Your Medical Plans Compared
In-Network vs. Out-of-Network
Both the PPO and the High Deductible Health Plan (HDHP) use the same network of providers. Staying in-network for all services, providers, and facilities is essential to receiving the maximum benefit from your medical coverage.
- In-network: Lower out-of-pocket costs and higher coverage levels.
- Out-of-network: Coverage is based on the allowable amount for the same service from an in-network provider. You may be balance billed for any amount exceeding this allowable amount.
Preventive Care
Both plans cover preventive care at 100% from the first day of your plan — before satisfying your deductible. Examples of preventive care include:
- Well-child visits
- Annual checkups
- Age and gender-based screenings
- For more information, see https://www.uhc.com/health-and-wellness/preventive-care
Finding a Provider
To locate a UnitedHealthcare provider, visit UHC.com.
Surcharges
Biometric Screening Surcharge
A preventive screening must be completed each year, either with your own provider (annual physical) or by attending one of MCESC’s on-site screening clinics, held in October of each year.
Failure to complete the screening will result in a $50 monthly surcharge.
Biometric Screening Form: Biometric Health Screening Form 25-26
Screening forms must be submitted to the Treasurer’s Office by December 1st prior to the start of the plan year.
Spousal Surcharge
If you carry your spouse on Montgomery County ESC’s plan and they have access to other group health insurance through their employer, they are required to join their employer’s plan and terminate coverage through MCESC. Failure to do so will result in a $100 monthly surcharge.
Dependent Coverage
Dependent children are eligible for coverage under Montgomery County ESC’s dental plan until the end of the month in which they turn 26 years old.
Where to Seek Care
Knowing where to go for medical needs can be challenging. Use the following guidelines:
- Emergency: Call 911 or go to the emergency room.
- Non-emergency:
- Call your doctor
- Visit a retail health clinic
- Go to an urgent care facility
- Use Virtual Visits online
Differences Between PPO and HDHP
How Your Benefits Pay on PPO
The PPO plan offers first-dollar coverage, meaning coverage begins on the first day of the plan. You will have copays for various services and prescriptions before meeting your deductible. These copays and coinsurance payments apply directly to your out-of-pocket maximum. Once your medical and prescription out-of-pocket maximums are met, coverage is paid in full.
How Your Benefits Pay on HDHP
The HDHP does not offer copays on the first day of the plan. Instead, you pay the negotiated rate your carrier has with your providers for services and prescriptions. You continue paying this negotiated rate until you meet your deductible and out-of-pocket maximum. After that, all services and prescriptions are covered in full.