Members of the EPO only have coverage for care provided within the CDPHP network. This includes access to a national network of 825,000+ providers of care. This summary offers highlights but does not detail all benefits, limitations, or exclusions. We are creating a better kind of health plan experience for individuals and families. It links physician, hospital and health plan solutions together to offer a different level of care – one that takes you through the entire process from seeing your doctor to understanding your coverage. Find out more about us.
Group Dental Plan No. 301016: Personal & Dependent Dental Care | |||||||||||||||||||||||||||||||||||||||||
The benefits described below apply separately to you and each of your covered dependents for expenses incurred for necessary dental services.
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We will determine orthodontic expense benefits according to the terms of the group plan for orthodontic expenses incurred by a Member. DETERMINING BENEFITS. The benefits payable will be determined by totaling all of the Covered Expenses submitted. This amount is reduced by the Deductible, if any. The result is then multiplied by the Benefit Percentage shown in the Schedule of Benefits. Benefits are subject to the Maximum Amount shown in the Schedule of Benefits. DEDUCTIBLE. The Deductible is shown on the Schedule of Benefits and is a specified amount of Covered Expenses that must be incurred and paid by each Covered person prior to any benefits being paid. MAXIMUM AMOUNT. The Maximum Benefit During Lifetime shown in the Schedule of Benefits is the maximum amount that may be paid for the Covered Expenses incurred by a Member during his or her lifetime. COVERED EXPENSES. Covered Expenses refer to the usual and customary charges made by a provider for necessary orthodontic treatment rendered while the person is covered under this section. Expenses are limited to the Maximum Amount shown in the Schedule of Benefits and Limitations. Usual and Customary (“U&C”) describes those dental charges that we have determined to be the usual and customary charge for a given dental procedure within a particular ZIP code area. The U&C is based upon a combination of dental charge information taken from our own database as well as from data received from nationally recognized industry databases. From the array of charges ranked by amount, your Planholder (in most cases your employer) has selected a percentile that will be used to determine the maximum U&C for your plan. The U&C is reviewed and updated periodically. The U&C can differ from the actual fee charged by your provider and is not indicative of the appropriateness of the provider’s fee. Instead, the U&C is simply a plan provision used to determine the extent of benefit coverage purchased by your Planholder. ORTHODONTIC TREATMENT. Orthodontic Treatment refers to the movement of teeth by means of active appliances to correct the position of maloccluded or malpositioned teeth. TREATMENT PROGRAM. Treatment Program ('Program') means an interdependent series of orthodontic services prescribed by a provider to correct a specific dental condition. A Program will start when the active appliances are inserted. A Program will end when the services are done, or after eight calendar quarters starting with the day the appliances were inserted, whichever is earlier. EXPENSES INCURRED. Benefits will be payable when a Covered Expense is incurred: a. at the end of every quarter (three-month period) of a Program for a Member who pursues a Program, but not beyond the date the Program ends; or b. at the time the service is rendered for a Member who incurs Covered Expenses but does not pursue a Program. The Covered Expenses for a Program are based on the estimated cost of the Member's Program. They are prorated by quarter (three-month periods) over the estimated length of the Program, up to a maximum of eight quarters. The last quarterly payment for a Program may be changed if the estimated and actual cost of the Program differ. BENEFITS PAYABLE UPON TERMINATION. If coverage terminates during a Program quarter, the quarterly benefit payable for that quarter will be pro-rated by day for the period of time that coverage was in-force and fee was received. LIMITATIONS. Covered Expenses will not include and benefits will not be payable for expenses incurred:
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FirstHealth of the Carolinas Flexible Spending Account Claim Procedures | |
Eligible claims are paid in full when they are received, up to the maximum amount you have elected to deposit in your account for the calendar year. Remember, expenses reimbursed for health and dependent care can not be claimed on your tax return. |
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Retirement Benefits Summary | ||||||||
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The following is a summary of the voluntary Short Term Disability Plan offered to FirstHealth employees through pre-tax payroll deduction. Employees applying for coverage during the initial eligibility may apply for coverage without being subject to pre-existing conditions. Employees applying for coverage beyond their initial eligibility date must complete an Evidence of Insurability form in addition to their application. Definitions of Disability Exclusions
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Employees and dependents covered under FirstHealth's medical insurance with FirstCarolinaCare Insurance Company are eligible for discounts on prescriptions* filled at the FirstHealth Outpatient Pharmacy. The FirstHealth Outpatient Pharmacy also offers dozens of over-the-counter medications such as Tylenol, Motrin and Claritin for less than you will pay in most area drug stores and supermarkets! The Outpatient Pharmacy offers delivery services available at RMH & MMH as well as convenient payment options:
To transfer a prescription, complete the Rx transfer form.
* This includes new and refill prescriptions. | |||||||||||||
When finding a health plan you should consider your budget, but more importantly your health care needs. Your health care needs over the next year must be considered.
