SAWS: Open Enrollment - Medican Plans
Aquifer Beaker

Edwards Aquifer

Aquifer Level 677.4'
10/12/18 - Official

The Edwards aquifer and its catchment area in the San Antonio region is about 8,000 square miles and includes all or part of 13 counties in south-central Texas.

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Year-Round Watering Hours

Watering with an irrigation system or sprinkler is allowed any day of the week before 11 a.m. or after 7 p.m.

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Aquifer Level 677.4 | Year-Round Watering Hours

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Benefits

2019 Health Plan Options

SAWS will continue to offer the choice of two self-funded medical plans in 2019. Self-funded plans use your premiums and SAWS contributions to pay for the increasing cost of health care (claims). UnitedHealthcare will continue as our third party administrator and Express Scripts, Inc. will continue as our pharmacy benefit manager.

Stay In-Network

There are several things you can do to help keep costs down. The most important of these is choosing a UnitedHealthcare network provider. A network is a group of doctors, hospitals and other providers and facilities that have a contract with UnitedHealthcare. As part of their contract they have agreed to follow UHC's guidelines and provide health care services at lower prices. It pays to stay in the network — using network providers can reduce outof- pocket costs, in addition to the overall health plan costs. All of these savings contribute to keeping premium increases to a minimum. Out-of-network providers do not have a contract with UnitedHealthcare and can bill you above the reasonable and customary rates. Depending on the plan, insurance may cover only a fraction of the cost or none at all.

UnitedHealth Premium Program (Tier 1 Premium Providers)

To help you make more informed choices about your health care, UHC created the UnitedHealth Premium Program. The Premium Program recognizes doctors who meet standards for quality and cost efficiency. Look for the two hearts and find out more on page 10 of the Benefit Guide.

  • Tier 1 Premium Provider – The physician meets the criteria for providing quality and cost-efficient care.
  • In 2019, office visits with Tier 1 Premium Providers will have lower copays than visits with Non-Tier 1 Premium Providers.

PPO Economy: The in-network benefit plan design has a $1,500 deductible and out-of-pocket maximum of $4,500 per individual.

2019 PPO Economy Medical Premiums
Hired Before Jan. 1, 2011 Hired After Jan. 1, 2011
Tier Selection SAWS Employee SAWS Employee
Employee Only $429 $35 $429 $23
Employee + Spouse $863 $110 $723 $226
Employee + Child(ren) $754 $80 $644 $172
Employee + Family $1,276 $160 $1,016 $390

EPO Plus: This in-network benefit plan has a deductible of $500 per individual and out-of-pocket maximum of $4,100 per individual.

2019 EPO Plus Medical Premiums
Hired Before Jan. 1, 2011 Hired After Jan. 1, 2011
Tier Selection SAWS Employee SAWS Employee
Employee Only $429 $35 $429 $35
Employee + Spouse $863 $110 $723 $250
Employee + Child(ren) $754 $80 $644 $190
Employee + Family $1,276 $160 $1,016 $420

PPO Networks: Both plans will offer the same PPO network through UnitedHealthcare. Go online to list of participating providers, and select the "UnitedHealthcare Choice Plus" network, or call 1-888-651-7277 to get personal assistance from a UnitedHealthcare representative. If you register on myuhc.com, your will access your personal account, along with direct access to the provider network.

Summary of Coverage
PPO Economy EPO PLus
Plan Benefit In-Network Out of Network In-Network Out of Network
Deductible $1,500 individual $2,500 individual $500 individual Not Covered
$4,500 family $7,500 family $1,500 family Not Covered
Coinsurance 80% after deductible 60% after deductible 80% after deductible Not Covered
Out of Pocket* $4,500 individual $7,500 individual $4,100 individual Not Covered
$11,250 family $18,750 family $8,200 family Not Covered
PCP Office Visit   60% after deductible   Not Covered
Tier 1 Premium Provider $40 $25
Non-Tier 1 $50 $40
Specialist    
Tier 1 $60 $40
Non-Tier 1 $70 $60
Preventive Care 100% 60% after deductible 100% Not Covered
Virtual Visits $30 N/A $15 N/A
Urgent Care $60 60% after deductible $60 Not Covered
Emergency Room $200 per visit co-pay, plus deductible and coinsurance $200 per visit co-pay, plus deductible and coinsurance
EMERGENCY ONLY
Hospital Inpatient 80% after deductible 60% after deductible 80% after deductible Not Covered
*Note: Out-of-pocket maximums for both the PPO Economy and EPO Plus include medical and prescription copay, deductible, and coinsurance amounts.

For all of the coverage details, see the official plan documents below.


In this section:

Medical Downloads

2019 SAWS Medicare Part D Creditable Coverage Notice

SAWS has determined that the prescription drug coverage offered by SAWS through Express Scripts, Inc. is, on the average for all plan participants, expected to pay out as much as, or more than, what the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage under Medicare.

2019 Summary of Benefits and Coverage - EPO Plan

2019 Summary of Benefits and Coverage - PPO Plan

ACA Uniform Glossary of Medical Terms

Tier 1 Premium Provider

UHC - Advocate4Me

Advocate4Me is your one-stop shop for help with questions about your health plan benefits.

UHC - Healthcare Cost Estimator

Quickly and easily estimate your health care costs on myuhc.com or the UnitedHealthcare Health4Me app.

UHC - Medical Provider Search

How to find a UHC medical provider online.

UHC - Transition of Care

Learn more about transition of care.

UHC - Virtual Visits

A virtual visit lets you see and talk to a doctor online, any time.

UHC - Welcome Handbook

Learn more about your UHC health benefits.

UHC - Where Should I Go for Care

This resource can help you understand where to go when you need care.



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