Medical

MEDICAL COVERAGE

The Total Health Medical Plan options provide generous coverage for illness and injury. You pay nothing for an annual wellness exam and only a small in-network copay for doctor’s office visits with all four Total Health Medical Plan options. Here are the differences between the four options:

  • The plan administrator, which are Texas Health Aetna and UnitedHealthcare (UHC)
  • Network coverage – only one plan option covers out-of-network medical care
  • The amount you pay for services, including your annual deductible and co-insurance
  • The premiums you pay, which depend on the plan you choose and your salary tier (Texas Health pays a large percentage of the premiums for all employees – and pays more for employees who earn less) .

Choose Your Medical Plan

All four Total Health Medical Plan options cover the same medical services. The differences are in the premiums, the network composition, and the amount you pay out of your own pocket for medical care. When choosing your option, you’ll need to decide which factors are most important to you:

  • Paying lower premiums but having a higher deductible and/or a smaller provider network
  • Having a higher level of coverage for medical care at non-Preferred Hospitals
  • Paying higher premiums but having a lower deductible
  • Having coverage for out-of-network hospitals and doctors.

Not sure which option is right for you? Watch the Medical Plan Comparison video.

There are two plan administrators: Texas Health Aetna and United Healthcare. Under all four plans you can choose from, regardless of the plan administrator, there are some services that pay the same. For example, under all four plans, you pay:

  • $0 copay for well-visits
  • $0 copay for virtual visits
  • $30 copay for a PCP office visit
  • $50 copay for a specialist office visit
  • $50 copay for Urgent Care Center
  • $100 copay, then 10% after the deductible for an Emergency room visit
video thumbnail- terms

The Medical Terms & Concepts video can help you understand your coverage.

To find out how much you pay for medical care with each of the plans, see the corresponding Your Cost for Covered Services charts:

To see a list of network physicians and facilities:

Your Medical Plan Can Help

  • Should I go to the ER?
  • I don’t think this bill is right.
  • I need help with my complex condition.

Just call 1-877-MyTHRLink (1-877-698-4754) and select prompt 1 for Texas Health Aetna or prompt 2 for UHC.

Also be sure to read about the special features of the Texas Health Aetna Select Plan 1000 and the UHC Choice Plans.

Who do I contact with questions?

  • For a list of Frequently Asked Questions about the Total Health Medical Plan, click here.
  • Texas Health Aetna
  • UHC:
    • Phone: 1-877-698-4754, prompt 2
    • Web: myUHC.com

 

Which Medical Plan Option Is Right for You?

Under all medical plan options, you pay only an office visit copay for visits to your in-network family doctor or specialist.

In the Texas Health Aetna Select Plan 1000, for services such as outpatient surgery, lab work, and diagnostic testing, you pay:

  • 10% when performed by any in-network provider
  • 100% when performed by any other provider.

In the UHC plans, for services such as outpatient surgery, lab work, and diagnostic testing, you pay:

  • 10% when performed at Texas Health Preferred Hospitals
  • 10% when performed at in-network free-standing facilities that are not affiliated with a hospital
  • 70% when performed at UHC Choice network hospitals that are not Texas Health Preferred Hospitals (applies to Choice Plan 500 and Choice Plan 1000)
  • 50% at hospitals out-of-network or within the UHC Choice Network (applies only to the Choice Plus Plan 1500).