MEDICAL INSURANCE

20944575

BankUnited offers three medical plans to eligible employees: The Choice Plan, The Choice Plus Plan, and The Choice Plus HSA Plan. All medical plans are administered in partnership with UnitedHealthcare. All plans provide the same full coverage for preventive care services, the same comprehensive list of covered prescription drugs, as well as the same nationwide network of providers. To enroll in any of these plans during an eligible timeframe (i.e. Open Enrollment, New Hire Enrollment, or Qualifying Life Event) log in to ADP Employee Self Service Portal.

  • Preventive Care Guidelines document outlines the services UHC covers at 100% for preventive care based on age and gender.
  • Prescription Drug List document also known as the formulary lists all prescriptions that are covered (with applicable copays and deductible amounts to be paid) on all plans. Each medication will be categorized as a Tier 1, 2, or 3 drug for which copays are outlined in the details of each plan.
  • Vital Medications List - This is a list of UHC selected Vital Medications that BankUnited will cover at no cost to employees in any of the three medical plans.
  • HSA $0 Copay Prescription List - This is a list of Preventive Medications that may be covered under your plan. If your plan covers these Preventive Medications, your insurance benefit is applied before you meet your deductible.
  • All three medical plans benefit from the same nationwide network. In network providers and facilities can be found in the UHC website.

 

Medical Plans

IN-NETWORK 
Deductible (Individual / Family)$1,500/$3,500
Maximum Out-of-Pocket (Individual / Family)$6,000/$12,000
Out-of-Pocket Max includescopays, Rx, coinsurance, CYD
Lifetime Major Medical MaximumUnlimited
Coinsurance80%
CO-PAYS 
PCP Required / Open AccessOpen Access
Office Visits/Consultations for Illness/Injury$30
Specialist Visits$50
Physician Services (Out of Office)80% after CYD
Inpatient Hospital80% after CYD
Outpatient Surgery80% after CYD
Emergency Room$500
Urgent Care$75
OUTPATIENT DIAGNOSTIC SERVICES 
Lab Services100%
X-Ray Services100%
Complex Diagnostic80% after CYD
PRESCRIPTIONS 
Retail (30 Day Supply)$10/$35/$60
Mail Order (90 Day Supply)2.5 x retail
OUT-OF-NETWORK 
Deductible (Individual / Family)N/A
Maximum Out-of-Pocket (Individual / Family)N/A
Lifetime Major Medical MaximumN/A
CoinsuranceN/A

 

Things to Know:

  • The Family deductible is $1,500 per person up to a family maximum of $3,500.
  • Co-pays do not count towards deductible.
  • Deductibles do not count toward out-of-pocket maximum.
  • Not available in all States.
  • No out of network allowance.

Not available in AL, AK, AR, AZ, HI, KS, LA, MN, MS, MT, NC, NM or OK

 

Resources:

 

This plan is structured the same as our Choice plan but with some slight differences in copays and deductible amounts as well as out of network options and is available in ALL states.

 

IN-NETWORK 
Deductible (Individual / Family)$2,000/$5,000
Maximum Out-of-Pocket (Individual / Family)$6,000/$12,000
Out-of-Pocket Max includescopays, Rx, coinsurance, CYD
Lifetime Major Medical MaximumUnlimited
Coinsurance70%
CO-PAYS 
PCP Required / Open AccessOpen Access
Office Visits/Consultations for Illness/Injury$25
Specialist Visits$45
Physician Services (Out of Office)70% after CYD
Inpatient Hospital70% after CYD
Outpatient Surgery70% after CYD
Emergency Room$500
Urgent Care$75
OUTPATIENT DIAGNOSTIC SERVICES 
Lab Services100%
X-Ray Services100%
Complex Diagnostic$200
PRESCRIPTIONS 
Retail (30 Day Supply)$10/$35/$60
Mail Order (90 Day Supply)2.5 x retail
OUT-OF-NETWORK 
Deductible (Individual / Family)$3,000/$9,000
Maximum Out-of-Pocket (Individual / Family)$9,000/$27,000
Lifetime Major Medical MaximumUnlimited
Coinsurance60%

 

*CYD stands for Calendar Year Deductible

 

Things to Know:

  • The Family deductible is $2,000 per person up to a family maximum of $5,000.
  • Co-pays do not count towards your deductible.
  • Out of network services are still subject to balance billing.

Resources:

 

IN-NETWORK 
Deductible (Individual / Family)$2,000/$4,000
Maximum Out-of-Pocket (Individual / Family)$4,500/$6,850
Out-of-Pocket Max includescopays, Rx, coinsurance, CYD
Lifetime Major Medical MaximumUnlimited
Coinsurance90%
CO-PAYS 
PCP Required / Open AccessOpen Access
Office Visits/Consultations for Illness/Injury90% after CYD
Specialist Visits90% after CYD
Physician Services (Out of Office)90% after CYD
Inpatient Hospital90% after CYD
Outpatient Surgery90% after CYD
Emergency Room90% after CYD
Urgent Care90% after CYD
OUTPATIENT DIAGNOSTIC SERVICES 
Lab Services90% after CYD
X-Ray Services90% after CYD
Complex Diagnostic90% after CYD
PRESCRIPTIONSAfter CYD:
Retail (30 Day Supply)$10/$35/$60
Mail Order (90 Day Supply)2.5 x retail
OUT-OF-NETWORK 
Deductible (Individual / Family)$4,000/$8,000
Maximum Out-of-Pocket (Individual / Family)$9,000/$27,000
Lifetime Major Medical MaximumUnlimited
Coinsurance60%

 

Things to Know:

  • High Deductible Health Plan/ Health Savings Account (2 Part plan).
  • Family Deductible is a household deductible meaning covered household participants may contribute towards meeting it.
  • Out of network services are subject to balance billing.
  • BankUnited Contributes $1,000 to all employee HSA accounts (prorated after January).
  • Rx subject to deductible (unless listed on $0 copay list – see link below).
  • Office visits are subject to deductible.
  • Not an HMO plan. Participants are free to see any in-network provider without referral.

Resources:

  • Health Savings Account Information: The HSA medical plan is paired with a free BankUnited (HSA) Health Savings Account. This is considered a tax advantaged account with numerous benefits and therefore is subject to IRS rules. Learn more about how to start and use an HSA to maximize it’s benefits in the Tax Advantaged Accounts Section.
  • The HSA $0 Copay List: The drugs listed on this document are covered at absolutely no cost to the HSA plan participants. This list is an addition to the already existing formulary of covered prescription drugs for all BankUnited medical plans.
  • An easy to read Summary of Benefits and Coverage (SBC) that lets you make apples to apples comparisons of costs and coverage. The SBC shows how the cost for covered health services would be shared with the health plan.
  • Summary Plan Description (SPD) Plan provides a deeper dive into all covered and excluded benefits as required by law.

 

Medical Plans Comparison