Coverage and Benefits for

Medical & RX Member ID : {{memberID}}
{{medicalPlanName}}
Dental Member ID : {{memberID}}
{{dentalPlanName}}
Vision Member ID : {{memberID}}
{{visionPlanName}}
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You are covered for:

Medical Account Summary

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In-network accounts - As of {{date | date:'MM/dd/yyyy'}}

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Deductibles

{{firstName}}'s Deductible

{{firstName}}'s

{{medicalAccountSummary.individualSpentAmt | currency}} N/A of {{medicalAccountSummary.individualMaxAmt | currency}} Spent

$0.00

Family Deductible

Family

{{medicalAccountSummary.familySpentAmt | currency}} N/A of {{medicalAccountSummary.familyMaxAmt | currency}} Spent

$0.00

Out-of-Pocket Maximums

{{firstName}}'s Out-of-Pocket Max

{{firstName}}'s

{{medicalAccountSummary.individualOopSpentAmt | currency}} N/A of {{medicalAccountSummary.individualOopMaxAmt | currency}} Spent

$0.00

Family Out-of-Pocket Max

Family

{{medicalAccountSummary.familyOopSpentAmt | currency}} N/A of {{medicalAccountSummary.familyOopMaxAmt | currency}} Spent

$0.00

Current Balance - As of {{date | date:'MM/dd/yyyy'}}

Health Savings Account (HSA) {{hsaCurrentBalance|currency}}

Explanation of Deductible and Out-of-Pocket Maximum

Benefits Summary for

and {{dependents}}

Medical Benefits Summary

Plan Summary

Coverage started {{startDate | date:"MM/dd/yyyy"}}

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Member Number

Members Covered

Coinsurance

Primary Care Provider: Select a primary care provider; Not Selected; Not Selected

Referral Required: Required; Not Required

Current Spending

Your deductible

Network medical

{{memberInNetworkDeductible.individual.ytdAmount | currency}} of {{memberInNetworkDeductible.individual.deductibleAmount | currency}} Spent

$0.00 {{memberInNetworkDeductible.individual.deductibleAmount | currency}}
You have no individual deductible with your plan.
Individual Out-of-Pocket Maximum Your out-of-pocket limit

Network medical

{{MedicalOOP.individual.oopYTDAmount | currency}} of {{MedicalOOP.individual.planIndividualOOP| currency}} Spent

$0.00 {{MedicalOOP.individual.planIndividualOOP | currency}}
You have no individual out-of-pocket maximum with your plan.
Family deductible

Network medical

{{memberInNetworkDeductible.family.ytdAmount | currency}} of {{memberInNetworkDeductible.family.deductibleAmount | currency}} Spent

$0.00 {{memberInNetworkDeductible.family.deductibleAmount | currency}}
Family out-of-pocket limit Family Out-of-Pocket Maximum

Network medical

{{MedicalOOP.family.oopYTDAmount | currency}} of {{MedicalOOP.family.planFamilyOOP | currency}} Spent

$0.00 {{MedicalOOP.family.planFamilyOOP | currency}}

U.S. Network

Individual Network deductible

Network Medical You have no individual deductible with your plan.

{{memberInNetworkDeductible.individual.ytdAmount | currency}} of {{memberInNetworkDeductible.individual.deductibleAmount | currency}} Spent

$0.00 {{memberInNetworkDeductible.individual.deductibleAmount | currency}}

Individual Out-of-Pocket maximum

Network Medical You have no individual out-of-pocket maximum with your plan.

{{MedicalOOP.individual.oopYTDAmount | currency}} of {{MedicalOOP.individual.planIndividualOOP| currency}} Spent

$0.00 {{MedicalOOP.individual.planIndividualOOP | currency}}

International

Individual Network deductible

Network Medical You have no individual deductible with your plan.

{{memberInNetworkDeductibleTIER.individual.ytdAmount | currency}} of {{memberInNetworkDeductibleTIER.individual.deductibleAmount | currency}} Spent

$0.00 {{memberInNetworkDeductibleTIER.individual.deductibleAmount | currency}}

Individual Out-of-Pocket maximum

Network Medical You have no individual out-of-pocket maximum with your plan.

