The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
DEDUCTIBLES, COINSURANCE AND
MAXIMUMS
Note: If you are enrolled in Kaiser Colorado, UnitedHealthcare or Medica Plan options, this
information does not apply to you. Please see the separate Kaiser, UnitedHealthcare or Medica
Plan options materials.
Deductibles
A deductible is the per plan year amount you must pay toward eligible expenses before you and
the health care option begin to share covered expenses. The deductible is applied to the out-ofpocket
maximum. The medical and pharmacy deductibles under the health care options work
differently as explained below. The deductibles stated are for in-network/participating providers
only. Information for out-of-network/non-participating deductibles can be found in the “Health
Care Option Summary” section in this SPD.
Early Retiree Medical Option
The Early Retiree Medical option has a combined medical/pharmacy deductible and the
deductible is non-embedded, which means:
• If you elect the Individual coverage level, you only need to meet the per person
deductible of $2,000.
• If you elect the Family coverage level, you will need to meet the Family deductible of
$3,000. The Family deductible can be met by one covered member or any combination of
covered members. The per person deductible does not apply.
Example 1. Sally is covered under the Early Retiree Medical option at the Individual level.
She must have eligible expenses of $2,000 before she and the Program begin to share
covered expenses.
Example 2. Joe is covered under the Early Retiree Medical option at the Family level. He
and his spouse must have eligible expenses of $3,000 before he and the Program begin to
share covered expenses.
Example 3. Tim is covered under the Early Retiree Medical option at the Family level, with
his spouse and two children enrolled. He and his family must have eligible expenses of
$3,000 before he and the Program begin to share covered expenses.
For the Early Retiree Medical option the following charges do not apply to your combined
medical/pharmacy deductible:
• Your monthly health care premiums.
• Any costs not covered by your option.
• Any amounts that exceed the Program's allowed amounts when non-participating providers
are used for medical services. In certain locations, this also applies when out-of-network
providers are used. Refer to the “Which Network Providers to Use” section in this SPD for
more information.
• Any penalty for failing to provide required preadmission notification.
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