PPO: Human Resources - Northwestern University

PPO

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 UHC Choice Plus network provider, you will be charged the in-network rates.

This is a summary of the plan benefits. Complete benefit information is available in the UHC PPO Booklet [available soon] and Summary of Benefit Coverage (SBC) 2026.

Benefit information broken down by in- and out-of-network coverage.
	In-Network	Out-of-Network
Deductible	$750 member, $1,500 family	$1,500 member, $3,000 family
Coinsurance	20%	40%
Out-of-Pocket (OOP) Maximum	$3,000 member, $6,000 family	$6,000 member, $12,000 family
Prescription OOP Maximum	$1,500/year per member	N/A
Wellness Checkup	Covered 100% according to age/sex guidelines	Deductible + 40% coinsurance
Office Visit	$40 physician/ $55 specialist	Deductible + 40% coinsurance
Emergency Room Costs	$150 copay + 20% coinsurance	$150 copay + 20% coinsurance

*All health care copays apply toward the out-of-pocket maximums.

**The in- and out-of-network deductibles and out-of-pocket maximums are tracked separately.

Find a doctor

In-network provider finder

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

CVS Online Formulary

Use this tool to verify inclusion of a medication on the formulary as well as pricing under your plan - enter your medication and ZIP code. Review the Prescription Drug Plan website for more information about the plan.

Enhanced UHC Customer Support

The UHC support model will allow faculty and staff to contact UHC directly in three different ways:

For general questions about medical coverage, contact UHC at 833-314-1787 for the PPO plan.
For questions about complex medical needs or ongoing treatment, you can schedule a one-on-one meeting with UHC to discuss how your treatment will be covered and transition of care questions. You may also email these questions to UHC directly at northwestern@uhc.com.
If your provider is not in-network, see the nomination tool on the UHC benefits website to request UHC invite them to join the network.

If you are unable to obtain information from UHC via the dedicated phone line, a 1:1 consultation, and from the UHC email address (after at least 2 business days) you can email benefits@northwestern.edu for additional support. General questions should be sent to the askHR Service Center at askHR@northwestern.edu or 847-491-4700.

Virtual visits

UHC offers access to virtual care for a variety of care needs. To get started, sign in at myuhc.com/virtualvisits, call the number on your health plan ID card, or download the UnitedHealthcare app.

24/7 Virtual Visits are a way to schedule same-day, urgent care visits, so you can talk with a provider 24/7 for common urgent care needs or when your primary care provider (PCP) is not available.
Access to primary care and specialist providers without the office visit.

Premiums are deducted from your paycheck on a pre-tax basis. Employees who are paid bi-weekly will have half of the monthly deduction taken from the first two checks of each month.

Jump to:

Full-time employees
Part-time employees

Premiums for full-time employees

Monthly premiums for full-time employees by annual salary and family members insured.
Annual Salary	You	You + Spouse	You + Child(ren)	You + Spouse + Child(ren)
Under $42,000	$63	$138	$117	$208
$42,001-$75,000	$116	$254	$216	$382
$75,001-$128,000	$197	$431	$366	$647
$128,001-$182,000	$278	$607	$516	$913
$182,001 and above	$434	$950	$807	$1,428

For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2026 are based on your 9/1/2025 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time. When your 9/1 salary crosses a salary tier due to a salary increase not associated with a change in full-time/part-time status, you will pay the lower premium for the following year.

Premiums for part-time employees

Premier PPO monthly premiums for part-time employees by annual salary and family members insured.
Annual Salary	You	You + Spouse	You + Child(ren)	You + Spouse + Child(ren)
Under $42,000	$369	$805	$686	$1,210
$42,001-$75,000	$400	$880	$751	$1,326
$75,001-$128,000	$458	$1,000	$850	$1,503
$128,001-$182,000	$510	$1,117	$952	$1,681
$182,001 and above	$616	$1,347	$1,144	$2,024

Benefits

Prescription coverage

CVS Caremark - administered prescription plan
Use this tool to verify inclusion of a medication on the formulary as well as pricing under your plan - enter your medication and ZIP code.

Discounts and Programs

Calm App - included in your health plan and available at no additional cost
One Pass Select - offers a variety of discounts on gym memberships
Hearings aids coverage available

Virtual Visits

24/7 Virtual Visits are a way to schedule same-day, urgent care visits, so you can talk with a provider 24/7 for common urgent care needs or when your primary care provider (PCP) is not available.
Access to primary care and specialist providers without the office visit.

Immunizations

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

Routine mammogram and pap smear

Covered with no cost-sharing
Mammogram covered for women age 35+

Laboratory tests and x-rays

Coinsurance after deductible is met

Physical therapy and chiropractic care

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
- Glucometer
- 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
Other supplies and equipment are covered under prescription drug program

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