Results for Medical

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Health Savings Account (HSA) option

The Health Savings Account option (HSA) option is designed to protect you and your family financially when you need care. The HSA option comes with an account funded by Rockwell Automation; the amount you receive is based on who you cover. You can contribute to your account, too, up to IRS limits. You can find the limits on the IRS website: irs.gov.

Here’s what you pay in the HSA option when you receive care.

 HSA In-NetworkHSA Out-of-Network
Deductible

You
$2,000

You + one
$3,000

You + family
$5,000

You
$4,000

You + one
$6,000

You + family
$10,000

Money from Rockwell Automation

You
$200
You + one
$400
You + family
$600

You
$200
You + one
$400
You + family
$600

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
$3,000

You + one
$4,500

You + family
$7,500

You
$6,200

You + one
$9,400

You + family
$15,600

Reasonable and Customary Charges: A charge is considered “reasonable and customary” (R&C) if it matches the general cost of that service within your geographic area. If your health care provider charges above the reasonable and customary charge, you may have to pay the difference between the R&C charge and how much your provider charges.

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.

Provider Network

Find the Tier 1 Provider you need by searching the Choice Plus network. Look for the Tier 1 icon next to a provider’s name.

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 HRA option.

Use Your Network’s Provider Search Tool

To look up providers, log in to www.myuhc.com.