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S&P Option
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S&P Option
UnitedHealthcare
1-866-328-6575
www.myuhc.com
Claims Office
P.O. Box 740800
Atlanta, GA 30374-0800
Medco Health Solutions, Inc.
1-800-807-5607
www.medco.com
Claims Office
P.O. Box 14711
Lexington, KY 40512
ValueOptions
1-800-544-8320
www.valueoptions.com
Claims Office
P.O. Box 1347
Latham, NY 12110
This indemnity option is available for eligible Standard & Poor's employees represented by the Newspaper Guild of New York who are employed by Standard and Poor's Financial Services LLC and are currently enrolled in this option. (The option is not open for new enrollments.)
This summary describes benefits in effect as of January 1, 2010 under the S&P Medical Option. The summary covers the major provisions of this medical choice. It does not provide complete details. You can find more information by calling the phone number listed in the address box.
Certain benefits and services in this Option are not provided by UnitedHealthcare. For additional details on those services, call the administrator at the phone number shown here.
    Prescription drug benefits are provided through Medco Health, at 1-800-807-5607.
    Mental health and substance abuse benefits are provided through ValueOptions, at 1-800-544-8320.
How the Plan Works
 
Salary Range
Individual/Family
Annual Deductible
<$675 per week
$250 / $500
$676-$1,299 per week
$300 / $600
$1,300 or more per week
$350 / $700
 
Salary Range
Individual/Family
Out-of-Pocket Maximum
<$675 per week
$3,000 / $6,000
$676-$1,299 per week
$3,500 / $7,000
$1,300 or more per week
$4,000 / $8,000
Advance Approval
(Pre-Certification)
Pre-Certification is required for all hospital admissions. Call the administrator to arrange for pre-certification.
Caps
Annual
None
Lifetime
None
What the Option Pays
Services
Outpatient Care
Office visits
80% after deductible
Preventive Care: benefits are based on recommendations from the United States Preventive Services Task Force, although other preventive care services recommended by your physician, based on your family or medical history, may be covered as well.
80% after deductible
Laboratory Tests and X-rays
80% after deductible
Maternity Care
Prenatal doctor office visits: 80% after deductible
Inpatient delivery and associated hospital care: 80% after deductible
Outpatient Surgery
80% after deductible
Emergency Care (approval required)
Ambulance
80% after deductible
Hospital Emergency Room
80% after deductible
Urgent Care
80% after deductible
Inpatient Care (approval required)
Room and board (semi-private); intensive care; covered inpatient services
100% after deductible
Pre-admission testing
100% with no deductible
Inpatient surgery
80% after deductible
Other Services
Home healthcare, extended care facility, or hospice care through discharge planning
100% after deductible; if not through discharge planning, 80% after deductible
Private duty nursing care
80% after deductible
Physical therapy, radiation therapy, speech therapy, occupational therapy, and chemotherapy
80% after deductible
Treatment recommended by Patient Management Services
100% after deductible
Chiropractic Care and Acupuncture
80% after deductible (visit limits may apply)
Durable Medical Equipment
80% after deductible; prior notification required on expenses over $1,000; $2,500 annual maximum
Infertility Testing
100% coinsurance with no deductible
In Vitro Fertilization
Not Covered
Prescription Drugs
Retail Pharmacy for up to one month's supply
At Medco Health Network Pharmacies:
$10 copayment for generic drugs
$15 copayment for formulary brand-name drugs
$25 copayment for non-formulary brand-name drugs
At Non-network Pharmacies:
Option pays cost submitted less applicable copayment amount after separate $50 annual deductible.
Mail Order for up to a 90-day supply
100% after $20 copayment for generic drugs
100% after $30 copayment for formulary brand-name drugs
100% after $50 copayment for non-formulary brand-name drugs
Mental Health/Substance Abuse provided by ValueOptions
Service
In-network
Out-of-Network
EAP (Employee Assistance Program)
5 visits paid at 100% per problem per year with an Employee Assistance Professional. Counseling; beyond 5 visits with an EAP counselor is not a covered EAP benefit.
No out of Network EAP benefits.
Mental Health
Inpatient: Pre-Certification Required: 90% of ValueOptions (VO) fee schedule.
Outpatient: $20 copayment. Outpatient Treatment Report due after the 8th visit if therapy is to continue beyond 10 visits.
Inpatient: Pre-Certification Required: 70% of VO fee schedule.
Outpatient: 70% of VO fee schedule. Outpatient Treatment Report is due after the 26th visit if therapy is to continue beyond 26 visits.
Substance Abuse
Inpatient: Pre-Certification Required: 90% of VO fee.
Outpatient: $20 copayment. Outpatient Treatment Report is due after the 8th visit if therapy is to continue beyond 10 visits.
Inpatient: Pre-Certification Required: 70% of VO fee schedule
Outpatient: 70% of VO fee schedule. Outpatient Treatment Report is due after the 26th visit if therapy is to continue beyond 26 visits