Your Medical Plan Options

Medical coverage offers health care protection for you and your family. You may visit any medical provider you choose, but In-Network providers offer the highest level of benefits and lower out-of-pocket costs.

Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the full cost of Out-Of-Network services (HMO plans) or the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits (PPO and CDHP plans). Additionally, several Out-Of-Network services require pre-authorization.

 

2022 Medical Plans

SignatureValue HMO
(CA only)

Administered by: UHC

Receive coverage for In-Network care only, coordinated by your Primary Care Physician (PCP). This plan is only available in California.

SignatureValue Harmony HMO
(Southern CA only)

Administered by: UHC

Receive the same benefits and coverage as the Signature Value HMO plan, but with lower employee contributions. This plan has a narrower network of participating providers and is only available in Southern California.

Select Plus HSA Compatible CDHP

Administered by: UHC

This plan has a higher deductible and the opportunity to enroll in a tax-free Health Savings Account (HSA).

Select Plus PPO

Administered by: UHC

You’ll save money when you choose network providers, though you can choose any provider you’d like.

 

Key Plan Features and Differences

Before you pick your medical plan for 2022, here’s a quick look at how the plans line up side by side.

SignatureValue HMO (CA only) SignatureValue Harmony HMO (Southern CA only) Select Plus HSA Compatible CDHP Select Plus PPO
In-Network In-Network In-Network Out-Of-Network In-Network Out-Of-Network
Calendar Year Deductible
Individual $0 $0 $1,500 $3,000 $500 $1,000
Family* $0 $0 $2,800 $6,550 $1,500 $3,000
Calendar Year Out-of-Pocket Maximum (Includes Deductible)
Individual $2,000 $2,000 $6,000 $6,550 $3,000 $6,000
Family $4,000 $4,000 $6,000 $6,550 $6,000 $12,000
You pay You pay You pay You pay
Coinsurance
Preventive Care No Charge No Charge No Charge Not Covered No Charge Not Covered
Primary Care Physician $20 copay $20 copay 20%* 40%* $20 40%*
Specialist $40 copay $40 copay 20%* 40%* $40 40%*
Urgent Care $20 (in area) $20 (in area) 20%* 40%* $20 copay per visit 40%*
Emergency Room $150 copay (waived if admitted) $150 copay (waived if admitted) 20%* 20%* $200 copay (waived if admitted) $200 copay (waived if admitted)
Pharmacy**
Retail RX (up to 31-day supply)
Tier 1 $10 copay $10 copay $10* Copay plus the difference between non-network and network cost* $10 Copay plus the difference between non-network and network cost*
Tier 2 $30 copay $30 copay $30* Copay plus the difference between non-network and network cost* $30 Copay plus the difference between non-network and network cost*
Tier 3 $50 copay $50 copay $50* Copay plus the difference between non-network and network cost* $50 Copay plus the difference between non-network and network cost*
Mail Order RX (up to 90-day supply)
Tier 1 $20 copay $20 copay $20* Copay plus the difference between non-network and network cost* $20 Copay plus the difference between non-network and network cost*
Tier 2 $60 copay $60 copay $60* Copay plus the difference between non-network and network cost* $60 Copay plus the difference between non-network and network cost*
Tier 3 $100 copay $100 copay $100* Copay plus the difference between non-network and network cost* $100 Copay plus the difference between non-network and network cost*

*After deductible

**Specialty covered at applicable Tier

 

Signature Value HMO Plan

(Available to eligible employees in California only)

HMO plans are designed for you to visit in-network providers. You will need to choose a Primary Care Physician (PCP) and coordinate care with any specialists through this PCP. Note that services received outside the network are not covered, except for emergency services.

Plan Features
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  • If you are enrolled in the HMO plan, you and your enrolled dependents must each use a Primary Care Physician (PCP) from the HMO network to coordinate your care. UHC will pre-assign a PCP for you and each enrolled dependent.
  • You pay a copay when you visit your PCP or a specialist referred by your PCP.
  • You must receive a referral from your PCP to see a specialist. You don’t need referrals for certain specialists, such as an OB/GYN.
  • If you use doctors, hospitals, labs, pharmacies, or other health care facilities outside the HMO network or a network specialist without a referral, you’re responsible for paying the full cost (except in an emergency).
  • There are no claim forms to file

How to Find a UHC SignatureValue HMO Provider

  • To find an in-network provider in any of the UHC medical plans, go to www.myuhc.com, scroll down and click on “Find a provider”.
  • Select either the Medical or Mental Health Directory and then click on “All UnitedHealthcare Plans”.
  • Scroll down the page and select the “SignatureValue Plans.”
  • Enter the requested information to complete your search.
  • You can also visit www.myuhc.com for many of your other needs, like downloading a temporary ID card, viewing your claims history, and more. See the UHC Portal section for more about what www.myuhc.com has to offer.
  • For more information about the UHC HMO, call UHC at (800) 624-8822 or go to www.myuhc.com.
 

Signature Value Harmony HMO Plan

(Available to eligible employees in Southern California only)

The SignatureValue Harmony HMO Plan has the same benefits and coverage as our Signature Value HMO plan, but with lower bi-weekly employee contributions. The plan has a narrower network of participating providers. The SignatureValue Harmony HMO network includes the physician groups shown below. To find a SignatureValue Harmony HMO provider, go to “Find A Doctor” at www.myuhc.com and search under SignatureValue Plans > SignatureValue Harmony.

