United Airlines - Medicare Post 65 Current
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Post 65 Retirees
United Airlines – Medicare Post 65 Current
Group Number(s): 747
Effective Dates: January 1, 2018 – December 31, 2018
General Information
Website
Member Services Number
1-800-476-2167 or 711 (TTY)
Member Services Weekday Hours
8:00 a.m. to 8:00 p.m.
Member Services Weekend Hours
8:00 a.m. to 8:00 p.m.
Annual Deductible: Individual/Family
None
Annual Out-of-Pocket Max: Individual/Family
$2,500 individual / $0 Family
Office Visits (Outpatient)
Primary Care
$20 copay
Specialty Care
$30 copay
Preventive Care
100% covered
Scheduled Prenatal Visits and 1
Postpartum Visit
$20 copay
st
Well-Baby Care (23 months or younger)
100% covered
Vision Exam - Optometrist
$20 copay/ $100 hardware benefit every 2 years
Vision Exam - Ophthalmologist
$30 copay
Physical, Occupational, Speech Therapy
$20 copay
Outpatient/Ambulatory Surgery
$125 copay
Lab and X-Ray
Laboratory
100% covered
X-Ray
100% covered for diagnostic x-rays and $30 copay for therapeutic x-rays
MRI/CT/PET/Nuclear Medicine
$100 copay per procedure
Emergency Care
Ambulance (Ground or Air)
$50 copay per incident
Emergency Room
$50 copay
After Hours Care
$30 copay
Hospital Care (Inpatient)
Inpatient
$250 copay
Delivery and Inpatient Baby Care
$250 copay
This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, cost sharing, out-of-pocket maximums, exclusions, or
limitations, nor does it list all benefits and cost sharing. For a complete explanation, please refer to the applicable EOC, or to the Disclosure Form for
California, or to the Member Handbook for Hawaii.
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