How the Maroon Plan Works

How It Works

The Maroon Plan is a Preferred Provider Option (PPO). Each time you need care; you can visit any eligible licensed provider you choose. Generally, you pay the Deductible then the plan covers a percentage of the cost of your Medically Necessary Care. Once you reach your out-of-pocket maximum, the plan pays 100% of covered benefits for the rest of the year.

If you visit a network provider, your care is considered “in-network,” and the plan covers a higher percentage of your costs. Your doctor submits your claims directly to the Maroon Plan claims administrator.

If you do not visit a network provider, your care is considered “out-of-network,” and the plan pays less. You file your own claims. Plus, if you are admitted to an out-of-network Hospital, you must meet an additional $200 Deductible before the plan pays benefits. Amounts above the eligible or allowable charges are not covered and do not apply toward your Deductible or your out-of-pocket maximum.

Claims must be filed within 24 months of the date of service. Any claims received after 24 months will not be considered under the plan.

The table shows the Deductibles, Coinsurance amounts, out-of-pocket maximums and Lifetime Maximum benefits.

For a current list, visit our web site at http://hr.uchicago.edu or contact the Benefits Office.

	In-Network		Out-of-Network
Choice of Providers	Network		Any provider
Deductibles	Individual: $250 Individual plus one: up to $500 Family: up to $600		Individual: $250 Individual plus one: up to $500 Family: up to $600 Each Hospital admission: $200
Coinsurance
Most Services	Plan pays 80%, you pay 20%		Plan pays 65% of eligible or allowable charges, you pay the rest
Prescription Drugs	Retail: Copayment: $8 generic, $20 preferred brand-name, $35 non-preferred brand-name (30 day supply) Mail Service: $16 generic, $40 preferred brand-name, $70 non-preferred brand-name (90 day supply)
Eligible or Allowable Charges	No fee schedule		Your provider may charge more than the eligible or allowable charges. You are responsible for these added charges. These charges do not count toward your Deductible or Out-of-Pocket Limit.
Lifetime Maximum	$2,000,000 per person; $50,000 for infertility treatment
Claims	Provider files them for you.		You file your own claims.
Out-of-Pocket Limit	Out-of-pocket Maximum Is Based on Your Salary
	Your Salary	Individual		Family
	Under $39,000	$1,000		$2,000
	$39,000 - $65,999	$2,000		$4,000
	$66,000 - $89,999	$3,000		$6,000
	$90,000 or more	$4,000		$8,000

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.