As a U of U Health Plans member, you can call our Access Assistance line to help find a provider, transition to an in-network provider or schedule an appointment.
Call 801-587-2851.
Convenient care from providers offered from your phone, tablet or computer. Common conditions treated through telehealth include: allergies, cough, cold, flu, eye infections and skin conditions, such as rash.
U OF U HEALTH VIRTUAL VISITS
Available 9 am- 9 pm, 7 days a week
Call 801-213-UNOW
If you would like general information about health resources related to your insurance, our nurses are here to help 24 hours a day, 7 days a week.
Call 801-505-3198
First Health Network Payer Id 95397
We're here for you.
At University of Utah Health Plans we see health care from a different perspective – providing access to care that meets you right where you are. We understand the decisions of how, when and where you receive care is unique. That’s why we’ve created a network of behavioral health resources to make sure you receive care when you need it most.
| Healthy Premier | Healthy Preferred |
|---|---|
| Summary of Benefits | Summary of Benefits |
| Plan Brochure | Plan Brochure |
| Search for a Provider | Search for a Provider |
| Silver Copay | Silver Copay (Off) | Silver Copay 73% CSR | Silver Copay 87% CSR | Silver Copay 94% CSR | |||||
| Healthy Premier | Healthy Preferred | Healthy Premier | Healthy Preferred | Healthy Premier | Healthy Preferred | Healthy Premier | Healthy Preferred | Healthy Premier | Healthy Preferred |
| SBC | SBC | SBC | SBC | SBC | SBC | SBC | SBC | SBC | SBC |
| OOC | OOC | OOC | OOC | OOC | OOC | OOC | OOC | OOC | OOC |
| Find a Provider | Find a Provider | Find a Provider | Find a Provider | Find a Provider | Find a Provider | Find a Provider | Find a Provider | Find a Provider | Find a Provider |
| Healthy Premier | Healthy Preferred |
|---|---|
| Summary of Benefits | Summary of Benefits |
| Plan Brochure | Plan Brochure |
| Search for a Provider | Search for a Provider |
| Healthy Premier | Healthy Preferred |
|---|---|
| Summary of Benefits | Summary of Benefits |
| Plan Brochure | Plan Brochure |
| Search for a Provider | Search for a Provider |
| Healthy Premier | Healthy Preferred |
|---|---|
| Summary of Benefits | Summary of Benefits |
| Plan Brochure | Plan Brochure |
| Search for a Provider | Search for a Provider |
| Healthy Premier | Healthy Preferred |
|---|---|
| Summary of Benefits | Summary of Benefits |
| Plan Brochure | Plan Brochure |
| Search for a Provider | Search for a Provider |
2020 Plan Categories and Benefits
Key Benefits:
- Primary Care Office Visits-
$25 copay/visit DW - Specialist Office Visits-
$40 copay/visit DW - Urgent Care-
$25 copay/visit DW
Prescription Drug Deductible:
$500/$1,000
Key Benefits:
- Primary Care Office Visits-
$30 copay/visit DW - Specialist Office Visits-
$70 copay/visit DW - Urgent Care-
$30 copay/visit DW
Prescription Drug Deductible:
$2,000/$4,000
Key Benefits:
- Primary Care Office Visits-
$30 copay/visit DW - Specialist Office Visits-
$75 copay/visit DW - Urgent Care-
$30 copay/visit DW
Prescription Drug Deductible:
Included with MD
Key Benefits:
- Primary Care Office Visits-
$45 copay/ first 3 visits then 40% AD - Specialist Office Visits-
40% coinsurance AD - Urgent Care-
$45 /copay first 3 visits then 40% coinsurance AD
Prescription Drug Deductible:
Included with MD
Key Benefits:
- Primary Care Office Visits-
0% coinsurance AD - Specialist Office Visits-
0% coinsurance AD - Urgent Care-
0% coinsurance AD
Prescription Drug Deductible:
Included with MD
Key Benefits:
- Primary Care Office Visits- $25 copay AD
- Specialist Office Visits- $40 copay AD
- Urgent Care- $25 copay AD
Prescription Drug Deductible:
Included with MD
Key Benefits:
- Primary Care Office Visits-
$45 copay/visit DW - Specialist Office Visits-
$75 copay AD - Urgent Care-
$45 copay/visit DW
Prescription Drug Deductible:
$1,650/$3,300
MD = Medical Deductible|AD = After Deductible|Co AD = Coinsurance After Deductible|DW = Deductible Waived2019 Plan Categories and Benefits
Short Summary
Gold level plan offers the lowest deductible and out of pocket expenses with first dollar copays for many benefits.
Key Benefits
- Primary Care Office Visits- $25 copay/visit ded waived
- Specialist Office Visits- $40 copay/visit ded waived
- Urgent Care- $65 copay/visit ded waived
Out-of-Pocket Maximum
$7,000/$14,000
Short Summary
Silver level plan offers a mid level deductible and out of pocket maximum with first dollar copays for many benefits.
