Health, Dental, Vision Insurance 2026-27, Effective July 1, 2026.xlsx

	A	B	C	D	E	F	G	H	I	J	K
1	Health Insurance Rates with United Health Care
2	July 1, 2026
3	Web Site for physicians in network is: https://www.umr.com/tpa-ap-web/#				HSA PLANS - Health Saving Annuity
4		PLAN C			PLAN D			PLAN E
5		Employee	UCSD #6	UMR Premium	Employee	UCSD #6	UMR Premium	Employee	HSA	UCSD #6	UMR Premium
6	Single - 12 Month	$275.00	$873.00	$1148.00	$225.00	$893.79	$1,118.79	$0.00	$25.00	$852.73	$827.73
7	Employee/Spouse	$600.00	$2,007.62	$2,607.62	$525.00	$2,015.54	$2,540.54	$0.00	$50.00	$1,933.76	$1,883.76
8	Employee/Children	$500.00	$1,173.85	$1673.85	$400.00	$1,231.66	$1,631.66	$0.00	$0.00	$1,206.43	$1,206.43
9	Family	$675.00	$2,352.44	$3,027.44	$600.00	$2,349.53	$2,949.53	$0.00	$175.00	$2,356.31	$2,181.31
10	Dual: Employee/Spouse	$525.00	$2,082.62	$2607.62	$350.00	$2,190.54	$2,540.54	$0.00	$125.00	$2,008.76	$1,883.76
11	Dual: Family	$600.00	$2,427.44	$3,027.44	$400.00	$2,549.53	$2,949.53	$0.00	$250.00	$2,431.31	$2,181.31
12
13			In-Network	Out of-Network		In-Network	Out of-Network			In-Network	Out of-Network
14	Deductible:	Single	$2,500.00	$5,000.00	Single	$3,400.00	$5,800.00	Single		$5,000.00	$10,000.00
15	Deductible:	Family	$5,000.00	$10,000.00	Family	$6,800.00	$11,600.00	Family		$10,000.00	$20,000.00
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17	Co-Insurance		80.00%	50.00%	80.00%		50.00%	80.00%			50.00%
18						HSA Eligible				HSA Eligible
19	Dr. Office Co-Pay	Primary Care	$40.00	Ded/Co-Ins	Primary Care	Ded/Co-Ins		Primary Care		Ded/Co-Ins
20	Dr. Office Co-Pay	Specialist	$75.00	Ded/Co-Ins	Specialist	Ded/Co-Ins		Specialist		Ded/Co-Ins
21
22	Wellness		100.00%	Ded/Co-Ins		100.00%				100.00%
23
24	Prescription Card		Preferred	Non-Preferred	Preferred Generic	Ded/Co-Ins		Preferred Generic		Ded/Co-Ins
25		Generic	$15.00	$0.00	Generic	Ded/Co-Ins		Generic		Ded/Co-Ins
26		Brand Name	$45.00	$85.00	Preferred Brand	Ded/Co-Ins		Preferred Brand		Ded/Co-Ins
27					Non-Preferred Brand	Ded/Co-Ins		Non-Preferred Brand		Ded/Co-Ins
28		Specialty RX	$250.00		Specialty RX	Ded/Co-Ins		Specialty RX		Ded/Co-Ins
29		Mail Order	3 x Co-Pay for 3 mo. Supply		Mail Order	Ded/Co-Ins		Mail Order		Ded/Co-Ins
30
31	Hospital Co-pay (non-emergency)	In-Patient (per stay)	$0.00	$1,000.00	In-Patient (per stay)	Ded/Co-Ins	Ded/Co-Ins	In-Patient (per stay)		$0.00	$1,000.00
32	Hospital Co-pay (non-emergency)	Out-Patient (per Procedure)	$0.00	$500.00	Out-Patient (per Procedure)	Ded/Co-Ins	Ded/Co-Ins	Out-Patient (per Procedure)		$0.00	$500.00
33
34	Emergency Room Co-Pay		$250.00	Ded/Co-Ins		Ded/Co-Ins				Ded/Co-Ins
35	Urgent Care Co-Pay				Ded/Co-Ins			Ded/Co-Ins
36	Urgent Care Co-Pay		$75.00	Ded/Co-Ins	Ded/Co-Ins			Ded/Co-Ins
37
38
39	Out-Of-Pocket Maximum	Single	$6,500.00	$13,000.00	Single	$4,100.00	$8,200.00	Single		$5,500.00	$12,000.00
40	Out-Of-Pocket Maximum	Family	$13,000.00	$26,000.00	Family	$8,200.00	$16,400.00	Family		$12,000.00	$24,000.00
41										5/18/2026
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