Broker Broadcast
UnitedHealthcare - ER Visit Clarification
Agents,
We have heard that there may be some confusion as to how the Emergency Room (ER) benefit works on the new UHc plan portfolio so we wanted to clarify a few points:
For ER Facility Claims (Billed by Hospital)
- Plan Deductible is waived
- ER Copay plus Coinsurance is applied
- The ER Coinsurance does apply to the Out of Pocket Maximum (OOPM)
- Conversely the ER Copay does not apply to the OOPM
For Professional Claims (Billed by Physician)
- Plan Deductible is waived
- Plan Coinsurance is required
- ER Coinsurance does apply to the OOPM
Below is a practical example:
ER Facility Charges: $1000
ER Professional Charges: $250
Facility: $150 (copay) + $170 (coinsurance at 20% of $850) = $320
Professional: 20% coinsurance of $250= $50
Member Total = $370 ($320 + $50)
Amount Applied to OOPM = $220 ($370 – the copay of $150 that is not applied to the OOPM)
If you have any further questions regarding this benefit please direct them to your Sales Representative.
Many Thanks and We Appreciate Your Continued Support!
-The Insurance Exchange
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