2018 Rates - UCare · 2017. 12. 7. · ucare choices® fairview ucare choicessm age core* bronze...
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2018 Rates Choose the plan that best meets your needs from UCare Choices and Fairview UCare Choices
Transcript of 2018 Rates - UCare · 2017. 12. 7. · ucare choices® fairview ucare choicessm age core* bronze...
2018 Rates
Choose the plan that best meets your needsfrom UCare Choices and Fairview UCare Choices
UCare Choices • Fairview UCare Choices612-676-6606 • 1-855-307-6975 toll freeTTY: 612-676-6810 • 1-800-688-2534 toll freeHours: 8 a.m. to 5 p.m., Monday – Friday
U5437 (10/17)
UC FVC_092917 IA (09292017)
UCare Choices is available in the following Metro counties: Anoka, Benton, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne, Stearns, Washington and Wright.
UCare Choices is available in the following Northeast counties: Aitkin, Carlton, Cass, Chisago, Cook, Crow Wing, Isanti, Itasca, Kanabec, Koochiching, Lake, Mille Lacs, Morrison, Pine and Saint Louis.
Fairview UCare Choices is available in the following Metro counties: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne and Washington.
Fairview UCare Choices is available in the following Northeast counties: Chisago and Isanti.
Service Areas
UCARE CHOICES® FAIRVIEW UCARE CHOICESSM
AGE CORE* BRONZE SILVER GOLD BRONZE SILVER
0-20 $136.96 $190.84 $232.33 $287.93 $180.34 $219.56 21-24 $153.89 $214.43 $261.05 $323.52 $202.63 $246.69
25 $154.50 $215.28 $262.09 $324.81 $203.44 $247.68 26 $157.58 $219.57 $267.32 $331.28 $207.50 $252.61 27 $161.27 $224.72 $273.58 $339.05 $212.36 $258.53 28 $167.28 $233.08 $283.76 $351.67 $220.26 $268.15 29 $172.20 $239.94 $292.12 $362.02 $226.75 $276.05 30 $174.66 $243.37 $296.29 $367.19 $229.99 $280.00 31 $178.36 $248.52 $302.56 $374.96 $234.85 $285.92 32 $182.05 $253.67 $308.82 $382.72 $239.71 $291.84 33 $184.36 $256.88 $312.74 $387.58 $242.75 $295.54 34 $186.82 $260.31 $316.92 $392.75 $246.00 $299.48 35 $188.05 $262.03 $319.00 $395.34 $247.62 $301.46 36 $189.28 $263.75 $321.09 $397.93 $249.24 $303.43 37 $190.51 $265.46 $323.18 $400.52 $250.86 $305.40 38 $191.74 $267.18 $325.27 $403.11 $252.48 $307.38 39 $194.21 $270.61 $329.45 $408.28 $255.72 $311.33 40 $196.67 $274.04 $333.62 $413.46 $258.96 $315.27 41 $200.36 $279.18 $339.89 $421.22 $263.83 $321.19 42 $203.90 $284.12 $345.89 $428.66 $268.49 $326.87 43 $208.82 $290.98 $354.25 $439.02 $274.97 $334.76 44 $214.98 $299.55 $364.69 $451.96 $283.08 $344.63 45 $222.21 $309.63 $376.96 $467.16 $292.60 $356.22 46 $230.83 $321.64 $391.58 $485.28 $303.95 $370.04 47 $240.53 $335.15 $408.02 $505.66 $316.72 $385.58 48 $251.61 $350.59 $426.82 $528.95 $331.30 $403.34 49 $262.53 $365.81 $445.35 $551.92 $345.69 $420.86 50 $274.84 $382.97 $466.24 $577.81 $361.90 $440.59 51 $287.00 $399.91 $486.86 $603.36 $377.91 $460.08 52 $300.39 $418.56 $509.57 $631.51 $395.54 $481.54 53 $313.93 $437.43 $532.54 $659.98 $413.37 $503.25 54 $328.55 $457.80 $557.34 $690.71 $432.62 $526.69 55 $343.17 $478.17 $582.14 $721.45 $451.87 $550.12 56 $359.02 $500.26 $609.03 $754.77 $472.74 $575.53 57 $375.02 $522.56 $636.18 $788.42 $493.82 $601.19 58 $392.10 $546.36 $665.16 $824.33 $516.31 $628.57 59 $400.57 $558.15 $679.51 $842.12 $527.45 $642.14 60 $417.65 $581.95 $708.49 $878.03 $549.95 $669.52 61 $432.42 $602.54 $733.55 $909.09 $569.40 $693.20 62 $442.12 $616.05 $750.00 $929.47 $582.16 $708.75 63 $454.27 $632.99 $770.62 $955.03 $598.17 $728.23
64+ $461.66 $643.28 $783.15 $970.56 $607.89 $740.07
Non-Smoker Premium Rates – METRO
*Core plans are for those who are under 30 or obtain hardship exemptions.
