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ACA HDHP

This plan gives you the flexibility to choose any doctor/hospital that you wish without requiring a primary care physician (PCP) or referrals. If you choose a provider from UHC's Choice Plus network, you will be charged the in-network rates.

Non-benefits eligible faculty and staff who have worked an average of 30 hours per week during a 12-month initial measurement period (first 12-months) or subsequent standard measurement period will become eligible for this plan.  To remain eligible, faculty and staff must continue to work an average of 30 hours per week during a 12-month standard measurement period (fiscal year).  Those who qualify will be invited to participate via an email to their Northwestern email address.

This is a summary of the plan benefits. Complete benefit information is available in the UHC ACA HDHP Booklet [will be available closer to the start of the plan year] and Summary of Benefit Coverage (SBC) 2026 [Spanish].

In-Network Out-of-Network
Deductible $4,400 member*, $8,000 family $8,000 member*; $16,000 family
Coinsurance 20% 40%
Out-of-Pocket (OOP) Maximum $7,000 member*, $14,000 family $14,000 member; $28,000 family
Prescription OOP Maximum Included in health OOP max N/A
Wellness Checkup Covered 100% according to age/sex guidelines Deductible + 40% coinsurance
Office Visit Deductible + 20% coinsurance Deductible + 40% coinsurance
Emergency Room Costs Deductible + 20% coinsurance Deductible + 20% coinsurance

Find a Doctor

In-network provider search

  1. Navigate to the UHC Find a Doctor website
  2. Select Search as a Guest found on the right side of the page
  3. Select either Medical Directory or Behavioral Health Directory based on the type of care you need
  4. Select Employer and Individual Plans
  5. Scroll and select Choice Plus
  6. Select Change Location, enter your ZIP code in the search bar, click Update
    Location.

Those on this plan will be billed on a monthly basis for the premiums owed.  Our billing vendor Inspira will administer the billing process.  Monthly premiums must be paid on time.

The monthly premiums of the ACA value PPO plan by the family members insured.
You You + Spouse You + Child(ren) You + Spouse + Child(ren)
$129 $1,085 $820 $1,971

Benefits

Prescription coverage

Discounts and Programs

Immunizations

  • Covered under the Well Child Care provisions for children up to age 16

Routine mammogram and pap smear

  • Covered at 100% in network. Deductible does not apply

Laboratory tests and x-rays

  • Coinsurance after deductible is met

Physical therapy

  • Coinsurance after deductible is met
  • Member's condition must show continued improvement with physical therapy

Minor surgery in doctor's office or outpatient surgical operations

  • Coinsurance after deductible is met

Diabetes treatment

  • Covered at coinsurance after deductible is met
    • Self management training services rendered by a physician or licensed health care professional with expertise in diabetes management
    • Regular foot care examinations by a physician or podiatrist

Exclusion examples

  • Acupuncture
  • Dental care
  • Long-term care
  • Routine eye care
  • Routine foot care (with the exception of person with diagnosis of diabetes)
  • Weight loss programs
  • For a comprehensive list of exclusions, contact UHC at 833-314-1787