Emergency Room Services
Emergency Room: Pays 100% of network rates after $250 co-pay (co-pay waived if admitted).
Urgent Care Clinic
At UHS: $35 co-pay for urgent care clinic visit; Plan pays 90% for ancillary services (e.g., labs, x-rays, or durable medical equipment).
Outside of UHS: Pays 100% after $50 co-pay for network provider. Plan pays 50%1 of non-network rates.
Ambulance
Ambulance - Ground & Air: Pays 90% of charges if patient receives emergency care or is hospitalized.
1Subject to the $450 deductible.