Medical

Medical Plan Options

Texas Health is proud to offer benefits eligible employees a variety of medical plan options to meet their health care needs. The plan options work very differently, so it’s important to take the time to understand how each option works before enrolling.

When choosing the medical plan that is right for you and your family, you’ll want to consider the total cost of coverage: what you pay out of your paycheck, how much you pay for services out of your pocket, etc. The information below is intended to help you understand the difference in the medical plan options available to you and the costs for services. To compare what you’ll pay out of your paycheck for each of these plans, click here.

 

Co-Pay Plan Options

HDHP Option 
 

Quantum Care 750

UHC Choice 1000

UHC Choice Plan 2500
How It Works

You pay a set amount (called a copay) for things like doctor and urgent care visits without needing to meet your deductible first. When you need hospital care or MRIs, CTs, or PET scans, you must pay your deductible before the plan pays part of the bill (called coinsurance). 

 You pay the most when you need care because it is a High Deductible Health Plan option. Other than preventive care like checkups, this plan doesn’t pay any portion of your bill or prescriptions until you pay your full deductible.
Choosing a Facility

After you meet your deductible on any of the plans, your coinsurance payment depends on the facility you choose.

You pay 10% at Preferred Hospitals (a select list of hospitals where the plan pays the most for care, meaning you pay the least).

You pay 70% at all other in-network hospitals (hospitals that are covered in the UHC or Cigna network through Quantum but are not on the Preferred Hospital list).

You pay the full cost if you go out of network.
Search the Network for Doctors and Facilities 

To find a doctor or facility in the Cigna Open Access Plus Network through Quantum:

• Visit MyQHResource.com
• Under Find Provider, select Cigna Open Access Plus Provider Search

For the most up-to-date information, contact Quantum Care Coordinators at 1-877-MyTHRLink (1-877-698-4754), prompt 2, press 1.

To find a doctor or facility in the UHC Choice network:

• Visit WhyUHC.com/THR
• Click Health Plans
• Select a plan option

For the most up-to-date information, contact UHC customer service at 1-877-MyTHRLink (1-877-698-4754), prompt 2, press 2.
Deductible

Preferred Hospital:
$750 indiv / $2,250 family

Non-preferred Hospital:
$3,500 indiv / $10,500 family

Preferred Hospital:
$1,000 indiv / $3,000 family

Non-preferred Hospital:
$4,000 indiv / $12,000 family

Preferred Hospital: 
$2,500 indiv */ $7,500 family

Non-preferred Hospital:
$4,000 indiv */ $12,000 family
Medical and Rx Out-of-Pocket Maximum1 $6,850 individual
$13,700 family		 $6,750 individual 
$13,500 family 
Spending and Savings Accounts Health Care Flexible Spending Account:
You may contribute up to $2,850.		 Health Savings Account: 
You may contribute up to $3,850 (employee only coverage) or $7,750 (employee + family coverage)5. Comes with Employer contributions.
Office Visits $30 copay for PCP; $50 copay for specialist  Full deductible, then 10%
Urgent Care including Dispatch Health and Texas Health Breeze  $50 copay Full deductible, then 10%
Inpatient Hospital Care Preferred hospital: 10% after deductible 
Non-preferred hospital: 70% after deductible 		 Preferred hospital: Full deductible, then 10%
Non-preferred hospital:  Full deductible, then 70%
Outpatient Surgery Preferred hospital: Office visit copay applies; 10% after deductible if not in doctor’s office
Non-preferred hospital: 70% after deductible		 Preferred hospital: Full deductible, then 10%
Non-preferred hospital: Full deductible, then 70%
Virtual Care Services2 $0 Full deductible, then $0
Well Women/ Man Exams and Well Child Care3 $0
Emergency Room4  $200 copay, then 10% after deductible  Full deductible, then 10%

*The UHC Choice 2500 plan option has a non-embedded deductible. This means the family deductible must be paid out-of-pocket before the plan starts paying for health care services for any individual member.

1 The annual out-of-pocket maximum includes the annual deductible, medical coinsurance, medical copays, prescription coinsurance and prescription copays. It does not include non-compliance penalties, your premiums, or expenses that are not covered by the plan.

2 Virtual Care services at this price are available only when delivered through a Designated Virtual Network Provider. Quantum Health’s provider is MDLive and the virtual care services provided by UHC are through DocOnDemand, TelaDoc, and AmWell.

3 Wellness exams are covered in full if the claims administrator determines the physical is for preventive care. Additional screenings or services will be considered diagnostic services and will be covered after you pay the applicable copay or deductible and coinsurance. At the time of your preventive care visit, if other services are performed that are not preventive services, as determined by the claims administrator, they will not be paid at 100% even if they are submitted as part of a claim for preventive care. Some items require you to pay the appropriate copay or coinsurance, including electrocardiograms (EKGs), focused office visits, thyroid scans, breast MRI, vitamin D assays, and transvaginal ultrasounds

4 Non-emergency use of the emergency room is not covered

5 For the purposes of HSA enrollment, Employee + Family coverage includes Employee + Spouse, Employee + Children, or Employee + Family coverage

Features

All plan options have some of the same coverage, programs, and features including: 

  • DispatchHealth
  • ABA Therapy
  • Infertility Coverage
  • Gender Reassignment Coverage
  • Healthy Pregnancy

Resources

  • UnitedHealthcare
    • Customer Support: 1-877-MyTHRLink (1-877-698-4754) prompt 2, press 2
    • Website: MyUHC.com
  • Quantum Health 
    • Customer Support:  1-877-MyTHRLink (1-877-698-4754) prompt 2, press 1
    • Website: MyQHResource.com
  • Benefits Support