Key Benefits
- Primary Care Office Visits- $30 copay/visit ded waived
- Specialist Office Visits- $70 copay/visit ded waived
- Urgent Care- $75 copay/visit ded waived
Out-of-Pocket Maximum
$7,350/$14,700
Short Summary
Silver level plan offers a mid level deductible and out of pocket maximum with first dollar copays for many benefits.
Key Benefits
- Primary Care Office Visits- $30 copay/visit ded waived
- Specialist Office Visits- $75 copay/visit ded waived
- Urgent Care- $75 copay/visit ded waived
Out-of-Pocket Maximum
$7,900/$15,800
Short Summary
Bronze level plan offers a high deductible and out of pocket maximum, but low premium. All benefits are subject to the deductible being met first other than preventive. This plan is a qualified high deductible health plan.
Key Benefits
- Primary Care Office Visits- 0% coinsurance after ded
- Specialist Office Visits- 0% coinsurance after ded
- Urgent Care- 0% coinsurance after ded
Out-of-Pocket Maximum
$6,750/$13,500
Short Summary
Bronze level plan offers a high deductible and out of pocket maximum, but low premium. Many benefits are subject to the deductible being met first. This plan does have 3 office visits before meeting the deductible.
Key Benefits
- Primary Care Office Visits- $45 copay/ first 3 visits then 50% after ded
- Specialist Office Visits- 50% coinsurance after ded
- Urgent Care- 50% coinsurance after ded
Out-of-Pocket Maximum
$7,350/$14,700
Short Summary
Bronze level plan offers a high deductible and out of pocket maximum, but low premium. All benefits are subject to the deductible being met first other than preventive. This plan is a qualified high deductible health plan.
Key Benefits
- Primary Care Office Visits- $45 copay
- Specialist Office Visits- $75 copay after ded
- Urgent Care- 50% coinsurance after ded
Out-of-Pocket Maximum
$7,900/$15,800
2018 Plan Categories and Benefits
Short Summary
Bronze level plan offers a high deductible and out of pocket maximum, but low premium. Many benefits are subject to the deductible being met first.
Key Benefits
- Primary Care Office Visits- 50% coinsurance after ded
- Specialist Office Visits- 50% coinsurance after ded
- Urgent Care- 50% coinsurance after ded
Out-of-Pocket Maximum
$7,350/$14,700
Short Summary
Bronze level plan offers a high deductible and out of pocket maximum, but low premium. All benefits are subject to the deductible being met first other than preventive. This plan is a qualified high deductible health plan.
Key Benefits
- Primary Care Office Visits- 0% coinsurance after ded
- Specialist Office Visits- 0% coinsurance after ded
- Urgent Care- 0% coinsurance after ded
Out-of-Pocket Maximum
$6,500/$13,100
Short Summary
Bronze level plan offers a high deductible and out of pocket maximum, but low premium. Many benefits are subject to the deductible being met first. This plan does have 3 office visits before meeting the deductible.
Key Benefits
- Primary Care Office Visits- $45 copay first three visits, then ded applies
- Specialist Office Visits- 60% coinsurance after ded
- Urgent Care- 60% coinsurance after ded
Deductible
$45 copay first three visits, then ded applies
Short Summary
ilver level plan offers a mid level deductible and out of pocket maximum with first dollar copays for many benefits.
Key Benefits
- Primary Care Office Visits- $30 copay/visit ded waived
- Specialist Office Visits- $75 copay/visit ded waived
- Urgent Care- $75 copay/visit ded waived
Out-of-Pocket Maximum
$7,150/$14,300
Short Summary
Gold level plan offers the lowest deductible and out of pocket expenses with first dollar copays for many benefits.
Key Benefits
- Primary Care Office Visits- $25 copay/visit
- Specialist Office Visits- $40 copay/visit
- Urgent Care- $65 copay/visit
Out-of-Pocket Maximum
$7,000/$14,000
Enroll for Standalone Dental Benefits
Notice – This Plan does not include pediatric dental services as required under the Federal Patient Protection and Affordable Care Act. Coverage for pediatric dental services is available for purchase on a standalone basis or through the Health Insurance Marketplace. Please contact the Health Insurance Marketplace to purchase the required pediatric dental services.
First Health Network Copay Plan
- Trips to the emergency room
- Treatment in the hospital for inpatient care
- Outpatient Care - care without being admitted to a hospital
- Care before and after your baby is born
- Mental health and substance use disorder services: behavioral health treatment, counseling, and psychotherapy
- Your prescription drugs
- Services and devices to help recover if you are injured, or have a disability or chronic condition: physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
- Your lab tests
- Preventative services: counseling, screening, vaccines, chronic disease - no charge
- Pediatric services
- Call a nurse at anytime if you have any health concerns or general information questions
- Instant care online available 7 days a week