UnitedHealthcare of Illinois, Inc. - UHC Silver-E Standard (No Referrals)
Sample Care Costs
Having a baby
$6360
Having diabetes
$600
Treatment of a simple fracture
$2500
Primary Care Visit
$40 Copay
100% Coinsurance
Specialist Visit
$80 Copay
100% Coinsurance
Other Practitioner Office Visit (Nurse, Physician Assistant)
40% Coinsurance after deductible
100% Coinsurance
Preventive Care/Screening/Immunization
0% Coinsurance
100% Coinsurance
Laboratory Outpatient and Professional Services
40% Coinsurance after deductible
100% Coinsurance
X-rays and Diagnostic Imaging
40% Coinsurance after deductible
100% Coinsurance
Imaging (CT/PET scans, MRIs)
40% Coinsurance after deductible
100% Coinsurance
Generic Drugs
$20 Copay
100% Coinsurance
Preferred Brand Drugs
$40 Copay
100% Coinsurance
Non-Preferred Brand Drugs
$80 Copay after deductible
100% Coinsurance
Specialty drugs
$350 Copay after deductible
100% Coinsurance
Outpatient Facility Fee
40% Coinsurance after deductible
100% Coinsurance
Outpatient Surgery Physician/Surgical Services
40% Coinsurance after deductible
100% Coinsurance
Emergency Room Services
40% Coinsurance after deductible
40% Coinsurance after deductible
Emergency Transportation/Ambulance
40% Coinsurance after deductible
40% Coinsurance after deductible
Urgent Care
$60 Copay
100% Coinsurance
Inpatient Hospital Services
40% Coinsurance after deductible
100% Coinsurance
Inpatient Physician and Surgical Services
40% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Outpatient Services
$40 Copay
100% Coinsurance
Mental/Behavioral Health Inpatient Services
40% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Outpatient Services
$40 Copay
100% Coinsurance
Substance Abuse Disorder Inpatient Services
40% Coinsurance after deductible
100% Coinsurance
Prenatal and postnatal care
No Charge
100% Coinsurance
Delivery and All Inpatient Services for Maternity Care
40% Coinsurance after deductible
100% Coinsurance
Home Healthcare Services
40% Coinsurance after deductible
100% Coinsurance
Outpatient Rehabilitation Services
$40 Copay
100% Coinsurance
Habilitation Services
$40 Copay
100% Coinsurance
Skilled Nursing Facility
40% Coinsurance after deductible
100% Coinsurance
Durable Medical Equipment
40% Coinsurance after deductible
100% Coinsurance
Hospice Services
40% Coinsurance after deductible
100% Coinsurance
Chiropractic Care
40% Coinsurance after deductible
100% Coinsurance
Acupuncture
Not Covered
Not Covered
Rehabilitative Speech Therapy
$40 Copay
100% Coinsurance
Rehabilitative Occupational and Rehabilitative Physical Therapy
$40 Copay
100% Coinsurance
Well Baby Visits and Care
No Charge
100% Coinsurance
Allergy Testing
40% Coinsurance after deductible
100% Coinsurance
Diabetes Education
40% Coinsurance after deductible
100% Coinsurance
Nutritional Counseling
40% Coinsurance after deductible
100% Coinsurance
Eye Exam for Children
No Charge
100% Coinsurance
Eye Glasses for Children
40% Coinsurance after deductible
100% Coinsurance
Accidental Dental
40% Coinsurance after deductible
100% Coinsurance
Basic Dental Care (Adult)
Not Covered
Not Covered
Basic Dental Care (Child)
40% Coinsurance after deductible
100% Coinsurance
Dental Check Up (Child)
No Charge
100% Coinsurance
Major Dental Care (Adult)
Not Covered
Not Covered
Major Dental Care (Child)
40% Coinsurance after deductible
100% Coinsurance
Orthodontia (Adult)
Not Covered
Not Covered
Orthodontia (Child)
50% Coinsurance after deductible
100% Coinsurance
Routine Dental Services (Adult)
Not Covered
Not Covered