Active_Benefits_MWAA | Page 6

MEDICAL BENEFITS
You have three options for medical coverage. The same services are covered by all three options, but there are differences in the premiums, deductibles, and other costs that are your responsibility.
COVERAGE HIGHLIGHTS
FEATURE
UNITEDHEALTHCARE CHOICE PLUS
UNITEDHEALTHCARE CHOICE
KAISER PERMANENTE HMO
IN-NETWORK OUT-OF-NETWORK IN-NETWORK IN-NETWORK
Premiums( per pay period) You pay You pay You pay
Employee Only Employee + Child( ren) Employee + Spouse Family
$ 95 $ 180 $ 198 $ 282
$ 85 $ 162 $ 179 $ 255
$ 83 $ 157 $ 174 $ 249
Calendar year deductible
Employee Only Employee + Child( ren) Employee + Spouse Family
$ 300 $ 600 $ 600 $ 600
$ 750 $ 1,500 $ 1,500 $ 1,500
$ 200 $ 200 $ 200 $ 200
None
Annual out-of-pocket maximums
Medical expenses
Employee Only Employee + Child( ren) Employee + Spouse Family
$ 2,000 $ 4,000 $ 4,000 $ 4,000
$ 5,000 $ 10,000 $ 10,000 $ 10,000
$ 2,000 $ 4,000 $ 4,000 $ 4,000
$ 2,250 $ 4,500 $ 4,500 $ 4,500
Prescription expenses
Employee only Employee + Child( ren) Employee + Spouse Family
$ 2,500 $ 5,000 $ 5,000 $ 5,000
n / a
$ 2,500 $ 5,000 $ 5,000 $ 5,000
n / a
Office visits
Primary Care Physician
$ 35 copay
Plan pays 60 %
after deductible
$ 20 copay $ 20 copay $ 0 copay for children under age 5( nonspecialist visits)
Specialist
$ 40 copay
Plan pays 60 %
after deductible
$ 25 copay $ 25 copay
Virtual office visit $ 10 copay N / A $ 5 copay No copay Referral to specialist required No No No Yes
Did you know that MWAA pays 80 % of Medical insurance premiums?
On a bi-weekly basis: Randy ' s deduction: $ 255
4 | METROPOLITAN WASHINGTON AIRPORTS AUTHORITY
If Randy enrolled in UHC Choice with family coverage, his premiums are only 20 % of the cost of their medical benefits.
MWAA pays: $ 1,019
Randy ' s total: $ 255 x 26 = $ 6,630
Total Reward for medical( MWAA paid): $ 1,019 x 26 = $ 26,494