United Healthcare
|
Employer Application Package  |
Employee Application Package for New Group |
|
Add Employee to Existing Group Plan |
Common Ownership Form |
|
Common Law Marriage
|
COBRA/State Continuation |
Employee forms can be faxed to our office at (303) 721-1085. Please confirm that application was received by calling (303) 721-1145. Please call with any questions regarding eligibility or waiting periods.
Plan
Descriptions
| Health Plan Name |
Office Visit Copay |
In-Network Deductible |
In-Network Coinsurance Rate |
| $20 |
$250 | 90/10 | |
| USB |
$20 | $250 | 80/20 |
| USC |
$20 | $500 | 90/10 |
| USD |
$20 | $500 | 80/20 |
| USE |
$20 | $1000 | 90/10 |
| USF |
$20 | $1000 | 80/20 |
| USG |
Deductible/Coinsurance | $1500 | 90/10 |
| USH |
$25 |
$1500 | 90/10 |
| Deductible/Coinsurance | $1500 | 80/20 | |
| USJ |
$25 | $1500 | 80/20 |
| USK |
Deductible/Coinsurance | $2000 | 90/10 |
| USL |
$25 | $2000 | 90/10 |
| USM |
Deductible/Coinsurance | $2000 | 80/20 |
| USN |
$25 | $2000 | 80/20 |
| USO |
Deductible/Coinsurance | $2500 | 90/10 |
| USP |
$25 | $2500 | 90/10 |
| USQ |
Deductible/Coinsurance | $2500 | 80/20 |
| USR |
$25 | $2500 | 80/20 |
| USS |
Deductible/Coinsurance | $3000 | 90/10 |
| UST |
$30 | $3000 | 90/10 |
| USU |
Deductible/Coinsurance | $3000 | 80/20 |
| USV |
$30 | $3000 | 80/20 |
| USW |
Deductible/Coinsurance | $5000 | 90/10 |
| USX |
$30 | $5000 | 90/10 |
| USY |
Deductible/Coinsurance | $5000 | 80/20 |
| USZ |
$30 | $5000 | 80/20 |
| LIA |
$25 | $1500 | 100/0 |
| LIB |
$25 | $2500 | 100/0 |
| LIC |
$25 | $3000 | 100/0 |
| LID |
$25 | $4000 | 100/0 |
| LIE |
$25 | $5000 | 100/0 |
| LIF |
$25 | $1000 | 100/0 |
| LIG |
$25 | $500 | 80/20 |
| LIH |
$25 | $1000 | 80/20 |
| LII |
$25 | $1000 | 100/0 |
| LIJ |
$25 | $500 | 90/10 |
| LIK |
$25 | $250 | 90/10 |
| LIL |
$25 | $1500 | 100/0 |
| PUK |
Deductible | $2000 | 90/10 |
| PYD |
Deductible | $2000 | 100/0 |
| PZC |
$25 | $3000 | 100/0 |
| PZD |
$25 | $4000 | 100/0 |
| PZH |
$25 | $1000 | 80/20 |
| RQA |
Deductible | $1100 | 100/0 |
| EAA |
$20 | $500 | 80/20 |
| EAB |
$20 | $1000 | 80/20 |
| EAC |
$25 | $1500 | 80/20 |
| EAD |
$20 | $1000 | 100/0 |
| EAE |
$25 | $2000 | 100/0 |
| ANA |
$20 | $1000 | 100/0 |
| ANB |
Deductible | $1000 | 100/0 |
| ANC |
$25 | $2000 | 100/0 |
| AND |
Deductible | $2000 | 100/0 |
| LCA |
$40 | $3000 | 100/0 |
| $40 | $3000 | 70/30 | |
| JDD (Std PPO) |
$25 | $1500 | 80/20 |
| JDE (Basic HMO) |
$40 | $0 | No coinsurance |
| JDF (Std HMO) |
$25 | $0 | No coinsurance |
| HDD (HSA) |
Deductible | $2000/$4000 | 100/0 |
| HDE (HSA) |
Deductible | $2000/$4000 | 80/20 |
| HDF (HSA) |
Deductible | $2850/$5600 | 100/0 |
| HDG (HSA) |
Deductible | $2850/$5600 | 80/20 |
| HDH (HSA) |
Deductible | $2850/$5600* | 80/20* |
| HDI (HSA) |
Deductible | $3500/$7000 | 100/0 |
| HDJ (HSA) |
Deductible | $3500/$7000 | 80/20 |
| HDK (HSA) |
Deductible | $3500/$7000* | 80/20* |
| HDL (HSA) |
Deductible | $5000/$10,000 | 100/0 |
| HDM (HSA) |
Deductible | $5000/$10,000* | 100/0* |
| HDN (HSA) |
Deductible | $1500/$3000 | 100/0* |
| HDO (HSA) |
Deductible | $1500/$3000 | 80/20 |
| HYA (HSA) |
Deductible | $2500/$5000 | 100/0 |
| HYB (HSA) |
Deductible | $2500/$5,000 | 80/20 |
| HYC (HSA) |
Deductible | $5000/$10,000 | 100/0 |
* These plans do not cover preventative care.
Prescription plans (click to view):
0H9 (HSA), 1A, 1E, 2V, C2, G4, H9, K4, S8
Dental Plan Descriptions
For comparison of all United
Healthcare dental plans, click
here.
More Dental information, click here.
Vision Product information, click here.
.