UCARE CHOICES® FAIRVIEW UCARE CHOICESSM
AGE CORE* BRONZE SILVER GOLD BRONZE SILVER
0-20 $149.24 $207.96 $253.17 $313.76 $196.52 $239.25 21-24 $167.69 $233.66 $284.46 $352.54 $220.80 $268.82
25 $168.36 $234.59 $285.60 $353.94 $221.69 $269.90 26 $171.71 $239.26 $291.30 $360.99 $226.11 $275.27 27 $175.73 $244.88 $298.12 $369.46 $231.41 $281.72 28 $182.28 $253.99 $309.21 $383.21 $240.02 $292.20 29 $187.65 $261.46 $318.32 $394.49 $247.09 $300.81 30 $190.33 $265.20 $322.87 $400.12 $250.62 $305.11 31 $194.36 $270.81 $329.70 $408.59 $255.91 $311.57 32 $198.38 $276.42 $336.52 $417.05 $261.21 $318.02 33 $200.90 $279.92 $340.79 $422.34 $264.52 $322.05 34 $203.58 $283.66 $345.35 $427.98 $268.06 $326.34 35 $204.92 $285.53 $347.61 $430.80 $269.83 $328.50 36 $206.26 $287.41 $349.89 $433.62 $271.60 $330.65 37 $207.60 $289.27 $352.17 $436.44 $273.36 $332.79 38 $208.94 $291.14 $354.44 $439.27 $275.13 $334.95 39 $211.63 $294.88 $359.00 $444.90 $278.66 $339.25 40 $214.31 $298.62 $363.54 $450.54 $282.19 $343.55 41 $218.33 $304.22 $370.38 $459.00 $287.49 $350.00 42 $222.19 $309.60 $376.91 $467.11 $292.57 $356.19 43 $227.55 $317.08 $386.02 $478.40 $299.63 $364.79 44 $234.26 $326.42 $397.40 $492.50 $308.47 $375.54 45 $242.14 $337.40 $410.77 $509.06 $318.84 $388.17 46 $251.53 $350.49 $426.70 $528.81 $331.21 $403.23 47 $262.10 $365.21 $444.62 $551.01 $345.13 $420.16 48 $274.18 $382.04 $465.10 $576.39 $361.02 $439.52 49 $286.08 $398.62 $485.29 $601.42 $376.70 $458.61 50 $299.49 $417.32 $508.06 $629.64 $394.36 $480.11 51 $312.74 $435.78 $530.53 $657.48 $411.81 $501.35 52 $327.33 $456.10 $555.27 $688.15 $431.02 $524.73 53 $342.09 $476.66 $580.31 $719.18 $450.45 $548.39 54 $358.02 $498.86 $607.33 $752.66 $471.42 $573.93 55 $373.95 $521.06 $634.35 $786.16 $492.40 $599.46 56 $391.22 $545.13 $663.66 $822.47 $515.14 $627.15 57 $408.66 $569.43 $693.24 $859.14 $538.11 $655.11 58 $427.27 $595.36 $724.82 $898.27 $562.62 $684.95 59 $436.50 $608.21 $740.46 $917.65 $574.76 $699.74 60 $455.11 $634.15 $772.04 $956.78 $599.28 $729.57 61 $471.21 $656.58 $799.34 $990.63 $620.47 $755.38 62 $481.78 $671.31 $817.27 $1,012.84 $634.38 $772.32 63 $495.01 $689.76 $839.74 $1,040.69 $651.82 $793.55
64+ $503.07 $700.98 $853.39 $1,057.61 $662.42 $806.46
Smoker Premium Rates – METRO
*Core plans are for those who are under 30 or obtain hardship exemptions.
