The UnitedHealthcare PPO Plan (formerly the Wells Fargo Health Plan) is available nationwide, except in Hawaii.
How the Plan Works
Your benefits depend on whether you live within the UnitedHealthcare Choice Plus network area or outside it, and where you choose to receive care.
Within the Choice Plus network area. If you live within the Choice Plus network area you can choose where to receive care. When you visit a network doctor you pay $30. For hospital, out-patient, or emergency care, you pay 20% of contracted rates when you use a network provider and 40% of usual and customary charges for medical services when you don’t use the UnitedHealthcare Choice Plus network of doctors and hospitals. Due to an alliance between Medica and UnitedHealthcare, team members in Minnesota, North Dakota and South Dakota will have access to Medica’s network of doctors and hospitals.
Outside the Choice Plus network area. If you live outside the Choice Plus network area, your plan is designated an Indemnity Plan. You may go to any provider and pay 20% of costs, after you meet the deductible. If you utilize a PPO network provider, payment is based on the provider's contract. If you utilize a non PPO provider, payment is based on usual and customary charges (i.e. the fees that are most consistent with that of physicians, hospitals, or other health care providers for a given procedure). You will be responsible for any amount over the reasonable and customary charge.
Medco manages the prescription drug benefits for the UnitedHealthcare PPO Plan. Participants receive benefits through Medco’s network of pharmacies as well as mail-order service for medications you take long term. For plan features, refer to the Rates and Comparison Charts 2009.
The prescription drug benefit provides a low copayment for generic drugs and a higher coinsurance for brand-name drugs. The plan Is designed to encourage participants to use generic drugs and switch to mail-order services for drugs you take long term.
Participants who use mail-order services have the financial protection of an annual out-of-pocket maximum for mail-order prescription drug purchases. See the chart below.
