2026_Active_Benefits_MWAA | Page 7

FEATURE
UNITEDHEALTHCARE CHOICE PLUS
UNITEDHEALTHCARE CHOICE
KAISER PERMANENTE HMO
Preventive care, diagnostics and surgery
IN-NETWORK OUT-OF-NETWORK IN-NETWORK IN-NETWORK
Preventive care, Well child care, Adult physical, Routine OB / GYN, Mammogram, Cancer screening
No copay
Plan pays 60 % after deductible
No copay
No copay
Diagnostic services, lab & X-ray
Plan pays 90 % after deductible
Plan pays 60 % after deductible
Plan pays 100 % deductible does not apply
No copay
Outpatient surgery
Inpatient surgery
Plan pays 90 % after deductible
Plan pays 90 % after deductible
Major imaging and outpatient therapies
Major imaging services( CT, PET, MRI, MRA, nuclear medicine)
Outpatient chiropractic, speech, occupational, physical therapy
Plan pays 90 % after deductible
Plan pays 60 % after deductible
Plan pays 60 % after deductible
Plan pays 60 % after deductible
$ 35 copay Plan pays 60 % after deductible
$ 50 copay after deductible
$ 100 copay per admission
Plan pays 100 % after deductible
$ 25 copay, deductible does not apply
$ 25 copay
$ 250 copay per admission
No copay
$ 25 copay, limited to 30 visits per year
Emergency Room and urgent care
Emergency room( true emergency only)
$ 400 copay( waived if admitted)
$ 400 copay( waived if admitted)
$ 400 copay( waived if admitted)
$ 200 copay
Urgent Care
$ 40 copay
Plan pays 60 % after
deductible
$ 25 copay $ 25 copay
Eye exams and vision correction
Routine eye exam( once every calendar year, excludes contact lens exam)
Eyeglasses and contact lenses
Plan pays 100 %
Plan pays 60 % after deductible
Plan pays 100 % $ 20 copay
n / a
n / a
n / a
Kaiser vision discount
program
SPECIALTY PROGRAM: NAVIGUARD
Participants in our UHC Choice and Choice Plus medical options are able to use Naviguard, a program to help you navigate coverage and cost issues that can arise when you use providers who are not in the UHC network. It combines:
• Robust advocacy services on your behalf, provided by UHC professionals
• UHC’ s extensive and proprietary knowledge of pricing data in the marketplace, and
• Enforcement of provisions protecting patients from egregious billing practices.
If out-of-network medical providers file claims with UHC for services you received, the Naviguard team may contact you to offer their services and reduce your potential out-of-pocket cost.
7 | METROPOLITAN WASHINGTON AIRPORTS AUTHORITY