Medical Insurance

Health insurance is designed to help prepare for unexpected moments in life, like accidents or illnesses. Without health insurance, you could be faced with paying medical bills yourself, and health care can be expensive. Health insurance can keep you on track with preventive care — which may be covered by insurance at 100%, in many cases. Regular doctor visits may help you stay healthier over time. Taking care of your health needs in a timely way is important to your overall health. That’s why getting health insurance may be one of the most important choices you make.

Benefits Summary

Traditional Buy-Up Traditional Basic Nexus ACO OA Limited Network Plan (PCP selection required)
Medical Benefits In-Network In-Network In-Network
Deductible (Individual / Family) $2,500 / $5,000 $5,500 / $11,100 $3,000 / $6,000
Out-of-Pocket Maximum (Individual / Family) $3,750 / $7,500 $6,000 / $12,000 $6,500 / $13,000
Coinsurance (UHC / Member) 80% / 20% 80% / 20% Tier 1 Network: 20%
Network: 50%
Prescription Drugs $15 / $45 / $70 / $120 $10 / $60 / $100 /$200 $10 / $35 / $70 / N/A
Mail Order Drugs (90 Day Supply) $37.50 / $112.50 / $175 / $300 $25 / $150 / $250 / $500 $25 / $87.50 / $175 / N/A
$0 Global Rx – Mail Order International Pharmacy Program for Brand Medications $0 Copay available for over 250 Brand Medications
Physician Office Visits
Primary Care Physician (including E-Visits) $25 $40 Tier 1 Network: $30
Network: Deductible + 50%
Virtual Visits $0 $0 $0
Specialist (Tier 1 Provider) $50 ($25) $80 ($40) Tier 1 Network: $60
Network: Deductible + 50%
Behavioral Health Visits $25 $50 Tier 1 Network: $30
Network: Deductible + 50%
Virtual Behavioral Health Visits $0 $0 $0
EAP (Employee Assistance Program) 3 Face-to-Face Visits included through EAP Core with UHC
Referral Needed for a Specialist? No No No (PCP selection required)
Preventive Care
Routine Adult Physical Exams Covered 100% Covered 100% Covered 100%
Well Woman Exams
Routine Mammograms and Colonoscopy
Well Child Exam & Immunizations
Diagnostic / Laboratory
Independent Clinical Lab (Blood Work) $0 $0 Deductible / Coinsurance
Independent Diagnostic Testing Facility (X-rays) $0 $0
Advanced Imaging (MRI, PET, CT Scan, Nuclear Medicine) Deductible / Coinsurance Deductible / Coinsurance
Hospitalization / Outpatient Services
Inpatient Hospitalization (Facility) Deductible / Coinsurance Deductible / Coinsurance Tier 1 Network: Deductible + 20%
Network: $500 + Deductible + 50%
Outpatient Surgical Care (Hospital Facility) Deductible / Coinsurance Deductible / Coinsurance Tier 1 Network: Deductible + 20%
Network: $250 + Deductible + 50%
Emergency Room $500 $500 $500
Urgent Care $50 $50 Deductible / Coinsurance

The information above summarizes the Celebration Restaurant Group Medical Insurance plans and is for illustrative purposes only.  In the event of a discrepancy between this illustration and the official plan documents, the official documents will govern.

Last Updated: October 25, 2024

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