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Plan B Nevada United Healthcare Medical Options
Medical Procedure
United Healthcare

Choice EPO Plan
Annual Deductible
None
Annual Co-Payment Limit on Allowable Charges
None
Overall Lifetime Maximum
$5,000,000 per person
Hospital -
Inpatient
 You pay $400 per admission
Outpatient
 You pay $100 per procedure
Extended Care Facility (Skilled Nursing) You pay $400 per admission; 30 days maximum
Physician Services - Routine Physical
Adults
 You pay $20 per visit
Children
 You pay $20 per visit
Office Visits
 You pay $20 per visit
Diagnostic X-Ray and Lab You pay $20 per visit for routine procedure
CAT Scans & MRI's You pay $20 per visit
Durable Medical Equipment Plan pays 100%, limited to $2,500 per calendar year
Casts, Splints, Trusses, Braces & Crutches Plan pays 100%
Home Nursing Care Plan pays 100%, limit of 100 visits per calendar year
Chiropractic Care
You pay $20 per visit, limit of 24 visits per calendar year
Physical Therapy You pay $20 per visit, limited 20 visits per calendar year
Speech Therapy You pay $20 per visit, limited 20 visits per calendar year
Maternity Care Same as any other illness
Psychiatric Care -
Inpatient
 You pay $400 per admission; prior authorization is required from the MH/SA designee
Outpatient
 You pay $20 per visit; 40 visit maximum; prior authorization is required from the MH/SA designee
Substance Abuse -
You may choose between coverage under the Beat It! Program or your , or a combination of both, as follows:
Inpatient
 You pay $400 per admission; prior authorization is required from the MH/SA designee
Outpatient
 You pay $20 per visit; prior authorization is required from the MH/SA designee
Prescription Drugs Must be obtained at a participating HMO pharmacy
Short-term (outpatient)
 You pay $10 for formulary generic, $25 for formulary brand name and $50 for non-formulary prescription
Maintenance (30 day supply or more thru the Mail Order)
 Mail order - you pay 21/2 co-pays per prescription for a 90-day supply
Hearing Aids Plan pays 100%, limited to $2,500 per calendar year
Emergency Room Care You pay $35 per visit

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The information contained on this website is intended to provide only highlights of the benefits available under the Sheet Metal Workers Trust Funds' plans and plans of benefits. Complete details about the plans are contained in the governing plan documents. In the event of any inconsistency between the information on this website and the official plan documents, the terms of the plan documents, as interpreted by the plan's Board of Trustees in its sole and absolute discretion, will control. The respective Boards of Trustees of the plans reserve the right to amend, modify, or terminate all or part of the plans at any time, subject to applicable law.