Specialist Copay



Specialist

United Healthcare Specialist Copay

Basic Option
Preventive Care Nothing for covered preventive screenings, immunizations and services
Physician Care

$30 for primary care1
$40 for specialists1

Virtual doctor visits by Teladoc®

$0 for first 2 visits
$15 all additional visits

Urgent Care Center $35 copay
Prescription Drugs Preferred Retail Pharmacy:
Tier 1 (Generics): $10 copay
Tier 2 (Preferred brand): $55 copay2
Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum)2
Tier 4 (Preferred specialty): $65 copay2
Tier 5 (Non-preferred specialty): $90 copay2
Mail Service Pharmacy:
Available to members with Medicare Part B primary only. Visit the Medicare page for more information.
Tier 1 (Generics): $20
Tier 2 (Preferred brand): $100 copay
Tier 3 (Non-preferred brand): $125 copay
Specialty Pharmacy:
Tier 4 (Preferred specialty): $85 copay2
Tier 5 (Non-preferred specialty): $110 copay2
Maternity Care $175 inpatient
$0 outpatient
Hospital Care

Inpatient (Precertification is required): $175 per day; up to $875 per admission

Outpatient: $100 per day per facility1

Surgery

$150 in an office setting1

$200 in a non-office setting1

ER (accidental injury)

Download asetek driver. $175 per day per facility

ER (medical emergency)

$175 per day per facility

Lab work (such as blood tests) $0 copay1
Diagnostic services
(such as sleep studies, CT scans)

Download avanquest software modems driver. Up to $100 in an office1

Up to $150 in a hospital1

Chiropractic Care $30 per treatment; up to 20 visits per year
Dental Care $30 copay per evaluation; up to 2 per year
Rewards Program

Earn $50 for completing the Blue Health Assessment3

Earn up to $120 for completing three eligible Online Health Coach goals3

Specialist Copay Aetna

Up to $100 in an office 1. Up to $150 in a hospital 1. Chiropractic Care. $30 per treatment; up to 20 visits per year. $30 copay per evaluation; up to 2 per year. Rewards Program. Earn $50 for completing the Blue Health Assessment 3. Earn up to $120. The lowest copays will be for office visits to a primary care physician, physician’s assistant or nurse practitioner. If you need to visit urgent care or see a specialist like a cardiologist or an immunologist, your copay will be a little higher. The most expensive copays will come when you visit the emergency room.