 2011
Tier Selection SAWS Employee SAWS Employee
Employee Only $429 $35 $429 $35
Employee + Spouse $863 $110 $723 $250
Employee + Child(ren) $754 $80 $644 $190
Employee + Family $1,276 $160 $1,016 $420

EPO Plus: This in-network benefit plan has a deductible of $500 per individual and out-of-pocket maximum of $4,100 per individual.

2019 EPO Plus Medical Premiums
Hired Before Jan. 1, 2011 Hired After Jan. 1, 2011
Tier Selection SAWS Employee SAWS Employee
Employee Only $481 $115 $481 $115
Employee + Spouse $965 $285 $825 $425
Employee + Child(ren) $847 $225 $742 $330
Employee + Family $1,440 $405 $1,165 $680

PPO Networks: Both plans will offer the same PPO network through UnitedHealthcare. Go online to list of participating providers, and select the "UnitedHealthcare Choice Plus" network, or call 1-888-651-7277 to get personal assistance from a UnitedHealthcare representative. If you register on myuhc.com, your will access your personal account, along with direct access to the provider network.

Summary of Coverage
PPO Economy EPO PLus
Plan Benefit In-Network Out of Network In-Network Out of Network
Deductible $1,500 individual $2,500 individual $500 individual Not Covered
$4,500 family $7,500 family $1,500 family Not Covered
Coinsurance 80% after deductible 60% after deductible 80% after deductible Not Covered
Out of Pocket* $4,500 individual $7,500 individual $4,100 individual Not Covered
$11,250 family $18,750 family $8,200 family Not Covered
PCP Office Visit   60% after deductible   Not Covered
Tier 1 Premium Provider $40 $25
Non-Tier 1 $50 $40
Specialist    
Tier 1 $60 $40
Non-Tier 1 $70 $60
Preventive Care 100% 60% after deductible 100% Not Covered
Virtual Visits $30 N/A $15 N/A
Urgent Care $60 60% after deductible $60 Not Covered
Emergency Room $200 per visit co-pay, plus deductible and coinsurance $200 per visit co-pay, plus deductible and coinsurance
EMERGENCY ONLY
Hospital Inpatient 80% after deductible 60% after deductible 80% after deductible Not Covered
*Note: Out-of-pocket maximums for both the PPO Economy and EPO Plus include medical and prescription copay, deductible, and coinsurance amounts.

For all of the coverage details, see the official plan documents below.


In this section:

Medical Plan - UnitedHealthCare Downloads

Employees have the choice between the PPO Economy and EPO Plus plans offered by UnitedHealthCare.

2019 Plan Document - EPO Plus

This document describes the terms and conditions of coverage available under the EPO Plus Medical Plan.

2019 Plan Document - PPO Economy

This document describes the terms and conditions of coverage available under the PPO Economy Medical Plan.

2019 SAWS Medicare Part D Creditable Coverage Notice

SAWS has determined that the prescription drug coverage offered by SAWS through Express Script, Inc. is, on the average for all plan participants, expected to pay out as much as, or more than, what the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage under Medicare.

Cost-Saving Tips: Lab, X-Ray and Scan

Tips to save money on medical procedures.

Directory - Urgent Care Centers

This directory provides a list of the Urgent Care Centers in the San Antonio area. Members can call either Nurseline at 800-846-4678 or Customer Services at 888-651-7277 for additional locations outside of San Antonio.

Frequently Asked Questions - 1095-C Form

This FAQ provides answers to the frequently asked questions regarding the new 1095-C Form required under by the federal health reform law. The 1095-C form is the employee's proof of insurance.

Health Insurance Marketplace Notice

Information on the Health Insurance Marketplace Option.

UHC - Advocate4Me

Trying to understand your health plan benefits can often be confusing. Whether you call or email us, you’ll be connected to an Advocate whose goal is to help you get the answers and information you need about your health plan. Call the member phone number listed on your health plan ID card, or email us at Advocate4Me@uhc.com. See attached.

UHC - Convenience Care Clinics

Sometimes, you may not be able to get to your doctor’s office, and your condition is not urgent or an emergency. In these situations, you may want to consider a Convenience Care Clinic. See attached for more info.

UHC - Directory of Laboratory Facilities

UHC - Directory of Radiology,MRI, X-Ray Centers

UHC - Glossary of Health Coverage & Medical Terms

This glossary contains many commonly used terms and definitions intended to be educational, but isn’t a full list.

UHC - Health4Me

Health4Me is an app designed to make managing health care a lot simpler. You can easily access your health plan ID card, benefit amounts, account balances, Personal Health Records, and much more.

UHC - Medical Provider Search Link

The attached document contains a link to help you find a medical doctor in the SAWS provider network.

UHC - myHealthcare Cost Estimator

Using your benefit information, myHealthcare Cost Estimator shows you the estimated cost for a treatment or procedure, and how that cost is impacted by your deductible, co-insurance and out-of-pocket maximum. This means that you’ll get an estimate of what you’ll be responsible for paying out of your pocket, providing you with useful information for planning and budgeting.

UHC - Nurseline

Nurseline services are provided to help you with: • Immediate answers to your health questions any time, anywhere — 24 hours a day, 7 days a week • Access to experienced registered nurses • Trusted, physician-approved information to guide your health care decision.

UHC - Ordering an ID Card

Instructions for ordering an ID card via www.myuhc.com.

UHC - Premium Program FAQs

Answers to frequently asked questions about the UHC Premium program.

UHC - Transition of Care

Transition of Care is a service which enables UnitedHealthcare new enrollees to receive time-limited care for specified medical conditions from a non-contracted physician at the benefit level associated with contracted physicians.

UHC - Welcome Handbook

This handbook contains helpful information on UHC's medical programs and services.

UHC - Where Should I Go for Care?

Doctor's office, convenience care clinic, urgent care center, or emergency room? This document will help you choose the right care.



<< 2018 Open Enrollment Home   Prescription Drug Plan >>