{{MedicalOOPTIER.individual.oopYTDAmount | currency}} of {{MedicalOOPTIER.individual.planIndividualOOP| currency}} Spent

$0.00 {{MedicalOOPTIER.individual.planIndividualOOP | currency}}

Medical Benefits Details

See Current Spending Balances

Health Financial Accounts

San Francisco Medical Option Account

Available {{HSAAccBal[0].accountTypeCode}} balance Total SFO Balance

Post Deductible Health Reimbursement Account

{{accDetails.accountTypeCode}} balance Total {{accDetails.accountTypeCode}} balance Total PDHRA balance

See All Health Account Balances

Prescription Drug Benefits Summary

Plan Summary

Coverage started {{rxStartDate | date:"MM/dd/yyyy"}}

Member Number

Members Covered

View and Print ID Card Prescription Drug Benefits Details

Mental Health Benefits Summary

Live and Work Well by Optum

Mental illness and substance use disorders are treatable conditions. Stop the stigma so those who suffer get the help they need. Learn more about how mental health and substance use disorders affect people just like you.

Other Mental Health Resources

Find more information about your plan's Mental Health coverage, locate a provider, and estimate costs.

Mental Health Benefits Details

Search for a Mental Health Provider

Dental Benefits Summary

Plan Summary

Coverage started {{dentalStartDate | date:"MM/dd/yyyy"}}

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Member Number

Members Covered

Coverage Limit: {{(dentalOOP.individual.planIndividualOOP) | currency}} per individual per year

Primary Care Dentist: None; Yes

Current Spending

U.S. Network

International

Your deductible Individual deductible

Network dental

{{memberInNetworkDeductibleDental.individual.ytdAmount | currency}} of {{memberInNetworkDeductibleDental.individual.deductibleAmount | currency}} Spent

$0.00 {{memberInNetworkDeductibleDental.individual.deductibleAmount | currency}}
Annual Maximum Annual Maximum Benefit

Network dental

{{(dentalOOP.individual.planIndividualOOP - dentalOOP.individual.planIndividualOOPRemaining) | currency}} of {{dentalOOP.individual.planIndividualOOP| currency}} Spent

$0.00 {{dentalOOP.individual.planIndividualOOP | currency}}
Family deductible

Network dental

{{memberInNetworkDeductibleDental.family.ytdAmount | currency}} of {{memberInNetworkDeductibleDental.family.deductibleAmount | currency}} Spent

$0.00 {{memberInNetworkDeductibleDental.family.deductibleAmount | currency}}
Family out-of-pocket limit

Network dental

{{dentalOOP.family.planFamilyOOP - dentalOOP.family.planFamilyOOPRemaining | currency}} of {{dentalOOP.family.planFamilyOOP | currency}} Spent

$0.00 {{dentalOOP.family.planFamilyOOP | currency}}

Dental Benefits Details U.S. Dental Cost Calculator

Find a Dentist Dental Cost Calculator

How your plan works

UHC Dental offers pre-negotiated rates with in-network dentists, so your out-of-pocket costs will be lower. Make sure your current or potential dentist is in-network. If a dentist is not contracted with UHC, they're considered out-of-network and can charge you full price.

Add Your Dentist to the Network Add Your Dentist to the Network

View Pre-Treatment Estimates View Pre-Treatment Estimates

Vision Benefits Summary

Plan Summary

Plan 1 Summary

Member Number

Members Covered

Vision Benefits Details

Plan 2 Summary

Member Number

Members Covered

Vision Benefits Details

Watch your personalized benefits overview video again.

Plan programs for you

Health Management

We can support you and your covered dependents with personalized health management for complex and high risk conditions by linking you with one of our clinicians. Reach out to us to learn more and talk to our team today.

Contact Us
International Employee Assistance Program (EAP)

Your international Employee Assistance Program provides support for everyday challenges and more serious problems. We offer assistance and support for a variety of concerns including depression, anxiety, stress, substance abuse, culture shock, financial and legal issues and more. Contact us to get connected with a specialist who can help.

Contact Us
My Wellbeing

Access our innovative digital health and wellness tool where you can get a personalized health score and receive coaching for your health and wellbeing goals. If you've lost your access code, contact us and we are glad to assist you.

Learn More

Your Member Handbook

Coordination of Benefits

Tell us about your other health insurance coverage

Having other health insurance coverage does not change your coverage with us. If you have other health insurance coverage we will work with them to pay your claims quickly and accurately. This is called your coordination of benefits.

Review Coordination of Benefits

Documents & Notices

PERSONS COVERED

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Coverage and Benefits for