UCARE CHOICES® FAIRVIEW UCARE CHOICESSM
AGE CORE* BRONZE SILVER GOLD BRONZE SILVER
0-20 $156.47 $218.03 $265.43 $328.95 $206.03 $250.83 21-24 $175.81 $244.97 $298.24 $369.61 $231.50 $281.83
25 $176.51 $245.95 $299.43 $371.08 $232.42 $282.96 26 $180.03 $250.85 $305.40 $378.48 $237.05 $288.60 27 $184.25 $256.73 $312.55 $387.35 $242.61 $295.36 28 $191.10 $266.29 $324.18 $401.76 $251.64 $306.35 29 $196.73 $274.12 $333.73 $413.59 $259.05 $315.37 30 $199.54 $278.04 $338.50 $419.50 $262.75 $319.88 31 $203.76 $283.92 $345.66 $428.37 $268.31 $326.65 32 $207.98 $289.80 $352.82 $437.24 $273.86 $333.41 33 $210.62 $293.48 $357.29 $442.79 $277.34 $337.64 34 $213.43 $297.40 $362.06 $448.70 $281.04 $342.15 35 $214.84 $299.36 $364.45 $451.66 $282.89 $344.40 36 $216.24 $301.32 $366.83 $454.62 $284.74 $346.66 37 $217.65 $303.28 $369.22 $457.57 $286.60 $348.91 38 $219.06 $305.24 $371.60 $460.53 $288.45 $351.17 39 $221.87 $309.16 $376.38 $466.44 $292.15 $355.67 40 $224.68 $313.08 $381.15 $472.36 $295.86 $360.18 41 $228.90 $318.95 $388.31 $481.23 $301.41 $366.95 42 $232.95 $324.59 $395.17 $489.73 $306.74 $373.43 43 $238.57 $332.43 $404.71 $501.56 $314.14 $382.45 44 $245.61 $342.23 $416.64 $516.34 $323.40 $393.72 45 $253.87 $353.74 $430.66 $533.71 $334.28 $406.97 46 $263.71 $367.46 $447.36 $554.41 $347.25 $422.75 47 $274.79 $382.89 $466.15 $577.69 $361.83 $440.51 48 $287.45 $400.53 $487.62 $604.31 $378.50 $460.80 49 $299.93 $417.92 $508.79 $630.55 $394.94 $480.81 50 $313.99 $437.52 $532.65 $660.12 $413.46 $503.36 51 $327.88 $456.87 $556.21 $689.32 $431.74 $525.62 52 $343.18 $478.19 $582.16 $721.47 $451.89 $550.14 53 $358.65 $499.74 $608.41 $754.00 $472.26 $574.94 54 $375.35 $523.02 $636.74 $789.11 $494.25 $601.72 55 $392.05 $546.29 $665.07 $824.22 $516.24 $628.49 56 $410.16 $571.52 $695.79 $862.29 $540.09 $657.52 57 $428.45 $597.00 $726.81 $900.73 $564.16 $686.83 58 $447.96 $624.19 $759.91 $941.76 $589.86 $718.11 59 $457.63 $637.66 $776.31 $962.09 $602.59 $733.61 60 $477.15 $664.86 $809.42 $1,003.11 $628.29 $764.90 61 $494.02 $688.37 $838.05 $1,038.59 $650.51 $791.95 62 $505.10 $703.81 $856.84 $1,061.88 $665.10 $809.71 63 $518.99 $723.16 $880.40 $1,091.08 $683.38 $831.97
64+ $527.43 $734.91 $894.71 $1,108.82 $694.50 $845.49
Non-Smoker Premium Rates – NORTHEAST
*Core plans are for those who are under 30 or obtain hardship exemptions.
UCARE CHOICES® FAIRVIEW UCARE CHOICESSM
AGE CORE* BRONZE SILVER GOLD BRONZE SILVER
0-20 $170.50 $237.59 $289.24 $358.45 $224.51 $273.33 21-24 $191.58 $266.94 $324.99 $402.76 $252.26 $307.11
25 $192.34 $268.01 $326.29 $404.36 $253.27 $308.34 26 $196.18 $273.35 $332.79 $412.43 $258.31 $314.49 27 $200.78 $279.76 $340.58 $422.09 $264.37 $321.85 28 $208.24 $290.17 $353.26 $437.80 $274.21 $333.83 29 $214.38 $298.71 $363.66 $450.69 $282.29 $343.66 30 $217.44 $302.98 $368.86 $457.13 $286.32 $348.57 31 $222.04 $309.39 $376.66 $466.79 $292.38 $355.95 32 $226.63 $315.79 $384.47 $476.46 $298.42 $363.31 33 $229.51 $319.80 $389.34 $482.51 $302.22 $367.92 34 $232.57 $324.07 $394.53 $488.95 $306.25 $372.84 35 $234.11 $326.21 $397.14 $492.17 $308.26 $375.29 36 $235.64 $328.35 $399.73 $495.40 $310.28 $377.75 37 $237.17 $330.48 $402.34 $498.61 $312.31 $380.20 38 $238.71 $332.62 $404.93 $501.84 $314.32 $382.67 39 $241.77 $336.89 $410.14 $508.28 $318.35 $387.57 40 $244.83 $341.16 $415.34 $514.73 $322.40 $392.49 41 $249.43 $347.56 $423.14 $524.39 $328.44 $399.86 42 $253.84 $353.70 $430.61 $533.66 $334.25 $406.92 43 $259.97 $362.25 $441.01 $546.55 $342.32 $416.75 44 $267.64 $372.93 $454.01 $562.65 $352.41 $429.03 45 $276.64 $385.47 $469.29 $581.58 $364.26 $443.47 46 $287.36 $400.42 $487.49 $604.14 $378.40 $460.67 47 $299.44 $417.23 $507.96 $629.50 $394.28 $480.02 48 $313.23 $436.45 $531.36 $658.51 $412.45 $502.13 49 $326.83 $455.40 $554.43 $687.11 $430.36 $523.94 50 $342.15 $476.76 $580.43 $719.33 $450.54 $548.51 51 $357.29 $497.85 $606.10 $751.15 $470.46 $572.76 52 $373.96 $521.08 $634.38 $786.18 $492.42 $599.48 53 $390.82 $544.56 $662.98 $821.63 $514.62 $626.51 54 $409.02 $569.93 $693.85 $859.89 $538.58 $655.69 55 $427.21 $595.29 $724.72 $898.15 $562.54 $684.86 56 $446.95 $622.78 $758.20 $939.63 $588.53 $716.50 57 $466.88 $650.55 $792.00 $981.52 $614.76 $748.43 58 $488.14 $680.18 $828.07 $1,026.23 $642.77 $782.52 59 $498.68 $694.85 $845.94 $1,048.38 $656.64 $799.41 60 $519.95 $724.49 $882.02 $1,093.08 $684.64 $833.51 61 $538.33 $750.11 $913.22 $1,131.74 $708.86 $862.98 62 $550.40 $766.94 $933.69 $1,157.12 $724.75 $882.34 63 $565.54 $788.02 $959.37 $1,188.94 $744.67 $906.59
