UHC DKW5 High Deductible Select Plus SBC

*Please note: If you enroll in this plan, you are eligible to enroll in a Health Savings Account (HSA) through Optum Bank. Please sign up in Employee Navigator.

In-Network Services - 

Deductible (Individual/Family): $5,500/$11,000

Out-of-Pocket Maximum (Individual/Family): $6,500/$13,000

Primary Care Visit: 30% coinsurance after deductible

Specialist Visit: 30% coinsurance after deductible

Urgent Care: 30% coinsurance after deductible

Prescription Drugs -

Generic: $10 copay after deductible

Preferred Brand: $35 copay after deductible

Non-Preferred Brand: $70 copay after deductible