2026 ORI Results Benefits Enrollment Guide

Choice Plus ELTU /P30 Health Insurance Benefits TUhneitfeodlHloewailnthgccahraerftobretlhoewJahniguhalriygh1ts some of the details included in the medical plan offered through st , 202 6 – December 31 st , 202 6 plan year.

In-Network ( AI nndni vu iadl uDa el /dFuacmt i ibl yl e) Coinsurance (carrier/member) O u(tI-nodf -ipv oi dcukaelt/MF aamx iiml yu) m Physician Visit Copay (Primary Care Provider Specialist) Urgent Care Emergency Room Copay (waived if admitted) Inpatient Hospitalization Outpatient Surgery Out of Network* Annual Deductible (Individual/Family) Coinsurance (carrier/member) O u(tI-nodf -ipv oi dcukaelt/MF aamx iiml yu) m Pharmacy Prescription Drugs Tier 1/ Tier 2/ Tier 3/ Tier 4

$2,700/$5,400

100% / 0%

$7,500 / $15,000

$40 (designated network) / $75 (Network) $60 (designated network) / $120 (Network)

$60 Copay

Deductible, then $500

Deductible, then $500 per admission

Deductible, then $60

$5,000 / $10,000

80% / 20%

$10,000 - $20,000

$20/ $50/ 20% w $150/ 30% w $300

Provider Directory Yproouvcidanerlso.gin to your UHC account or use the link below to search UHC's directory of In-Network · https://connect.werally.com/plans/uhc · Select Medical Directory -> Employer and Individual Plans -> · Under " What plan are you looking for? " select " Choice Plus "

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