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Supplemental Medical, Dental, and Life Insurance Retiree Definition for Health Insurance Continuation

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HumanResourcesOffice of

Out‐of‐Pocket Cost Comparisons

Pharmacy

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HumanResourcesOffice of

Out‐of‐Pocket Cost Comparisons

Plan Provision  HealthPartners, Medica, UCare       Plan 1 HealthPartners, Medica, UCare  Plan 2 Outpatient  Surgery 100% $75 copay Inpatient Hospital 100% $200 copay  Physician Office  Visit $15 copay HP & Medica – $20 primary  copay / $30 specialist copay  UCare – $20 copay 

Pharmacy

Out‐of‐Pocket Cost Comparisons

Plan Provision  HealthPartners, Medica, UCare         Plan 1 HealthPartners, Medica, UCare         Plan 2

Non Formulary $30 copay $70 – HP and Medica copays $60 – UCare copay Specialty Medication $30 copay 75% coverage  

Medicare Coverage 

Gap (Donut Hole)  Normal copay structure

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HumanResourcesOffice of

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