 

Select Plus HSA Compatible CDHP

A Consumer Directed Health Plan (CDHP) is made up of two unique components:

Medical Plan with provider network and benefits + Health Savings Account (HSA) = Consumer Directed Health Plan (CDHP)

The CDHP works much like a PPO plan in that you have access to a broad network of providers and you may choose any provider when you need care. However, in exchange for a lower per-paycheck cost, you must satisfy a higher deductible that applies to almost all health care expenses, including those for prescription drugs. Remember, that higher deductible is offset by lower premiums and the ability to use a Health Savings Account (HSA). Once your deductible has been met, you will continue to pay a coinsurance and/or medical and prescription copays until your out-of-pocket maximum is met, then the plan pays 100%.

A CDHP could be a good fit for you if you prefer:

  • For less to be taken from each paycheck for health benefits; and
  • For Belkin to contribute more to your health benefits coverage through a Health Savings Account (HSA).

For more information about the UHC CDHP, call UHC at (866) 314-0335 or go to www.myuhc.com.

How the HSA Works

If you select the CDHP health plan, you may elect to contribute to your HSA on a pre-tax basis for your current or future health care expenses. Belkin will also contribute to your account each year. You decide when and how to use these funds; you can choose to save them to pay future health care expenses – even into retirement. There isn’t a “use it or lose it” rule, as there is with a Flexible Spending Accounts (FSAs). Any amount remaining in your account at the end of the year will carry over into following years until you need it. And if you leave Belkin for any reason (including retirement), you can take your funds with you.

Having an HSA offers a triple tax advantage:

  • Any contributions you make to your account will reduce your taxable income.
  • Earnings on your account will build up tax-free.
  • Distributions for qualified health expenses from the account are not subject to taxation.
 

Select Plus PPO

This plan lets you visit the doctor of your choice. Although you may see a provider who does not participate in the plan’s network, in most cases your benefits are greater (and your out-of-pocket expenses smaller) when you see a network provider. You are not required to select a Primary Care Physician under this option. Once you reach the deductible, you will pay coinsurance until the out-of-pocket maximum is met, then the plan will pay 100% in-network.

With in-network providers:

  • For most covered services, you pay 20% coinsurance after you meet the deductible.
  • The deductible and coinsurance do not apply to physician office visits, preventive care, or prescription drugs.
  • Claims are filed for you.

With out-of-network providers:

  • You must pay the full cost of your medical care at the time of service. You will then file a claim with UHC to be reimbursed for the covered amount of your bill.
  • For most covered services, you pay 40% of the allowed amount after the deductible, plus any amount over the allowed amount.
  • For emergency medical care, reimbursement may be based on the reasonable and customary value in your area for that service. You may be responsible for charges over the reasonable and customary value.
  • For out-of-network pharmacies, you are responsible for any expense not covered under this plan and any amount in excess of the prescription drug maximum allowed amount.
  • You file claims yourself.

For more information about the UHC PPO Plan, call UHC at (866) 633-2446 or go to www.myuhc.com.

 

How to Find a UHC Select Plus Provider

To find an in-network provider in any of the UHC Select Plus medical plans, go to www.myuhc.com, scroll down and click on “Find a provider.” Select either the Medical or Mental Health Directory and then click on “All UnitedHealthcare Plans.” Scroll down the page and select the “Select Plus” plans. Enter the requested information to complete your search. You can also visit www.myuhc.com for many of your other needs, like downloading a temporary ID card, viewing your claims history, and more. See the UHC Portal section for more about what www.myuhc.com has to offer.

 

Getting the Most from Your Health Care

Because health care has evolved over time, it’s important to be an active participant in your own health care management. That means being proactive, cost-conscious and selective about your health care choices, which can help save money, time and frustration.

Here are some important tips:

  • Take advantage of preventive care, which is covered at 100% (in-network) regardless of the medical plan you choose.
  • Know where to go. Only visit an emergency room when it’s a true emergency. Urgent care centers are less expensive and faster than the emergency room. Virtual visits are an option, too.
  • Go to an in-network doctor, hospital, or another provider if possible. In-network providers are typically less expensive than their out-of-network equivalent.
  • Talk to your doctor about prescribing a generic prescription if it’s available. Generics have the same active ingredients and are just as safe and effective as a brand name.
  • Shop your prescriptions to find the most reasonable costs. You can look online for some viable options.
  • Take advantage of all of the tools and resources that are available to you.
Virtual Visit Doctor’s office Urgent care clinic Emergency room
Use it for
A non-emergency medical or mental health issue that can be diagnosed by phone or online A condition that doesn’t need immediate attention and can wait until the next day A condition that needs immediate care but is not life- or limb-threatening A life-threatening or potentially crippling condition that needs immediate attention
Examples
  • Colds and sinus problems, flu/cough
  • Ear infections, pink eye, migraines
  • Depression, anxiety
  • Sore throat, fever
  • Routine exam, screening
  • Checkup, vaccine, prescription refill
  • Broken bone, severe sprain or strain
  • Cut requiring stitches
  • Anxiety attack
  • Sudden weakness, dizziness, or loss of consciousness
  • Uncontrollable bleeding
  • Chest pain, difficulty breathing
Cost
You pay: $ You pay: $ You pay: $$ You pay: $$$
Find it
Visit www.myuhc.com to register Call your regular doctor or search for an in-network provider on your medical plan carrier’s website Search for urgent care clinics near you at www.myuhc.com Call 911 or search online for the nearest hospital