Medical – Lemek LLC

Which Medical Plan is Right?

Medical insurance is essential to your well-being, and our medical coverage provides you and your family the protection you need for everyday health issues or when the unexpected happens.

How a Health Plan Works

Preventive Care – like annual physical exams, vaccines and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need care.

The plans have different:

Annual deductible amount – The amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
Out-of-pocket maximums – The most you will pay each year for eligible network services including prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the plan year.
Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, called coinsurance. For example, you may pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.

Medical Plan Comparison

Medical Coverage	Premier Plan	Standard Plan	Advantage Plan	MEC Value Plan
	In-Network (You Pay)	In-Network (You Pay)	In-Network (You Pay)	In-Network (You Pay)
Annual Deductible
Individual / Family	$400 / $800	$1,000 / $2,000	$2,500 / $5,000	$5,000 / $10,000
Annual Out-of-Pocket Maximum
Individual / Family	$2,500 / $5,000	$4,000 / $8,000	$6,000 / $12,000	$7,150 / $14,300
Copay/Coinsurance
Primary Care Physician Annual Physical	No charge	No charge	No charge	No charge
Routine Preventive Care & Tests	No charge	No charge	No charge	No charge
Primary Care Physician (PCP) Office Visit, Diagnostic	$20 copay	$30 copay	$40 copay	30%
Specialist Office Visit	$30 copay	$50 copay	$60 copay	30%
Diagnostic Imaging Lab Work, X-rays, MRI	20%	20%	20%	30%
Telemedicine Online visits through www.myuhc.com	$10 copay	$10 copay	$10 copay	$10 copay
Urgent Care	$30 copay	$50 copay	$60 copay	30%
Emergency Room Copay waived if admitted	$150 copay	$200 copay	20%	30%
Inpatient Hospitalization	$250 copay then 20%	$250 copay then 20%	20%	30%
Mental Health / Substance Abuse Outpatient Services	$30 copay	$50 copay	$60 copay	30%
Mental Health / Substance Abuse Inpatient Services	$250 copay then 20%	$250 copay then 20%	20%	30%
Maternity Benefits — Includes prenatal care, delivery, postnatal care, ultrasounds, and any related complications. Refer to your plan documents for additional information.
Initial Visit to Provider	$20 copay	$30 copay	$40 copay	30%
Childbirth/Delivery – Inpatient Hospital	$250 copay then 20%	$250 copay then 20%	20%	30%

Out-of-Network Benefits

Medical Coverage	Premier Plan	Standard Plan	Advantage Plan	MEC Value Plan
	Out-of-Network (You Pay)	Out-of-Network (You Pay)	Out-of-Network (You Pay)	Out-of-Network (You Pay)
Annual Deductible
Individual / Family	$1,000 / $2,000	$2,000 / $4,000	$5,000 / $10,000	$10,000 / $20,000
Annual Out-of-Pocket Maximum
Individual / Family	$5,000 / $10,000	$8,000 / $16,000	$10,000 / $20,000	$14,300 / $28,600

Medical Bi-Monthly Contributions

UnitedHealthcare	Premier Plan	Standard Plan	Advantage Plan	MEC Value Plan
Your Bi-monthly Deductions
Employee Only	$136.00	$87.00	$60.00	$35.00
Employee + Spouse	$306.00	$195.00	$166.00	$136.00
Employee + Child(ren)	$278.00	$177.00	$150.00	$124.00
Employee + Family	$435.00	$277.00	$235.00	$193.00