Physician Benefits

The Orange-Ulster Health Plan is a Plan of choice.

The OU Plan utilizes a hospital and facility network through Blue Cross/Blue Shield. You can find a participating provider at www.bcbs.com.   Find a Doctor or Hospital Member ID = OUH.

Some Providers are part of a network of providers who have agreements with the Plan to accept certain payment for services. These are called In-Network providers. Professional Providers who do not have agreements with the Plan to accept certain payment for services are considered Out-of-Network providers. Members have the choice of using either for their medical care. However, your out-of-pocket costs will differ depending upon which provider you choose.

When using In-Network providers, members need only pay a co-pay.

The choice of using Out-of-Network providers would result in meeting an annual deductible ($1,000 for Individual and $3,000 for family), paying a co-pay and co-insurance. After meeting the annual deductible, the Plan would pay 80% of the Usual & Customary (U&C) charges (co-insurance) and you would be responsible for the balance of the charges.

Examples below: For additional information, see the Plan Document.

  Services You May Need In-Network Out-of-Network
If you visit a health care provider’s office or clinic
Primary care visit to treat an injury or illness $25 co-pay per visit  $25 co-pay per visit, plus deductible and 20% co-insurance
Specialist visit $25 co-pay per visit $25 co-pay per visit, plus deductible and 20% co-insurance
Other practitioner office visit $25 co-pay per visit $25 co-pay per visit, plus deductible and 20% co-insurance
Urgent care $35 co-pay per visit $35 co-pay per visit, plus deductible and 20% co-insurance
Telemedicine (Live health online)   $10 per virtual visit N/A

 

Many of the benefits covered by the Health Plan are currently mandated by New York State Insurance Law and Regulations. If State law or regulations change, then the Plan will change accordingly. For specific coverage, please see the section Plan Document.

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