7-6.0-Medical Services.pdf

This document is a Benefits Summary for the FMIT/UHC Medical Plan Rates effective October 1, 2025, specifically detailing the FMIT/UHC Choice Plus Plan 15. The plan outlines comprehensive medical coverage with various deductible and coinsurance options, including a calendar year deductible of $250 for individuals and $500 for families, with a 90%/10% cost-sharing arrangement. The medical plan covers a wide range of services including hospital services (inpatient and outpatient), emergency room visits, urgent care, skilled nursing facilities, physician services, mental health and substance abuse treatments, home health and outpatient rehab services, and diagnostic procedures.

The monthly premiums for this medical plan vary based on coverage type, ranging from $896.05 for an employee-only plan to $2,430.67 for an employee with spouse and children. The plan features out-of-pocket maximums of $2,500 for individuals and $5,000 for families, with specific copayments for various medical services such as primary care physician visits ($20), specialist visits ($40), emergency room visits ($150), and prescription drugs. Generic medications have lower copays compared to brand-name drugs, and the plan offers both retail and mail-order prescription options with different pricing structures. Out-of-network benefits are also available with different deductible and coinsurance rates, providing flexibility for plan participants.