Results for Medical
| HSA In-Network | HSA Out-of-Network | |
|---|---|---|
| Deductible | You You + family | You You + family |
| Money from Rockwell Automation | You You + family | You |
| The Plan Pays: Preventive Care | 100% no deductible | 60% after deductible |
| The Plan Pays: Doctor Office Visits | 80% after deductible 85% (after deductible) for Tier 1 providers and Freestanding Facilities | 60% after deductible |
| The Plan Pays: Urgent Care Clinic | 80% after deductible 85% (after deductible) for Tier 1 providers and Freestanding Facilities | 60% after deductible |
| The Plan Pays: Emergency Room | 80% after deductible 85% (after deductible) for Tier 1 providers and Freestanding Facilities | 60% after deductible |
| The Plan Pays: Hospital Stay | 80% after deductible 85% (after deductible) for Tier 1 providers and Freestanding Facilities | 60% after deductible |
| Out-of-Pocket Maximum | You You + family | You You + family |
Reasonable and Customary Charges: The plan pays up to reasonable and customary (R&C) charges for out of network care. You are responsible for any cost difference if your expenses are more than the R&C limits.
Using Tier 1 Providers and Freestanding Facilities
Using Tier 1 providers and Freestanding Facilities is optional. The Tier 1 designation helps you find providers known for offering the best combination of quality and cost. (The availability of Tier 1 providers varies by location.) Freestanding Facilities are outpatient, diagnostic or ambulatory centers, or independent laboratories in the Choice Plus network that perform services and submit claims as freestanding entities and not as hospitals.
Out-of-Pocket Maximum
Once your expenses reach a certain amount, Rockwell Automation will pay 100% of all remaining eligible costs for the rest of the year. You may pay additional amounts out of pocket for prescription drugs in the Broad Access Plan and High-Performance Plan options.
Use Your Network’s Provider Search Tool
To look up providers, log in to myuhc.com.
