2024 Health Plan Options
You and SAWS share in the cost of the medical plan, and we are committed to providing you with better coverage at lower costs. For the third year in a row, there will not be an increase to premiums.
Our self-funded plans use your premiums and SAWS contributions to pay for the increasing cost of health care. To keep health care costs down and to stay healthy, it is best to take advantage of preventive care, which has no copays and includes things like your annual check-ups and vaccinations (including COVID-19).
Stay In-Network
When it comes to lowering health care costs, choosing a UnitedHealthcare network provider can help you save on your health care expenses. A network is a group of doctors, hospitals, providers and facilities that have a contract with UnitedHealthcare. As part of their contract they have agreed to follow UnitedHealthcare’s guidelines and provide health care services at lower prices. All
of these savings help keep 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. The PPO Economy plan may cover only a fraction of the cost while the EPO Plus plan does not cover any out-of-network costs.
Visit the UnitedHealthcare website at myuhc.com to verify if your provider is in-network. You can also contact SAWS’ UnitedHealthcare Representative, Jorge Torres, at uhcrep@saws.org.
Reduced Copays
For the PPO Economy Plan, Primary Care Physician (PCP) Tier 1 provider copays will be reduced from $40 to $30 and Non-Tier 1 provider copays will be reduced from $50 to $45. Specialist Visit Tier 1 provider copays will be reduced from $60 to $50 and Non-Tier 1 provider copays will be reduced from $70 to $65.
Remember, office visits are not subject to your deductible. This means you can visit your primary care doctor or specialist and you will only pay the office visit copay, without having to pay your full deductible first. Your copayments will not apply to your annual deductible.
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 Tier 1 icon or two hearts when searching for providers. To and find out more look on page 6 of the Benefit Guide.
- Tier 1 Premium Provider – The physician meets the criteria for providing quality and cost-efficient care.
- Office visits with Tier 1 Premium Providers have lower copays than visits with Non-Tier 1 Premium Providers.
| 2024 Monthly Medical Premiums | ||
|---|---|---|
| PPO Economy (Base Plan) | EPO Plus (Buy Up Plan) | |
| Tier Selection | Employee | Employee |
| Employee Only | $36 | $117 |
| Employee + Spouse | $115 | $290 |
| Employee + Child(ren) | $83 | $229 |
| Employee + Family | $167 | $413 |
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 | $1,500 individual | $2,500 individual | $1,000 individual | Not Covered |
| $4,500 family | $7,500 family | $3,000 family | Not Covered | |
| Coinsurance | 20% after deductible | 40% after deductible | 20% after deductible | Not Covered |
| Out of Pocket 1 | $4,500 individual | $7,500 individual | $4,500 individual | Not Covered |
| $11,250 family | $18,750 family | $9,000 family | Not Covered | |
| PCP Office Visit | 40% after deductible | Not Covered | ||
| Tier 1 Premium Provider | $30 | $25 | ||
| Non-Tier 1 | $45 | $40 | ||
| Specialist | ||||
| Tier 1 | $50 | $40 | ||
| Non-Tier 1 | $65 | $60 | ||
| Preventive Care | $0 | 40% after deductible | $0 | Not Covered |
| Virtual Visits | $30 | N/A | $15 | N/A |
| Urgent Care | $50 | 40% after deductible | $50 | Not Covered |
| Emergency Room | $300 per visit co-pay, plus deductible and coinsurance | $300 per visit co-pay, plus deductible and coinsurance EMERGENCY ONLY |
||
| Hospital Inpatient | 20% after deductible | 40% after deductible | 20% after deductible | Not Covered |
1 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, call 210-233-2025 for a copy of the official plan documents
For all of the coverage details, see the UHC plan documents.
If your spouse is not covered through your SAWS medical plan, this does not apply to you. However, if you choose to cover your spouse, who is working and has access to medical coverage through their own employer, there is a $150 monthly surcharge ($75.00 per pay period) added above and beyond the regular employee medical contribution (premium). If your spouse is not working or does not have access to medical coverage through his/her employer, you must request a waiver for the surcharge. Waiver forms are located on INSIDER or contact the HR Benefits Office at 210-233-2025.
Points to Remember About the Surcharge
- All employees who cover spouses will have a Spouse Premium Surcharge unless a waiver form is turned in for 2024 or was on file for 2023.
- The loss of your spouse’s employment and related benefits during the year is a qualifying event that would allow you to enroll your spouse (and any affected dependents) into health care coverage through SAWS within 31 days of the qualifying event and apply for a Spouse Premium Surcharge waiver.