64+ $574.74 $800.84 $974.96 $1,208.27 $756.79 $921.34
Smoker Premium Rates – NORTHEAST
*Core plans are for those who are under 30 or obtain hardship exemptions.
Notice of Nondiscrimination UCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. UCare does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.
We provide aids and services at no charge to people with disabilities to communicate effectively with us, such as TTY line, or written information in other formats, such as large print.
If you need these services, contact us at 612-676-6500 (voice) or toll free at 1-866-457-7144 (voice), 612-676-6810 (TTY), or 1-800-688-2534 (TTY).
We provide language services at no charge to people whose primary language is not English, such as qualified interpreters or information written in other languages.
If you need these services, contact us at the number on the back of your membership card or 612-676-6500 or toll free at 1-866-457-7144 (voice); 612-676-6810 or toll free at 1-800-688-2534 (TTY).
If you believe that UCare has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file an oral or written grievance.
Oral grievance
If you are a current UCare member, please call the number on the back of your membership card. Otherwise please call 612-676-6500 or toll free at 1-866-457-7144 (voice); 612-676-6810 or toll free at 1-800-688-2534 (TTY). You can also use these numbers if you need assistance filing a grievance.
Written grievance Mailing Address UCare Attn: Complaints, Appeals and Grievances PO Box 52 Minneapolis, MN 55440-0052 Email: [email protected] Fax: 612-884-2021
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 1-800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
PMAP MnCare MSC+ SNBC H5937 UC FVC_072116 IA (07212016) H2456 Y0120_B_G_072116 Non-Marketing U7076A (07/16)
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LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 612-676-6500/1-866-457-7144 (TTY: 612-676-6810/1-800-688-2534).
XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 612-676-6500/1-866-457-7144 (TTY: 612-676-6810/1-800-688-2534).
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 612-676-6500/1-866-457-7144 (TTY: 612-676-6810/1-800-688-2534).
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 612-676-6500/ 1-866-457-7144（TTY：612-676-6810/1-800-688-2534）。
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ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 612-676-6500/1-866-457-7144 (መስማት ለተሳናቸው: 612-676-6810/1-800-688-2534).
ymol.ymo;=erh>uwdRAunDAusdmtCd<AerRM>Ausdmtw>rRpXRvXAwvXmbl.vXmphRAeDwrHRb.ohM.vDRIA ud; 612-676-6500/1-866-457-7144 (TTY: 612-676-6810/1-800-688-2534).
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របយក� ៖ េបើសនជអ�កនយ ភសរ �ខ� រ, រសវជនយរ �ផ�កភស េដយមនគតឈ� �ល គឤចមនសរបបររ �អ�ក។ ចរ ទរសព� 612-676-6500/1-866-457-7144 (TTY: 612-676-6810/ 1-800-688-2534)។
برقم اتصل .بالمجان لك تتوافر اللغویة المساعدة خدمات فإن اللغة، اذكر تتحدث كنت إذا :ملحوظة : 2534-688-800-6810/1-676-612).والبكم الصم ھاتف رقم 612-676-6500/1-866-457-7144 (
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 612-676-6500/1-866-457-7144 (ATS : 612-676-6810/1-800-688-2534).
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 612-676-6500/1-866-457-7144 (TTY: 612-676-6810/1-800-688-2534) 번으로 전화해 주십시오.
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 612-676-6500/1-866-457-7144 (TTY: 612-676-6810/1-800-688-2534).
