Medical
Our medical and vision plans are bundled together. UHA Health is our medical coverage provider and offers the UHA 3000 Plan. This plan offers full coverage for in-network preventive care. It also offers the flexibility to see any provider, but you will pay less out of pocket when you use UHA Health network providers.
Medical Plans Overview & Contributions
Great News! There are no deductible, out-of-pocket maximum, or copay changes to our benefit plans for the 2024-2025 plan year.
| Medical Plan Highlights | In-Network | Out-of-Network | |||
| Calendar Year Deductible (Indiv. / Family) | $200 / $600 | $200 / $600 | |||
| Coinsurance: Paid by Carrier | 80% | 80% | |||
| Primary Care Physician (PCP) / Specialist Copay | $12 Copay | $12 Copay plus difference between actual charge and allowed charge | |||
| Adult Preventive Care Office Visit | No Copay | No Copay | |||
| Calendar Year Out-of-Pocket Max (Including Deductible) | $2,200 / $6,600 | $2,200 / $6,600 | |||
| Impatient Hospital | Ded + 20% | Ded + 20% | |||
| Outpatient Surgery | Ded + 20% | Ded + 20% | |||
| Emergency Room | Ded + 20% | Ded + 20% | |||
| Maximum Lifetime | Unlimited | ||||
| Rx Deductible | None | ||||
| Rx Out-of-Pocket Max | $5,400 per person / $8,300 family | ||||
| Rx Retail (30 Day Supply) | $10 / $20 / $40 | $30 Coinsurance | |||
| Rx Mail Order (90 Day Supply) Generic/Brand/Non Formulary | $15 / $30 /$60 | Not Covered | |||
| Out-of-Network UCR Level | N/A | Fee Schedule | |||
| Dependent Age Limit | To Age 26 | ||||
| NOTE: This chart does not describe all covered services. Please review the plan summaries for complete coverage information. | |||||
Visit Vision Benefits for vision plan details.
Employee Medical & Vision Contributions (24 times per plan year)
Please review contributions carefully. Contribution changes will take effect on October 1, 2024.
| EMPLOYEE | EMPLOYER | |
| Employee | $0.00 | $193.41 |
| Employee + 1 | $104.46 | $282.35 |
| Family | $208.92 | $371.31 |
Save Money on Health Care Expenses
No one wants to spend any more than necessary on health care. Here are some ways to be a smart health care consumer and save money.
Stay in your network. Seeing a doctor in your network will almost always cost you less. Use in-network convenience care clinics. For minor illnesses and injuries, convenience care clinics located in pharmacies, grocery stores, and other retail stores provide quick, affordable care.
Use the emergency room only for true emergencies. For non-life-threatening emergencies, visit an urgent care center instead of the emergency room. You’ll get treated more quickly and pay less.
Ask for generic drugs. You can save up to 80% compared to brand-name drugs.
Limit hospital visits. Many procedures like MRIs and colonoscopies cost less when done at independent outpatient centers instead of a hospital. Outpatient surgery is also less expensive than hospitalization.
Get regular preventive care. Getting checkups, immunizations and other health screenings can help detect health problems early when they are less expensive to treat.
Talking with Your Doctor About Health Care Costs
If you need help navigating your benefits, contact one of the below resources:
- UHA Member Services: Call the number on the back of your ID card 808-532-4000, or 800-458-4600 from the neighbor islands.
- Health Advocate at 866-799-2731: Available 24 hours a day, 7 days a week.
- Benefits Help Desk: 877-373-6535 or benefitshelpdesk@epicbrokers.com
- ZARA Benefits Team: benefits@us.inditex.com
Remember: Certain services may require precertification. Typically, in-network providers will obtain the required precertification and approval. For out-of-network services, it is the member’s responsibility to handle the precertification process.
You may contact member services first to determine if precertification is necessary and if the provider is out-of-network.
Don’t be afraid to ask about the costs and benefits of different treatment options and make choices that are right for you.
When your doctor recommends tests – To make sure you don’t spend time and money on unnecessary tests, ask your doctor why the test is needed and where you can have it done at the lowest cost.
If your doctor recommends surgery or hospitalization – Ask if there are other treatment options that don’t require surgery or if the procedure can be done on an outpatient basis. If you do need surgery, make sure the hospital, the surgeon and any other specialists your doctor refers you to are in the network.
When your doctor writes you a prescription – Ask if there are less expensive generic drugs or even over-the-counter medications that might work for you. Ask if you can improve your condition without drugs by changing your eating habits or getting more exercise.
Savings & Finance 
Voluntary Benefits