Choose the RIGHT Medical Plan Option for YOU!





Greenville University offers four medical plan options.


All four medical plan options:


•Are administered by United Healthcare

•Keep you and your family healthy by covering preventive care – such as annual physicals, screenings and immunizations – at 100%

•Protect you if something unexpected happens by limiting the amount you pay out-of-pocket during a single calendar year

•Include prescription drug coverage through OptumRx

•Have the same network of hospitals and physicians

•Offer programs to help address your and your family’s needs


Benefits
Diamond Plan
Emerald Plan
Ruby Plan
Sapphire Plan
Preventive Services
You pay 0%
You pay 0%
You pay 0%
You pay 0%
Annual Deductible
(Single / Family)
The amount you pay each year before the Plan pays benefits
$750 / 2,250
$1,500 / 4,500
$2, 000 / 6,000
$3,000 / 6,000
Office Visits
(PCP / Specialist)
You pay $25 copay for primary
$50 copay for specialist
You pay $25 copay for primary
$50 copay for specialist
You pay $30 copay for primary
25% after deductible for specialist
You pay 20% after deductible
Virtual Visit
You pay $25 copay
You pay $25 copay
You pay $30 copay
You pay $40 visit charge
Coinsurance
The amount you pay for most covered services after you meet the deductible
20% after deductible
20% after deductible
25% after deductible
20% after deductible
Emergency Room
You pay 20% after deductible and $200 copay (copay waived if admitted)
You pay 20% after deductible and $200 copay (copay waived if admitted)
You pay 25% after deductible and $200 copay (copay waived if admitted)
20% after deductible
Out-of-Pocket Maximum
(Single / Family)*
The most you will pay is $2,500 / 7,500
The most you will pay is $3,500 / 10,500
The most you will pay is $4,000 / 12,000
The most you will pay is $5,000 / 10,000
Prescription Drugs
RETAIL (30 day supply)
 Tier 1: Generic
You must first meet your deductible, then you pay your coinsurance
$10
$10
You must first meet your deductible, then you pay your coinsurance
 Tier 2:  Preferred
$30
$35 after $100 Combined Deductible
 Tier 3:  Non-Preferred
$50
$70 after $100 Combined Deductible
MAIL (90 day supply)


 Tier 1: Generic
$25
$25
 Tier 2: Preferred
$75
$87.50 after $100 Combined Deductible
 Tier 3:  Non-Preferred
$125
$175 after $100 Combined Deductible



Coverage Category
Greenville University Contribution
Diamond Plan Contribution
Emerald Plan Contribution
Ruby Plan Contribution
Sapphire Plan Contribution
Employee Only
$336
$300
$242
$194
$96
Employee & Spouse
$720
$616
$500
$413
$219
Employee & Child(ren)
$683
$547
$408
$349
$192
Family
$965
$906
$682
$603
$374